Need for Survivorship Plans Emphasized

As the number of breast cancer survivors grows, so does the emphasis on establishing individualized survivorship plans that address diverse needs, said Debu Tripathy, MD, co-leader of the Women’s Cancer Program at the USC/Norris Comprehensive Cancer Center in Los Angeles, California.

Indeed, Tripathy said, planning for survivorship should begin at diagnosis. He said the most recent statistics estimate that there are >2.5 million breast cancer survivors in the United States and that care among these cancer patients often becomes fragmented as time goes on.

In breast cancer care, continued mammograms have been a key aspect of surveillance for patients who are disease-free after early-stage cancer, Tripathy said.

However, he said, there are no data showing the survival impact of ongoing screenings. In some instances, he said, repeated screenings increase patients’ anxiety levels and deliver false positives. "Aggressive screening may result in overtreatment of early disease," he said.

In other areas, screenings should be part of the survivorship care. Tripathy said patients should undergo a baseline DEXA scan after chemotherapy, and take calcium and vitamin D supplements. "Patients receiving tamoxifen should have annual gynecologic examinations and be aware of uterine risks," such as bleeding and malignancy, Tripathy said.

In addition, he said that patients should be monitored for a variety of lingering side effects. These include cardiac and pulmonary side effects, as well as effects of early menopause, depression, and lymphedema.