Follow-up Of Cancer Survivors Research Articles

Hepatic focal nodular hyperplasia during follow-up of patients after cyclophosphamide- or oxaliplatin-based chemotherapy: differentiation from liver metastasis

ObjectivesNewly detected hepatic nodules during follow-up of cancer survivors receiving chemotherapy may pose a diagnostic dilemma. We investigated a series of hepatic focal nodular hyperplasia (FNH) diagnosed by either typical MRI features and follow-up or pathology in cancer survivors.MethodsThis retrospective study evaluated 38 patients with tumours who developed new hepatic FNH after cyclophosphamide-based (n = 19) and oxaliplatin-based (n = 19) chemotherapies. The main tumour types were breast cancer (n = 18) and colorectal cancer (n = 17). MRI findings, clinical features, and temporal evolution of all target hepatic lesions (n = 63) were reported. In addition, the two chemotherapy drug groups were compared.ResultsThe median interval between chemotherapy completion and FNH detection was 30.4 months (12.9, 49.4). Six patients underwent biopsy or surgery, while the remaining patients were diagnosed based on typical MRI features and long-term follow-up. Among the patients, 60.5% (23/38) presented with multiple nodules and 63 target lesions were detected. The median size of target lesions was 11.5 mm (8.4, 15.1). The median follow-up time was 32.5 months (21.2, 48.6), and 15 patients experienced changes in their lesions during the follow-up period (11 increased and 4 decreased). The cyclophosphamide-based treatment group had a younger population, a greater proportion of females, and a shorter time to discovery than the oxaliplatin-based chemotherapy group (all p ≤ 0.016).ConclusionsFNH may occur in cancer survivors after cyclophosphamide- or oxaliplatin-based chemotherapy. Considering a patient’s treatment history and typical MRI findings can help avoid misdiagnosis and unnecessary invasive treatment.Clinical relevance statementWhen cancer survivors develop new hepatic nodules during follow-up, clinicians should think of the possibility of focal nodular hyperplasia in addition to liver metastasis, especially if the cancer survivors were previously treated with cyclophosphamide or oxaliplatin.Key PointsCancer survivors, after chemotherapy, can develop hepatic focal nodular hyperplasia.Cyclophosphamide and oxaliplatin are two chemotherapeutic agents that predispose to focal nodular hyperplasia development.Focal nodular hyperplasia occurs at shorter intervals in patients treated with cyclophosphamide.Graphical

Multimodality Cardiovascular Imaging of Cardiotoxicity Due to Cancer Therapy.

Cancer therapies have revolutionized patient survival rates, yet they come with the risk of cardiotoxicity, necessitating effective monitoring and management. The existing guidelines offer a limited empirical basis for practical approaches in various clinical scenarios. This article explores the intricate relationship between cancer therapy and the cardiovascular system, highlighting the role of advanced multimodality imaging in monitoring patients before, during, and after cancer treatment. This review outlines the cardiovascular effects of different cancer therapy classes, offering a comprehensive understanding of their dose- and time-dependent impacts. This paper delves into diverse imaging modalities such as echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, and nuclear imaging, detailing their strengths and limitations in various conditions due to cancer treatment, such as cardiac dysfunction, myocarditis, coronary artery disease, Takotsubo cardiomyopathy, pulmonary hypertension, arterial hypertension, valvular heart diseases, and heart failure with preserved ejection fraction. Moreover, it underscores the significance of long-term follow-up for cancer survivors and discusses future directions.

FRI225 Clinical Course Of Late-onset Adrenal Insufficiency Due To Treatment Of Childhood Acute Lymphoblastic Leukemia

