Adult Female Survivors Research Articles

Acaricidal activity and sublethal effects of the microbial pesticide spinosad on Tetranychus urticae (Acari: Tetranychidae)

Laboratory bioassays were conducted to evaluate the toxicity of the microbial pesticide spinosad to different life stages of the two-spotted spider mite, Tetranychus urticae Koch, as well as its sublethal effects on reproduction and population growth of this important mite pest. The biopesticide was applied to bean primary leaves or leaf discs carrying spider mites using a Potter spray tower (2.7 mg/cm2 aqueous deposit). The following LC50 and LC90 (mg/L) estimates for motile stages were obtained in acute toxicity bioassays: 27.52 and 116.72 (larvae), 36.55 and 136.20 (protonymphs), 82.76 and 721.28 (female deutonymphs), and 61.47 and 457.21 (adult females). Spinosad showed no significant ovicidal action: toxic effect observed after spraying eggs (LC50 = 105.78 mg/L, LC90 = 596.95 mg/L) was the result of its residual action on larvae that hatched from the treated eggs. The effects of spinosad on life history traits and population growth of adult female survivors from treatments with 240, 120 and 60 mg/L were evaluated in two successive 7-day bioassays on untreated leaf discs. In the first bioassay, females that survived treatments as 24 h old eggs and completed their juvenile development on treated leaves had significantly lower gross fecundity, net fecundity and instantaneous rate of increase (ri) but the reduction was merely 4–6%, 9–11%, and 2–3%, respectively. Female longevity was significantly reduced (approximately by half a day) only after treatment with 240 mg/L. In the second bioassay, in which females were treated during their pre-ovipositional period, the treatments with 240 and 120 mg/L significantly reduced their gross fecundity (16–17%), net fecundity (28–31%), ri values (8–9%) and female longevity (approximately by one day). Spinosad effects on the intrinsic rate of increase (rm) and other demographic parameters were evaluated in two successive bioassays in which life tables were constructed for females that survived treatment with 120 mg/L at the egg stage (first demographic bioassay) or pre-ovipositional period (second demographic bioassay). In the first bioassay, the intrinsic rate of increase was significantly higher in treated (rm = 0.278) than control mites (rm = 0.267) as a result of higher net fertility at the beginning of reproduction of treated females. In the second bioassay, treated females had significantly lower rm than control females (0.254 and 0.283, respectively). The results obtained in this study indicate that spinosad, applied against insect pests (at field relevant rates of 60–240 mg/L), could eliminate a part of T. urticae population as well, but survivors would retain a significant potential for population recovery.

Fertility-related knowledge and reproductive goals in childhood cancer survivors: short communication.

Do young adult survivors of childhood cancer know their fertility status, in the context of their parenthood goals and screening for gonadal functioning? While 80% of survivors (who were without children) wanted children in the future, most did not know their fertility status, and screening for gonadal functioning was underutilized. Survivors of childhood cancer are at risk for infertility, but fertility counseling and assessment are underutilized. Separate studies indicated that survivors' fertility-related knowledge is poor and that they often wanted to have children. Yet, studies have not investigated the intersection of both issues, as well as potential distress if parenthood goals are not met. Young adult male and female survivors of childhood cancer (N = 149) completed cross-sectional surveys, and data for those without children (n = 105, 70.5%) are presented here. Participants were 20-40 years old (M = 26.5), diagnosed 5-33 years prior to study participation, and completed questionnaires online. Knowledge of fertility status, parenthood goals, and potential distress if survivors were unable to have children were assessed. Medical records were reviewed for hormone levels as indicators of screening for gonadal functioning. Most survivors (n = 81; 77.1%) did not know their fertility status, while over 80% (n = 89) wanted children (neither aspect varied by socio-demographic/cancer-specific factors). Two-thirds of survivors indicated they would be distressed if parenthood goals remained unfulfilled; especially female (versus male, t = 2.64; P = 0.01) or partnered (versus single, t = -3.45; P < 0.001) survivors. Forty survivors (38.1%) had documented assessments of gonadal functioning, of which 33 (82.5%) reported not knowing their fertility status. Relevant risk factors may have not been identified owing to limited sample size and missing treatment information. The underutilization of screening for gonadal functioning needs further exploration in other pediatric centers. Most adult childhood cancer survivors want to become parents, but do not know their fertility status, which could cause significant psychological distress. Healthcare providers should continuously address fertility among survivors, but more research is needed on how to implement routine fertility counseling and/or testing. This study was funded by the Research Institute at Nationwide Children's Hospital (V.L.) and Dutch Cancer Society (RUG2009-4442, M.A.T.). All authors have no conflict of interest to declare.

