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Breast Cancer Survivorship: Why, What and When?

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Survivorship medicine is fairly new in the realm of oncology. As we broaden our focus from treatment and prevention to include survivorship there is substantial opportunity to enhance the care of the patient. Important in successful management of recovery after cancer treatment is managing the side effects of therapy and improving quality of life. This ranges from sexual dysfunction, depression to lymphedema. Guideline-based surveillance after treatment with clear communication of care plans to the patient and their providers, especially primary care, is paramount. Thoughtful pre-surgical treatment planning, which may include neoadjuvant approaches or consideration of fertility preservation, results in superior long-term patient outcomes. Understanding the importance of the teachable moment in effecting behavioral and lifestyle changes that reduce risk of recurrence is also an essential component of excellent cancer survivor patient care. We identified the following areas for focus as they represent the key areas for accreditation and patient driven needs. Development of survivorship plans, post treatment surveillance, sexuality and fertility preservation, lymphedema management and risk reduction lifestyle and behavioral changes.

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References

  1. Society, A.C. American Cancer Society Facts and Figures. http://www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/.

  2. SEER. Cancer Statistics. https://seer.cancer.gov/statfacts/html/breast.html.

  3. Surgeons, A.C.o. Accreditation Committee Clarifications for Standard 3.3 Survivorship Care Plan. https://www.facs.org/publications/newsletters/coc-source/special-source/standard33#sthash.MFJbgTuH.dpuf. 2014; https://www.facs.org/publications/newsletters/coc-source/special-source/standard33.

  4. Khatcheressian JL, et al. Breast cancer follow-up and management after primary treatment: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(7):961–5.

    Article  CAS  PubMed  Google Scholar 

  5. Runowicz CD, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol. 2016;34(6):611–35.

    Article  CAS  PubMed  Google Scholar 

  6. Winters-Stone K, Hilton CM, Luoh SW, et al. Comparison of physical function and falls among women with persistent symptoms. 2016.

  7. Brennan ME, et al. Survivorship care plans in cancer: a systematic review of care plan outcomes. Br J Cancer. 2014;111(10):1899–908.

    Article  CAS  PubMed Central  Google Scholar 

  8. Bulloch KJ, et al. Systematic approach to providing breast cancer survivors with survivorship care plans: a feasibility study. J Oncol Pract. 2015;11(2):e170–6.

    Article  PubMed  Google Scholar 

  9. Rowland JH, Bellizzi KM. Cancer survivorship issues: life after treatment and implications for an aging population. J Clin Oncol. 2014;32(24):2662–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grunfeld E, et al. Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol. 2011;29(36):4755–62.

    Article  PubMed  Google Scholar 

  11. Berman AT, et al. Use of survivorship care plans and analysis of patient-reported outcomes in multinational patients with lung cancer. J Oncol Pract. 2016;12(5):e527–35.

    Article  PubMed  Google Scholar 

  12. NCCN Guidlines 1.2016 BINV-16, B.-B.

  13. Lehman CD, et al. Screening MRI in women with a personal history of breast cancer. J Natl Cancer Inst. 2016;108(3):djv349

    Article  PubMed  Google Scholar 

  14. Houssami N, et al. Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening. Cancer Epidemiol Biomarkers Prev. 2013;22(5):946–61.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shah, A., et al., Building a rapid learning health care system for oncology: why CancerLinQ collects identifiable health information to achieve its vision. J Clin Oncol. 2016;34(7):756–63.

    Article  PubMed  Google Scholar 

  16. Administration, F.A.D., Silicone gel-filled breast implants: updated safety information, 2011.

  17. Baynosa J, et al. Timing of breast cancer treatments with oocyte retrieval and embryo cryopreservation. J Am Coll Surg. 2009;209(5):603–7.

    Article  PubMed  Google Scholar 

  18. Munhoz RR, et al. Gonadotropin-releasing hormone agonists for ovarian function preservation in premenopausal women undergoing chemotherapy for early-stage breast cancer: a systematic review and meta-analysis. JAMA Oncol. 2016;2(1):65–73.

    Article  PubMed  Google Scholar 

  19. Moore HC, et al. Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy. N Engl J Med. 2015;372(10):923–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Azim HA Jr., et al. Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study. J Clin Oncol. 2013;31(1):73–9.

    Article  PubMed  Google Scholar 

  21. Avis NE, Crawford S, Manuel J. Psychosocial problems among younger women with breast cancer. Psychooncology. 2004;13(5):295–308.

    Article  PubMed  Google Scholar 

  22. Meyerowitz BE, et al. Sexuality following breast cancer. J Sex Marital Ther. 1999;25(3):237–50.

    Article  CAS  PubMed  Google Scholar 

  23. Fobair P, et al. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15(7):579–94.

    Article  PubMed  Google Scholar 

  24. Gochros JFH. Approaches to specific problems. In: Handbook of behavior therapy with sexual problems, 1st edn. Elsevier, 2013:388

  25. American College of Obstetrics and B.-G. Gynecologists Committee on Practice, ACOG Practice Bulletin No. 119: female sexual dysfunction. Obstet Gynecol. 2011;117(4):996–1007.