Abstract Disclosure: M. Iwabuchi: None. Background: Some people who were treated for cancer during childhood may develop endocrine problems as because of changes in the function of endocrine system. Acute lymphoblastic leukemia is the most common type of cancer and leukemia in children and components of ALL treatment are induction, consolidation, maintenance, and central nervous system prophylaxis. It is recommended that people who had irradiation in a dose of 40 Gy or higher to the central area of the hypothalamic-pituitary axis should have a blood test done to check the cortisol level and should be done yearly for at least 15 years since this complication can occur many years after irradiation. Clinical Case: A man in his 40s was admitted with symptoms of diarrhea, low-grade fever, and drowsiness. The serum sodium level that caused his symptoms decreased to 100 mEq/L and was adequately corrected. Endocrinological examination confirmed the diagnosis of central adrenal insufficiency. Soon after starting hormonal replacement therapy with hydrocortisone, his general conditions improved. After establishing our relationship, he confessed to having a history of ALL in childhood. According to his medical records at the time, he underwent induction therapy with vincristine-prednisone in 1977, maintenance therapy with 6-mercaptopurine, and radiation therapy to the central nervous system of 25 Gy in 1983. In 2023, 40 years have passed since radiation therapy. He was able to lead a normal life on oral hydrocortisone 20 mg/day without recurrence of adrenal insufficiency. Clinical Lesson: A 40-old male survivor of ALL developed adrenal insufficiency in 30 years after cranial irradiation during childhood. Undiagnosed adrenal insufficiency is often the cause of death. We should consider childhood cancer survivors have the risk of a central adrenal insufficiency. The Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers (COG LTFU Guidelines) are a resource for healthcare professionals who provide ongoing care to survivors of pediatric malignancies. The screening recommendations in these guidelines are appropriate for asymptomatic survivors of childhood, adolescent, or young adult cancer presenting for routine exposure-based medical follow-up. It is recommended that people who had irradiation in a dose of 40 Gy or higher to the central area of the hypothalamic-pituitary axis should have a blood test done to check the cortisol level and should be done yearly for at least 15 years since this complication can occur many years after irradiation. This case highlights the importance of long-term follow-up of cancer survivors after irradiation and the delayed presentation of adrenal insufficiency. This is the first report of the subsequent treatment course of late-onset adrenal insufficiency that developed 30 years after irradiation for childhood central nervous system ALL. Presentation: Friday, June 16, 2023

MP45-09 CANCER SURVIVORSHIP IN MALE PATIENTS: THE IMPORTANCE OF INVOLVING THE ANDROLOGIST IN THE REAL-LIFE WORLD

You have accessJournal of UrologyCME1 Apr 2023MP45-09 CANCER SURVIVORSHIP IN MALE PATIENTS: THE IMPORTANCE OF INVOLVING THE ANDROLOGIST IN THE REAL-LIFE WORLD Simone Cilio, Edoardo Pozzi, Federico Belladelli, Giuseppe Fallara, Luigi Candela, Alessandro Bertini, Christian Corsini, Francesco Lanzaro, Donato Cannoletta, Massimiliano Raffo, Fausto Negri, Ludovica Cella, Margherita Fantin, Luca Boeri, Paolo Capogrosso, Alessia D'arma, Francesco Montorsi, and Andrea Salonia Simone CilioSimone Cilio More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Christian CorsiniChristian Corsini More articles by this author , Francesco LanzaroFrancesco Lanzaro More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Fausto NegriFausto Negri More articles by this author , Ludovica CellaLudovica Cella More articles by this author , Margherita FantinMargherita Fantin More articles by this author , Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Alessia D'armaAlessia D'arma More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003291.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male cancer survivors may develop sexual dysfunction (SD) even many years after the recovery from the original malignant disease. An andrological assessment of these patients is not routinely provided in the everyday clinical practice. We aimed to evaluate the prevalence of and the clinical characteristics of cancer survivors in a cohort of men seeking medical help for SD (any) in the real-life setting of an andrological tertiary-referral centre. METHODS: Complete data from 2841 men consecutively assessed for new-onset SD between 2005 and 2022 were analysed. All patients were assessed with a comprehensive sexual and medical history, including history of any non-metastatic cancer (i.e., urological cancers, non-urological solid cancers, haematological cancer). All patients were invited to complete the International Index of Erectile Function (IIEF), and the Beck’s Depression Index (BDI). The IIEF-Erectile function (IIEF-EF) domain was categorized according to Cappelleri’s criteria. RESULTS: Of all, 237 (8.34%) patients reported a history of non-metastatic cancer, either solid or haematological. Of 237, 118 (49.8%) patients had a history of urological cancer, 92 (38.8%) of non-urological solid cancer, and 27 (11.4%) of haematological malignancies. Overall, the most frequent complaint was ED (76.4% of patients), followed by Peyronie’s disease (PD) (13.9%), low sexual desire/interest (LSD/I) (13.5%), premature ejaculation (PE) (6.8%), and delayed ejaculation (2.1%). Moreover, the most frequent concurrent complaints were ED and LSD/I reported together by 11.4% of patients, followed by ED and PD reported by 8.4% of patients. Of all, prostate cancer (PCa) survivors accounted for 41.0% of solid cancer survivors and 37.1% of the whole cohort. The most frequent non-urological cancer was colorectal cancer (CRC), reported by 10.6% of patients. Men with a history of either PCa or CRC complained more of ED [98 (92.5%) vs .68 (62.4%) men; p=0.001] and had lower rates of normal IIEF-EF [1 (0.9%) vs. 6 (5.5%) men; p=0.03], with respect to patients with a history of other types of cancers, whom conversely reported higher rates of PE [4 (3.8%) vs. 12 (11%) men; p=0.03] and of PD [9 (8.5%) vs. 21 (19.3%) men; p=0.007]. CONCLUSIONS: Almost 10% of men seeking first medical help for SD in a tertiary-referral andrology centre are cancer survivors. Following the improvement of survivorship rates in male patients, an andrological assessment should always be included throughout the follow-up of cancer survivors. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e624 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Simone Cilio More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Luigi Candela More articles by this author Alessandro Bertini More articles by this author Christian Corsini More articles by this author Francesco Lanzaro More articles by this author Donato Cannoletta More articles by this author Massimiliano Raffo More articles by this author Fausto Negri More articles by this author Ludovica Cella More articles by this author Margherita Fantin More articles by this author Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Alessia D'arma More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF downloadLoading ...