Employment status and health related quality of life among Hodgkin-lymphoma survivors\u2019\u2013 results based on data from a major treatment center in Hungary

BackgroundDue to risk and response adapted treatment strategies, more than 80% of newly diagnosed classical Hodgkin lymphoma (HL) patients can be cured, and become long-term survivors. However, a high proportion of survivors suffer from treatment-related long-term side effects such as secondary malignancy, organ failure, persistent fatigue and psychological distress. The aim of this study was to evaluate psychological distress and its risk factors among our HL survivors.MethodsOne hundred sixty-three (50% female) adult HL survivors were contacted between January 1, 2012 and march 31, 2015 in our outpatient centre. The patients were asked to complete a standardized, validated, self-administered Hungarian questionnaire with demographic questions and the following scales: Hospital anxiety and depression scale (HADS14), general health questionnaire (GHQ12), sense of coherence (SOC13) perceived stress scale (PSS4), dysfunctional attitude scale (DAS17). Disease and treatment data were acquired from hospital records.ResultsMajority of HL survivors are in early adulthood, our most important goal should be to return them to normal life after their lymphoma is cured. The employment status at the time of survey seemed to be crucial so patients were divided into either active (n = 93) or inactive (n = 47) group. Retired survivors (n = 19) were excluded from the subgroup analysis. Psychological distress was significantly lower in active patients. Multiple logistic regression analysis showed significant differences between the inactive and active subgroups, such as age at diagnosis (≥30 years or below, p = 0.001), education level (below college vs. college, p = 0.032) and treatment related long-term side effects (yes vs. no, p < 0.001). Predictors for treatment-related long-term side effects are female gender (p = 0.011), chemotherapy protocol (ABVD vs. other, p < 0.001).ConclusionsOur data suggest that employment status and treatment-related long-term side effects play a critical role in the health related quality of life outcome among Hungarian HL survivors.

Research ethics in practice: lessons from studies exploring interpersonal violence in different contexts

Studies researching interpersonal violence (IPV) are associated with a range of ethical challenges. In this article, lessons are drawn from three case studies exploring the experiences of different groups of survivors and perpetrators of IPV in diverse contexts: refugees in the Thailand-Burma border area; partner-violent adult men and female survivors in Ireland; and school children in five European countries. The ethical – and associated methodological – challenges faced, and the ways in which they were overcome, are presented. Drawing on the case studies presented, the article concludes that three key areas require special attention when conducting research in this field: accessing and recruiting participants, researcher skills and experience, and appropriate use of data.

An integrated intervention to reduce intimate partner violence and psychological distress with refugees in low-resource settings: study protocol for the Nguvu cluster randomized trial

BackgroundIntimate partner violence (IPV) is a critical public health and human rights concern globally, including for refugee women in low-resource settings. Little is known about effective interventions for this population. IPV and psychological distress have a bi-directional relationship, indicating the potential benefit of a structured psychological component as part of efforts to reduce IPV for women currently in violent relationships.MethodsThis protocol describes a cluster randomized controlled trial aimed at evaluating an 8-session integrated psychological and advocacy intervention (Nguvu) with female adult survivors of past-year IPV displaying moderate to severe psychological distress. Outcomes are reductions in: recurrence of IPV; symptoms of anxiety, depression and post-traumatic stress (primary); and functional impairment (secondary). Hypothesized mediators of the intervention are improvements in social support, coping skills and support seeking. We will recruit 400 participants from existing women’s support groups operating within villages in Nyarugusu refugee camp, Tanzania. Women’s groups will be randomized to receive the intervention (Nguvu and usual care) or usual care alone. All eligible women will complete a baseline assessment (week 0) followed by a post-treatment (week 9) and a 3-month post-treatment assessment (week 20). The efficacy of the intervention will be determined by between-group differences in the longitudinal trajectories of primary outcomes evaluated using mixed-effects models. Study procedures have been approved by Institutional Review Boards in the United States and Tanzania.DiscussionThis trial will provide evidence on the efficacy of a novel integrated group intervention aimed at secondary prevention of IPV that includes a structured psychological component to address psychological distress. The psychological and advocacy components of the proposed intervention have been shown to be efficacious for their respective outcomes when delivered in isolation; however, administering these approaches through a single, integrated intervention may result in synergistic effects given the interrelated, bidirectional relationship between IPV and mental health. Furthermore, this trial will provide information regarding the feasibility of implementing a structured intervention for IPV and mental health in a protracted humanitarian setting.Trial registrationISRCTN65771265, June 27, 2016.