    Article  Google Scholar 

  26. Committee Opinion No. 659: The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol. 2016;127(3):e93–6.

    Article  Google Scholar 

  27. Schover LR, et al. Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer. 1995;75(1):54–64.

    Article  CAS  PubMed  Google Scholar 

  28. Ganz PA, et al. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16(2):501–14.

    CAS  PubMed  Google Scholar 

  29. Ganz PA, et al. Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol. 1999;17(8):2371–80.

    CAS  PubMed  Google Scholar 

  30. Rowland JH, et al. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst. 2000;92(17):1422–9.

    Article  CAS  PubMed  Google Scholar 

  31. Burwell SR, et al. Sexual problems in younger women after breast cancer surgery. J Clin Oncol. 2006;24(18):2815–21.

    Article  PubMed  Google Scholar 

  32. Pozo C, et al. Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery. J Clin Oncol. 1992;10(8):1292–8.

    CAS  PubMed  Google Scholar 

  33. Yurek D, Farrar W, Andersen BL. Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress. J Consult Clin Psychol. 2000;68(4):697–709.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Arora NK, et al. Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma: a prospective study. Cancer. 2001;92(5):1288–98.

    Article  CAS  PubMed  Google Scholar 

  35. Parker PA, et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol. 2007;14(11):3078–89.

    Article  PubMed  Google Scholar 

  36. Perez M, et al. Changes in sexual problems over time in women with and without early-stage breast cancer. Menopause. 2010;17(5):924–37.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Engel J, et al. Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J. 2004;10(3):223–31.

    Article  PubMed  Google Scholar 

  38. Aerts L, et al. Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. Breast. 2014;23(5):629–36.

    Article  CAS  PubMed  Google Scholar 

  39. Gerber B, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238(1):120–7.

    PubMed  PubMed Central  Google Scholar 

  40. Wang F, et al. Total skin-sparing mastectomy and immediate breast reconstruction: an evolution of technique and assessment of outcomes. Ann Surg Oncol. 2014;21(10):3223–30.

    Article  PubMed  Google Scholar 

  41. Petit JY, et al. When mastectomy becomes inevitable: the nipple-sparing approach. Breast. 2005;14(6):527–31.

    Article  CAS  PubMed  Google Scholar 

  42. Rivadeneira DE, et al. Skin-sparing mastectomy with immediate breast reconstruction: a critical analysis of local recurrence. Cancer J. 2000;6(5):331–5.

    CAS  PubMed  Google Scholar 

  43. Didier F, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118(3):623–33.

    Article  CAS  PubMed  Google Scholar 

  44. Robinson VC. Support for the hypothesis that sexual breast stimulation is an ancestral practice and a key to understanding women’s health. Med Hypotheses. 2015;85(6):976–85.

    Article  CAS  PubMed  Google Scholar 

  45. Levin R. The breast/nipple/areola complex and human sexuality. Sex Relation Ther. 2006;21(2):237–49.

    Article  Google Scholar 

  46. Wei CH, et al. Psychosocial and sexual well-being following nipple-sparing mastectomy and reconstruction. Breast J. 2016;22(1):10–7.

    Article  PubMed  Google Scholar 

  47. Kwait R, Pesek S, Onstad M, Edmonson D, Ghandi C, Raker C, Stuckey A, Gass J. ASBrS Poster: Preserving sexual function in breast cancer survivorship: does surgical modality matter? 2016.

  48. Goldberg JI, et al. Morbidity of sentinel node biopsy in breast cancer: the relationship between the number of excised lymph nodes and lymphedema. Ann Surg Oncol. 2010;17(12):3278–86.

    Article  PubMed  Google Scholar 

  49. Caudle AS, Thompson AM. Less remains better: morbidity after axillary surgery. Ann Surg Oncol. 2015;22(1):4–6.

    Article  PubMed  Google Scholar 

  50. Boughey JC, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Boneti C, et al. Axillary reverse mapping: mapping and preserving arm lymphatics may be important in preventing lymphedema during sentinel lymph node biopsy. J Am Coll Surg. 2008;206(5):1038–42 (discussion 1042–4).

    Article  PubMed  Google Scholar 

  52. Passerelli MN, Hampton J, et al. Cigarette smoking before and after a breast cancer diagnosis: mortality from breast cancer and smoking related diseases. J Clin Oncol. 2016.

  53. Norman SA, et al. Modifiable risk factors for breast cancer recurrence: what can we tell survivors? J Womens Health (Larchmt). 2007;16(2):177–90.

    Article  Google Scholar 

  54. Lara Heflin SF, DeLuca AN, Melisko ME, Moasser MM, Park JW, Chien AJ, Munster PN, Landau SM, Jagust WJ, Kramer JH, Rugo HS. Prospective study of cognitive function (cog fcn) in women with early-stage breast cancer (BC): relationship between perceived and measurable cognitive deficits. J Clin Oncol. 2013.

  55. Dabrowski M, et al. Clinical experience with the NCCN distress thermometer in breast cancer patients. J Natl Compr Cancer Netw. 2007;5(1):104–11.

    PubMed  Google Scholar 

  56. Haque R, et al. Tamoxifen and antidepressant drug interaction in a cohort of 16,887 breast cancer survivors. J Natl Cancer Inst. 2016;108(3):djv337.

    Article  PubMed  Google Scholar 

  57. Fox SaD. Health Online 2013: One in three American adults have gone online to figure out a medical condition. 2013; http://www.pewinternet.org/2013/01/15/health-online-2013/.

  58. Munro D. Community #BCSM expands online to broaden patient engagement. http://onforb.es/1s2VenL.

  59. Kalter L. Hashtag helps cancer community find peace. 2015; http://bit.ly/1jbhqqA.

  60. Szabo L. Breast cancer survivor group is a social movement. http://usat.ly/1yrKIz.

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Correspondence to Jennifer Gass MD.

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Gass, J., Dupree, B., Pruthi, S. et al. Breast Cancer Survivorship: Why, What and When?. Ann Surg Oncol 23, 3162–3167 (2016). https://doi.org/10.1245/s10434-016-5403-0

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