Energy balance in cancer survivors at risk of weight gain: a review.

The study of energy balance [i.e., energy intake (EI) and energy expenditure (EE)] is a powerful tool for understanding body weight regulation and may contribute to our understanding of rapid weight gain risk in certain cancer survivors post-diagnosis. The purpose of this review was to summarize studies that assessed longitudinal, prospective changes in components of energy balance from diagnosis/start of treatment to any duration of follow-up in cancer survivors with prior evidence of weight gain (breast, prostate, thyroid, gynecologic, testicular, and acute lymphoblastic leukemia) RESULTS: The available literature suggests that energy balance components may be altered in cancer survivors who have a heightened risk of weight gain post-diagnosis. The evidence for EI was overall inconsistent. Conversely, decreases in resting and physical activity EE during the active phases of treatment (e.g., chemotherapy, hypothyroid state) were commonly noted, which then slowly rebounded towards baseline levels at the end of treatment and during follow-up assessments. Much of this evidence is based on data collected from breast cancer survivors, which highlights a paucity of data currently available on other cancer types. While there is growing acknowledgement that weight management interventions in cancer survivors are needed, it is important to recognize that changes in both behavioral (EI, physical activity EE) and passive (resting EE, thermic effect of food) components of energy balance may occur post-diagnosis. This information can help to inform weight management interventions which often entail modifications in diet and/or physical activity.

LONG-TERM THYROID DISORDERS IN CHILDREN RECEIVING ONCOLOGIC TREATMENT AND RADIOTHERAPY.