The role of therapy in personal recovery – Trauma clients’ use of resources to continue positive processes following group therapy

Traditionally, there has been a sharp division between ‘personal’ and ‘clinical’ recovery. What role, then, might therapy play in personal recovery? To explore how female adult trauma survivors experience working towards recovery after participation in trauma-specific group therapy, we carried out semi-structured qualitative interviews with 13 clients one year after their completion of a stabilization group approach. A hermeneutic-phenomenological approach was used to analyze interview transcripts. After therapy, the participants consolidated and continued their positive processes of change. Experiences from therapy gave rise to personal recovery processes that were categorized into two main themes: “tapping into pre-therapy resources” and “using therapy-related resources.” Therapy might play an important role in personal recovery through helping clients to rediscover and utilize existing resources, as well as being a source of new resources. The participants were active agents in this recovery, putting their therapies to use in the context of their daily living.

Physical and social characteristics and support needs of adult female childhood cancer survivors who underwent hormone replacement therapy.

Female childhood cancer survivors who develop gonadal dysfunction require female hormone replacement therapy (HRT) from puberty until menopause. However, the support provided in such cases has not been studied. We investigated the physical and social characteristics and support needs of adult female childhood cancer survivors who underwent HRT. Forty-nine adult female childhood cancer survivors completed self-administered questionnaires. We compared the clinical characteristics, health status, and social conditions between a group that underwent HRT and a group that did not, and we surveyed support needs of the group that underwent HRT. The median age of the subjects was 25.0years (range 20-41). Twenty subjects (40.8%) underwent HRT. A significantly high number of those who underwent HRT also underwent radiation therapy (p<0.01) and hematopoietic stem cell transplantation (p<0.001), and none of them had a history of pregnancy or childbirth (p<0.05). There were no significant differences in physical symptoms and social characteristics between the groups. Those who experienced anxiety regarding fertility required information about HRT, a platform to share their concerns, and psychological support and cooperation among healthcare providers. Although the subjects of this survey exhibited good social adjustment regardless of whether or not they underwent HRT, they were anxious about fertility. It is important to understand the concerns and anxieties unique to female childhood cancer survivors and to enhance psychological support in addition to providing educational support so that HRT can be administered.

Relationships, Intimacy, &amp; Body Image After Breast Cancer

Relationships, Intimacy, &amp; Body Image After Breast Cancer

Adoption consideration and concerns among young adult female cancer survivors.

We compared adoption consideration between female young adult cancer survivors and women of the same age in the general US population, hypothesizing that cancer survivors who desired children would report greater interest in adoption than an age-adjusted general population sample who desired children. After age-standardizing the cancer survivor cohort to match the age distribution of the 2006-2010 National Survey for Family Growth (NSFG), we estimated adoption consideration among women age 18-35years who wanted a (another) child in the two cohorts overall and within age groups. We assessed characteristics and concerns related to adoption consideration among cancer survivors. Among cancer survivors, 81.6% (95% CI 75.7-87.6) reported that they would consider adoption compared to 40.3% (95% CI 40.3-40.3) of women in the general population. While over 80% of the cancer survivor sample reported that they would consider adoption, only 15% of cancer survivors reported no concerns about adoption. The most common concerns were desire for a biological child (48%), expense (45%), adoption agency candidacy (41%), and needing more information (39%). We observed a twofold higher interest in adoption when comparing the cancer survivor with the general population, suggesting that adoption is a consideration for many young women who have survived cancer. Adoption is an important family-building option for those who want to have a child but are unable to or choose not to have a biological child. However, young adult survivors may need more support to understand and navigate this process.

