SAN ANTONIO – Long-term breast cancer survivorship care is transitioning to primary care clinicians, including nurse practitioners (NPs), according to research presented at the American Association of Nurse Practitioners (AANP) 2016 National Conference.

Daniel Blaz, LTC, AN, DNP, FNP-C, Kimbrough Ambulatory Care Center, Fort Meade, Maryland, presented an overview of care directives and considerations for primary care clinicians, assuming long-term care of the 14.5 million breast cancer survivors.

“It is becoming more challenging for oncology specialists to provide indefinite survivorship care for the increasing number of survivors,” said Dr Blaz. “[The] transition from treatment to survivorship is challenging for most breast cancer survivors, [and] adoption of a Survivorship Care Plan has not yet taken hold among survivorship healthcare providers.”

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Currently, the 5-, 10-, and 15-year relative survival rates for breast cancer are 89%, 83%, and 78%, respectively. Patients in remission often exhibit a number of the following persistent physical and emotional symptoms:

  • Fatigue (physical, emotional, and cognitive)
  • Vasomotor symptoms induced by chemotherapy and hormonal treatment
  • Sexual dysfunction (decreased libido, body image, dyspareunia, decreased lubrication)
  • Infertility and premature ovarian failure
  • Osteoporosis
  • Weight gain
  • Musculoskeletal
  • Hot flashes
  • Elevated cholesterol
  • Anxiety, depression, and other mood changes
  • Insomnia

The American Society of Clinical Oncology (ASCO) has developed the following survivorship guidelines for primary care providers:

Laboratory tests and imaging. Clinicians should not offer routine laboratory testing or imaging.

Routine cancer screening. Clinicians should screen for other cancers as they would screen the general population.

Bone health. Clinicians should conduct a baseline dual-energy x-ray absorptiometry (DEXA) scan

Cardiotoxicity impact. Clinicians should provide lipid and cardiovascular monitoring for cardiovascular symptoms.

Distress, depression, and anxiety. Clinicians should assess for distress, depression, and anxiety.

Premature menopause. Clinicians should offer selective serotonin re-uptake inhibitors (SSRI), serotonin–norepinephrine reuptake inhibitors (SNRI), gabapentin, and other lifestyle modifications to mitigate vasomotor symptoms.

Additional follow-up care should include regular physical examinations conducted every 3 to 6 months for the first 3 years post-treatment, every 6 to 12 months for the next 2 years, and then on an annual basis. Patients should be encouraged to perform monthly breast self-examinations, as well as to undergo routine gynecological examinations and mammography surveillance.

“NPs can implement efficient, high-quality survivorship care by using survivorship care plans and by communicating with oncology specialists,” concluded Dr Blaz. “A patient-centered approach is needed to address long-term physical and psychosocial effects.” 

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  1. Blaz D. Breast cancer survivorship care and considerations: A primary care perspective. Poster presented at: American Association of Nurse Practitioners (AANP) 2016 National Conference. June 21-26, 2016; San Antonio, TX.