Childhood cancer survival has increased substantially over the past few decades. However, long-term side effects associated with cancer treatment have also risen. Especially thyroid gland disorders are common. The present retrospective cross-sectional study aimed to investigate risk factors of long-term TD in survivors of leukemia-lymphoma. The study included 44 acute lymphoblastic leukemia (ALL) and 26 Hodgkin lymphoma survivors (HL). Abnormal laboratory and pathological ultrasonographic findings of the thyroid gland were accepted as a thyroid disorder. The possible causes of thyroid disorders were investigated. Long-term thyroid disorder was found in 40% of the patients. This rate was higher in HL patients than in ALL (65% vs. 25%). Thyroid disorder was significantly more common in patients who received radiotherapy to the neck (57% vs. 17%). Radiotherapy to the neck area was the only significant determinant for thyroid disorders in the regression models [OR 33.17, 95% CI (2.76-398.9) p = 0.006]. However, HL remained significantly associated with TD in the logistic model performed using cancer type [OR 19.25, 95% CI (2.39-155.3) p = 0.006]. The study showed that radiotherapy applied to the neck was an essential risk factor for long-term TD in the average 6-year follow-up of cancer survivors. However, we recommend that childhood cancer survivors should be followed closely for a long time since long-term endocrine side effects were reported during longer than six years follow-up periods.

Co-occurrence of thyroid and breast cancer is associated with an increased oncogenic SNP burden

BackgroundEpidemiological evidence suggests that synchronous or metachronous presentation of breast and thyroid cancers exceeds that predicted by chance alone. The following potential explanations have been hypothesized: common environmental or hormonal factors, oncogenic effect of the treatment for the first cancer, closer follow-up of cancer survivors, shared underlying genetic risk factors. While some cases were found to be related to monogenic disorders with autosomal inheritance, the genetic background of most cases of co-occurring breast and thyroid cancer is thought to be polygenic.MethodsIn this retrospective case-control study we compared the genetic profile of patients with a history of breast cancer (n = 15) to patients with co-occurring breast and thyroid cancer (n = 19) using next generation sequencing of 112 hereditary cancer risk genes. Identified variants were categorized based on their known association with breast cancer and oncogenesis in general.ResultsNo difference between patients with breast and double cancers was observed in clinical and pathological characteristics or the number of neutral SNPs. The unweighted and weighted number of SNPs with an established or potential association with breast cancer was significantly lower in the group with breast cancer only (mean difference − 0.58, BCa 95% CI [− 1.09, − 0.06], p = 0.029, and mean difference − 0.36, BCa 95% CI [− 0.70, − 0.02], p = 0.039, respectively). The difference was also significant when we compared the number of SNPs with potential or known association with any malignancy (mean difference − 1.19, BCa 95% CI [− 2.27, − 0.11], p = 0.032 for unweighted, and mean difference − 0.73, BCa 95% CI [− 1.32, − 0.14], p = 0.017 for weighted scores).ConclusionOur findings are compatible with the hypothesis of genetic predisposition in the co-occurrence of breast and thyroid cancer. Further exploration of the underlying genetic mechanisms may help in the identification of patients with an elevated risk for a second cancer at the diagnosis of the first cancer.

Psychosocial care for cancer survivors: A systematic literature review on the role of general practitioners.

To explore the general practitioners (GP's) role in providing psychosocial care for cancer survivors through a systematic literature review. We searched MEDLINE, EMBASE, PsycINFO, and CINAHL and included the studies that complied with the predefined inclusion and exclusion criteria. At least two independent reviewers performed the quality appraisal and data extraction. We included 33 (five qualitative, 19 observational, and nine intervention) studies; the majority of these studies focused on care for depression and anxiety (21/33). Cancer survivors were more likely to contact their GP for psychosocial problems compared with noncancer controls. Survivors were more likely to use antidepressants compared with controls, although 71% of survivors preferred depression treatment to be "talking therapy only." Overall, GPs and patients mostly agreed that GPs are the preferred healthcare provider to manage psychosocial problems. The major exception is a survivor's fear of recurrence-here, the oncologist was the preferred healthcare provider. Only two interventions effectively decreased depression or anxiety; these studies included patients who had a clinical indication for psychosocial care, were specifically designed for decreasing depression/anxiety, and consisted of a multidisciplinary team approach. The other interventions evaluated GP-led follow-up for cancer survivors and found that this did not impact the patients' levels of anxiety, depression, or distress neither negatively nor positively. Cancer survivors often prefer psychosocial care by their GP, and GPs generally consider they are well placed to provide this care. Although evidence on the effectiveness of psychosocial care by GPs is limited, an active multidisciplinary team approach seems key.