The cycle of healing - dissociation and attachment during treatment of CSA survivors

Childhood sexual abuse (CSA) is an extreme traumatic event associated with numerous long lasting difficulties and symptoms (e.g., Herman, 1992). These include, among other things, the impediment of basic interpersonal structures of attachment (Rumstein-McKean & Hunsley, 2001), as well as impairment of mental integration manifested in dissociation (Van Den Bosch et al., 2003). Theoretically, attachment insecurities and dissociation are closely linked, since dissociation is generated as a way to resolve the conflicted attachment demands faced by the abused child (e.g., Liotti, 1992). Nevertheless, the directionality of association between attachment insecurities and dissociation during treatment of adult CSA survivors remains largely uninvestigated. Filling this gap, the present prospective study assessed female adult survivors of CSA who were outpatients at four treatment centers in Denmark (n=407), at the start of treatment (T1), 6 months after starting treatment (T2) and 12 months after starting treatment (T3). Results indicated that both attachment insecurities and dissociation reduced over time during treatment. Elevated attachment insecurities were associated with elevated dissociation at each of the measurements. Moreover, there was a reciprocal association between attachment avoidance and dissociation during treatment. Low levels of attachment avoidance predicted a decline in dissociation and vice versa. Findings suggest that treatment creates a cycle of healing in which rehabilitation of attachment fosters reintegration, which in turn deepens the restoration of attachment.

Responding to Delayed Disclosure of Sexual Assault in Health Settings: A Systematic Review

Few adolescent and adult women seek out formal support services in the acute period (7 days or less) following a sexual assault. Instead, many women choose to disclose weeks, months, or even years later. This delayed disclosure may be challenging to support workers, including those in health-care settings, who lack the knowledge and skills to respond effectively. We conducted a systematic literature review of health-care providers’ responses to delayed disclosure by adolescent and adult female sexual assault survivors. Our primary objective was to determine how health-care providers can respond appropriately when presented with a delayed sexual assault disclosure in their practice. Arising out of this analysis, a secondary objective was to document recommendations from the articles for health-care providers on how to create an environment conducive to disclosing and support disclosure in their practice. These recommendations for providing an appropriate response and supporting disclosure are summarized.

Young adult female cancer survivors' unmet information needs and reproductive concerns contribute to decisional conflict regarding posttreatment fertility preservation.

Many young adult female cancer survivors (YAFCS) are at risk of experiencing premature menopause. The current study characterized the posttreatment fertility information needs, reproductive concerns, and decisional conflict regarding future options for posttreatment fertility preservation (FP) among YAFCS. Participants completed a Web-based, anonymous survey between February and March 2015. The survey included investigator-designed questions of perceived information needs, the Reproductive Concerns After Cancer Scale, and the Decisional Conflict Scale. Analyses included Pearson correlation coefficients, independent-sample Student t tests, and multiple regression. There was a total of 346 participants with an average age of 29.9 years (SD = 4.1 years) who were 4.9 years from treatment (SD = 5.4 years [range, 0-27 years]). The main analyses focused on a subgroup of YAFCS with uncertain fertility status who had not previously undergone/attempted FP and either wanted future children or were unsure (179 women). Across fertility information topics, 43% to 62% of participants reported unmet information needs. The greatest reproductive concerns were related to fertility potential and the health of future offspring. The regression model controlled for a priori covariates including current age, age at treatment completion, income, relationship status, nulliparity, and prior fertility evaluation. Greater unmet information needs were found to be related to greater decisional conflict (β = .43; p<.001); greater reproductive concerns were associated at the trend level (β = .14, p = .08; F[8,118] = 6.42, p<.001). YAFCS with limited awareness or knowledge of their risk of experiencing premature menopause and FP options reported higher levels of decisional conflict regarding future FP. Posttreatment survivorship care should include comprehensive reproductive health counseling, including posttreatment FP options and family-building alternatives. Cancer 2016;122:2101-9. © 2016 American Cancer Society.

Updates in preserving reproductive potential of prepubertal girls with cancer: Systematic review.