Main challenges in survivorship transitions: Perspectives of older adults with cancer

ObjectivesTo describe main challenges experienced by older adults (75+ years) following primary cancer treatment as a basis for development of age-appropriate survivorship care. Material and MethodsA national survey was conducted across ten Canadian provinces to identify experiences with follow-up for cancer survivors one to three years post-treatment. The survey included open-ended questions for respondents to add details that offered deeper insight into their experiences. This publication presents analysis of responses from older adults (75+ years) about the main challenge they faced in transitioning to survivorship. ResultsIn total, 3274 older adults (75+ years) responded to the survey and 2057 responded to the main challenge question. Fifty-five percent were male, 72% had not experienced metastatic disease and 75% reported comorbid conditions. The 1571 (48.0%) respondents reporting at least one main challenge described 2426 challenges categorized as physical, emotional, practical, lifestyle adjustments, health care delivery, and relationships/support. Physical challenges were identified most frequently (68.2%, n = 1655) including physical capacity (35.8%), symptoms/side effects (32.7%), and changes in bodily function/appearance (31.3%). Thematic analysis revealed three themes: ‘getting back on my feet’, ‘adjusting to the changes’, and ‘finding the support I needed’. ConclusionThis work highlights gaps in early cancer survivorship for older adults and raises concerns about unexamined ageism within the Canadian cancer care system. A need for comprehensive geriatric assessments is evident before and toward the end of primary treatment to individualize care plans. Proactive provision of information about managing changes from treatment, offered in meaningful multi-modal ways, is important.

Exploring the reasons cancer survivors do not seek help for their concerns: a descriptive content analysis

PurposeTo understand reasons why adult cancer survivors do not seek assistance as they transition from the end of cancer treatment to follow-up care. Understanding these reasons should inform survivorship care,...

1155TiP Pan-tumour study CheckMate 8TT for long-term follow-up of cancer survivors who have participated in trials investigating nivolumab

1155TiP Pan-tumour study CheckMate 8TT for long-term follow-up of cancer survivors who have participated in trials investigating nivolumab

Cancer survivorship care at the time of the COVID-19 pandemic.

Cancer survivorship care at the time of the COVID-19 pandemic.

Cancer and risk of Alzheimer's disease: Small association in a nationwide cohort study.

Small observational studies with short-term follow-up suggest that cancer patients are at reduced risk of Alzheimer's disease (AD) compared to the general population. A nationwide cohort study using Danish population-based health registries (1980-2013) with cancer patients (n = 949,309) to identify incident diagnoses of AD. We computed absolute reductions in risk attributed to cancer and standardized incidence rate ratios (SIRs) accounting for survival time, comparing the observed to expected number of AD cases. During up to 34 years of follow-up of cancer survivors, the attributable risk reduction was 1.3 per 10,000 person-years, SIR = 0.94 (95% confidence interval 0.92-0.96). SIRs were similar after stratification by sex, age, and cancer stage, and approached that of the general population for those surviving >10 years. Inverse associations between cancer and AD were small and diminished over time. Incidence rates in cancer survivors approached those of the general population, suggesting limited association between cancer and AD risk.

Cancer survivor’s perspectives on the major challenge in the transition to survivorship

ObjectivesTo understand cancer survivors’ perspectives regarding the major challenge in transitioning from cancer treatment to follow-up care. Identification of major issues should inform survivorship care and help reduce suffering. MethodsA national survey was conducted to identify experiences with follow-up for cancer survivors one to three years post-treatment. The survey included open-ended questions for respondents to add topics of importance and details that offer deeper insight into their experiences. This publication presents analysis of the open-ended question about the major challenge faced by adult cancer population. ResultsOf 13,534 unique adult survey respondents, 8706 respondents identified major challenges. Of those reporting challenges, 4727 (54.3 %) named a single challenge but 3979 (45.7 %) identified more than one. In total, 15,351 challenges were identified. Responses to open-ended questions are summarized under significant themes: major concerns are often more than singular issues; recovery and fear of recurrence; and information needs. Conclusions and practice implicationsResults indicate significant numbers of adult survivors have multiple concerns about physical, emotional, and practical issues but are not receiving assistance and/or appropriate information to help manage these concerns. It is important to determine how health care can be proactive in identifying and addressing needs of survivors.