With increasing numbers of adult female survivors of childhood cancers due to advances in early diagnosis and treatment, the issue of preserving the reproductive potential of prepubertal girls undergoing gonadotoxic treatments has gained greater attention. According to PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in PubMed in English throughout the past 15 years to explore the significant updates in preserving the reproductive potential of prepubertal girls with cancer. The two established fertility preservation options, embryo freezing and egg freezing, cannot be offered routinely to prepubertal girls as these options necessitate prior ovarian stimulation and subsequent mature oocytes retrieval that are contraindicated or infeasible before puberty. Therefore, the most suitable fertility preservation options to prepubertal girls are (1) ovarian tissue freezing and autotransplantation, (2) in vitro maturation, and (3) ovarian protection techniques. In this review, we discuss in detail those options as well as their success rates, advantages, disadvantages and future directions. We also suggest a new integrated strategy to preserve the reproductive potential of prepubertal girls with cancer. Although experimental, ovarian tissue slow freezing and orthotopic autotransplantation may be the most feasible option to preserve the reproductive potential of prepubertal girls with cancer. However, this technique has two major and serious disadvantages: (1) the risk of reintroducing malignant cells, and (2) the relatively short lifespan of ovarian tissue transplants. Several medical and ethical considerations should be taken into account before applying this technique to prepubertal girls with cancer.

The Nature of Posttraumatic Growth in Adult Survivors of Child Sexual Abuse

ABSTRACTPotential negative sequelae for survivors of child sexual abuse is well documented. However, growing evidence suggests that some individuals who actively cope with traumatic events can progress from a negative trajectory toward positive psychological change, often termed posttraumatic growth. Current posttraumatic growth theories may be of limited applicability to developmental considerations involved in child sexual abuse. This explorative study examines posttraumatic growth among adult female survivors of child sexual abuse. In-depth interviews were conducted with six participants who believed they had grown through coping with their abuse. Data was analyzed using interpretative phenomenological analysis. Three superordinate and nine subordinate themes were identified and explored. Some participants reported experiencing growth and distress simultaneously. Theoretical and clinical implications are examined in relation to the study’s findings.

Group psychotherapy for female adult survivors of interpersonal psychological trauma: a preliminary study in Scotland

Background: There is limited evidence on manualised group interventions that facilitate the development of trauma recovery skills, affect regulation and meaning making for survivors of interpersonal trauma.Aim: The study aimed to provide preliminary evidence on the effectiveness of group psychotherapy (based on Trauma Recovery and Empowerment Model, TREM) for psychological distress in adult survivors of interpersonal trauma.Method: Participants were a consecutive series of female patients (n = 71) from the waiting lists of five National Health Service (NHS) Boards in Scotland. Participants completed a set of self-rated measures (PCL, CORE, SCL-90, DES and RSES) at baseline, mid-intervention, post-intervention and 3-month follow-up.Results: Effect sizes were small to medium across measures and assessment points at post-treatment and follow-up. With regard to clinical significance, at post-treatment, a proportion of 9.9% to 54.9% of participants achieved clinical significance across measures. At follow-up, a proportion of 9.9% to 62.0% of participants achieved clinical significance across measures.Conclusions: Group psychotherapy may be useful for a proportion of participants and especially so for symptoms of dissociation and self-esteem. Survivors of interpersonal trauma should be offered a choice of individual or group treatment modalities to reduce drop-out rate and maximise outcomes.

Young adult female cancer survivors’ concerns about genetic cancer risk in offspring.