The impact of health literacy on medico-social follow-up visits among French cancer survivors 5years after diagnosis: The national VICAN survey.

BackgroundLong‐term medico‐social follow‐up of cancer survivors is a challenge because of frequent subsequent troubles. In particular survivors with lower health literacy (HL) have poorer health and might more often use primary care services. However, the impact of HL on cancer survivors’ medico‐social follow‐up visits is not known. Our aim was to study medico‐social follow‐up and its associated determinants with a focus on HL 5 years after diagnosis.MethodsVICAN is a national survey of French adult cancer survivors 5 years after a primary cancer. The Single‐Item Literacy Screener was used to define functional HL in this sample. We also asked patients to report the frequency of follow‐up visits with a general practitioner (GP) and/or social worker (SW) regarding their cancer disease.ResultsThe 4045 participants were 57.4 ± 12.9 years old at diagnosis (range 20‐82) and 1495 (37%) were classified as having inadequate HL. Most cancer survivors (66.7%) were followed up by a GP regarding their cancer while only 14.5% had contact with a SW. After adjustment for sociodemographic, medical, and psychosocial characteristics, medico‐social follow‐ups (GP and SW visits) were more frequent among survivors with low HL. Furthermore, low income, unemployment, impaired mental health, treatment by chemotherapy, and perception of sequelae and fatigue were also associated with more frequent medico‐social follow‐up. Cancer localization association with medico‐social follow‐up was heterogeneous.ConclusionFrench cancer survivors with limited HL, lower socioeconomic status, and more severe cancer were more likely to use GP care and social services. Raising awareness and training GPs and SWs on medico‐social follow‐up for patients with limited HL seem necessary to support these vulnerable survivors.

Management of lymphoma survivor patients in Italy: an evaluation by Fondazione Italiana Linfomi.

Several outpatient models for the follow-up of cancer survivors have been developed worldwide. A multidisciplinary approach is often necessary to guarantee the best monitoring of long-term toxicities. Guidelines also indicate a close education on healthy lifestyles. In this context, we have analyzed the Italian follow-up modalities of lymphoma survivors, with the aim to have a starting line to hypothesize and plan the best model for Italian hematology centers.

Secondary brain tumors after cranial radiation therapy: A single-institution study.

To study the probability of developing secondary brain tumors after cranial radiotherapy.Background Patients treated with cranial radiotherapy are at risk for developing secondary brain tumors. We planned an institutional survey for secondary brain tumors in survivors after cranial irradiation and reviewed the 30-year duration data. Event analysis and cumulative proportion curves were performed to generally estimate the cumulative proportion of developing secondary brain tumors, cavernoma and meningioma at different periods of time. Secondary brain tumors occurred in 21% of cases: 10% were cavernomas, 6% were meningiomas, 3% were skull osteomas, and 1% were anaplastic astrocytoma. The cumulative proportion of developing secondary brain tumor was 6% at 10 years and 20% at 20 years, while the cumulative proportion for developing cavernomas and meningiomas was 16% and 7% at 20 years, respectively. Our study shows that patients who received cranial irradiation were at risk of secondary brain tumors such as cavernomas and meningiomas. Thus, a meticulous follow-up of cancer survivors with history of cranial irradiation by an annual MRI scan is justifiable. This will help clinicians to detect secondary brain tumors early and make its management much easier.

P695Impact of atrial fibrillation on 10y all-cause mortality in curatively treated breast cancer patients

Abstract Background Contemporary treatment options for breast cancer have significantly improved survival during the last two decades. To estimate cancer survival, current practice typically relies on cancer size and the presence of metastases, whereas cardiovascular comorbidities such as atrial arrhythmias are typically not taken into account. Aim To evaluate the incidence of atrial fibrillation and flutter among curatively treated breast cancer patients and assess its impact on survival in an all-comer population at a tertiary care centre. Methods In a large, single centre, retrospective study we enrolled all patients with a diagnosis of breast cancer in 2007 and 2008 who received radiation therapy as part of their curative treatment regimen. We performed Kaplan-Meier and Cox survival analyses to calculate mortality risk over 10-year follow up. Results We included 1338 patients, 1326 (99.1%) of whom were women. Mean age (± standard deviation) at diagnosis was 57.6±13.4 years and the distribution of left sided breast cancer versus right sided or bilateral breast cancer was 655 (49.0%) patients versus 645 (48.2%) and 38 (2.9%) patients, respectively. A total of 805 (60.1%) patients had at least one ECG recorded during the 10 year follow up. In this subgroup, atrial fibrillation or flutter was present in 70 (8.7%); 23 patients had pre-existing atrial fibrillation or flutter (32.9%), 26 patients had had radiation therapy for left sided breast cancer (37.1%) versus 21 patients for right sided breast cancer (30%; p=0.375 for left versus right sided radiation therapy). Of the total cohort, 327 (24.4%) patients died during 10 year follow-up. In the subgroup with at least a single ECG recording, mortality equaled 44.3% (31/70) in patients with one or more documented episodes of atrial fibrillation or flutter during follow-up, compared to 21.9% (161/735) in patients who remained in sinus rhythm (p<0.0001). In patients with pre-existing atrial fibrillation or flutter, mortality equaled 47.8% (11/23) versus 42.6% (20/47) in patients with atrial fibrillation or flutter manifesting after treatment initiation (p=0.683). Survival Atrial Fibrillation/Flutter Conclusion Atrial fibrillation and flutter are common in patients with curative breast cancer treatment and have a significant impact on overall survival. Our study highlights the impact of cardiac comorbidities on overall survival following cancer treatment and emphasizes the importance of a dedicated cardiac follow-up in cancer survivors.

Surveillance après traitement d'un cancer cervicofacial

Post-therapeutic follow-up of patients with head and neck cancer involves numerous professionals. The radiation oncologist should play an active role in this process. His oncological knowledge and technical expertise position him as a cornerstone for the detection of recurrences from the treated tumor, the research of second primary cancers and the screening of potential side-effects induced by the different treatments administered. To improve the benefits/costs ratio and allow good patient-compliance, follow-up programs should be built through close collaboration between the different contributors and planned according to a feasible schedule. Paraclinical exams must be arranged to respond to accurate objectives. Patient-education is essential to ensure the patient's full understanding and active participation. Finally, the transfer of the long-term follow-up of cancer survivors from specialists to primary care physicians is relevant but would require a prospective evaluation of its efficiency for this specific population.

Primary Care Providers' Knowledge, Attitudes, Beliefs, and Practices Regarding Their Preparedness to Provide Cancer Survivorship Care.

Recent cancer care delivery models and clinical practice guidelines have expanded the role of primary care providers (PCPs) in routine follow-up of cancer survivors. We conducted a cross-sectional survey of PCPs affiliated with a large healthcare system to (1) examine practices, attitudes, and beliefs regarding preparedness to provide survivorship care and (2) explore predictors of confidence managing cancer survivors. We distributed a self-administered online survey to 1069 clinical affiliates providing primary care services within the University of Pittsburgh Medical Center system. Associations between PCPs' professional characteristics and attitudes and preparedness were evaluated. Multiple logistic regression explored predictors of confidence monitoring common cancer treatment-related symptoms. One hundred twenty-seven eligible PCPs responded. The sample was split between academic and community practice (48.0% vs. 52.0%, respectively), predominantly comprised of physicians (81.8%), and 64.6% had > 15years direct patient care experience. The majority agreed that PCPs play a valuable role in surveillance and adverse event monitoring in survivors, though less than 25% felt their professional training prepared them to perform each of these domains. Physicians were significantly more likely than advanced practice providers to be among the 65% of PCPs who were confident monitoring ≥ 1 symptom in each of the 5 evaluated symptom clusters (OR 3.6, 95% CI 1.2-10.8). PCPs appear willing to assume an enhanced role in cancer survivorship care but feel unprepared to do so. Enhanced training and dissemination of clinical practice guidelines are needed to facilitate effective implementation of PCP-delivered survivorship care.