121 Background: More than 362,000 female cancer survivors under 40 years old live in the US. Research consistently shows no increased cancer risk among offspring of cancer survivors in the absence of a hereditary cancer. Still survivors voice concerns over the health of future children. This analysis explores young adult female cancer survivors’ (YAFCS) perceptions of genetic cancer risk and related reproductive concerns. Methods: Eligible females were aged 18-35, at least one year post-treatment. Participants were recruited using social media posts from 17 young adult cancer advocacy groups and directed to an anonymous web-based survey that included the Reproductive Concerns after Cancer Scale (RCACS), with a 3-item “Concerns about Future Child Health” subscale. Results: 346 YAFCS completed the full survey, and based on logic-based branching, 192 respondents could have completed the RCACS: 177 (92%) completed the entire scale and 187 (97%) completed the child’s health subscale. Mean RCACS score was 58.5 (sd = 11.6; range 22-86); mean child’s health score was 11.3 (sd = 3.3; range 3-15), with a negative skew. At the item-level, 65% of the sample worried about passing along cancer risk to offspring; 71% worried about family health history affecting future children; and 60% were afraid their children would have a high chance of getting cancer. RCACS and child’s health subscale scores did not vary by age, race, education, income, or diagnosis. Further, mean scores did not vary between survivors of family cancer syndromes (breast, ovarian, colorectal) and those with other diagnoses (RCACS: t = 1.4, df = 175, p = .14; child’s health: t = 0.02, df = 185, p = .99). Conclusions: Despite studies showing minimal genetic cancer risk in offspring of survivors, many YAFCS have concerns about the health of future children. This may be related to mistaken beliefs that genetic mutations within tumor cells are transmissible or unawareness of availability of pre-implantation genetic diagnosis for embryo selection in those with transmissible genetic mutations. There is a need to educate patients about these issues to enable them to make family building choices based on accurate information about genetic risk.

The female self-advocacy in cancer survivorship scale: Validating a new measure to support patient voice and engagement.

96 Background: The Female Self-Advocacy in Cancer Survivorship (FSACS) Scale is a new measurement tool designed to address the increasing need for cancer survivors to lead their care in face of barriers. Based on previous input from female cancer survivors and other stakeholders, the purpose of this study is to evaluate the construct validity of the FSACS Scale. Construct validity is supported by evidence from: (I) Internal structure consistent with the underlying model of self-advocacy; (II) Sensitivity to differences between known groups; (III) Relationships between self-advocacy and key predictors (openness and conscientiousness; information engagement; social support) and outcomes (symptom distress and healthcare utilization); (IV) Relationships between self-advocacy and related concepts (patient activation; self-advocacy within the HIV/AIDS population); and (V) Relationships between self-advocacy and criterion measures. Methods: A mixed-mode cross-sectional survey design was used. Women with a history of an adult diagnosis of invasive cancer were recruited from two patient registries and seven advocacy organizations. Analyses included an exploratory factor analysis, t-tests, and bivariate correlations. Results: 315 adult female cancer survivors completed the survey. Evidence from all five construct validity hypotheses supports the construct validity of the FSACS Scale. The factor analysis confirmed the three underlying dimensions of self-advocacy resulting in a 20-item measure explaining 45.87% of the variance in responses with subscales’ Cronbach’s alphas between 0.791 and 0.850. Conclusions: Results support that the FSACS Scale is a theoretically-grounded measure of self-advocacy that can be used by clinicians and researchers to identify women at-risk for poor outcomes associated with low self-advocacy.

Emotional security in the family system and psychological distress in female survivors of child sexual abuse

The Emotional Security Theory (EST) was originally developed to investigate the association between high levels of interparental conflict and child maladaptative outcome. The objective of the present study was to analyze the effects of emotional security in the family system on psychological distress among a sample of young female adult survivors of child sexual abuse (CSA). The role of emotional security was investigated through the interactive effects of a number of factors including the type of abuse, the continuity of abuse, the relationship with the perpetrator and the existence of disclosure for the abuse. Participants were 167 female survivors of CSA. Information about the abuse was obtained from a self-reported questionnaire. Emotional security was assessed with the Security in the Family System (SIFS) Scale, and the Symptom Checklist-90-Revised (SCL-90-R) was used to assess psychological distress. In the total sample, insecurity (preoccupation and disengagement) was correlated with high psychological distress scores, whereas no relationship was found between security and psychological distress. The relationship between emotional insecurity and psychological distress was stronger in cases of continued abuse and non-disclosure, while the relationship between emotional security and distress was stronger in cases of extrafamilial abuse and especially isolated or several incidents and when a disclosure had been made. No interactive effect was found between any of the three emotional variables and the type of abuse committed. The results of the current study suggest that characteristics of CSA such as relationship with the perpetrator and, especially, continuity of abuse and whether or not disclosure had been made, can affect the impact of emotional security on psychological distress of CSA survivors.

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.