MON 2011 - Slide 28 - S. Faithfull - Spotlight session - Consequences of cancer treatment

Consequences of cancer treatment Professor Sara Faithfull Faculty of Healthy and Medical Science

Aim ,[object Object],[object Object],[object Object]

Why an issue? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Risk of late toxicity ,[object Object],[object Object],[object Object],[object Object]

Radiotherapy late effects: a complex injury Smooth muscle cell Vascular endothelium Cytokine cascade TGF-1 TGF-2 Swelling, Hyperplasia, Oedema, Fibrosis Vasculopathies Demyelination Oligodendrocyte Glial atrophy 2yrs Increased permeability Collagen formation Yarnold J & Vozenin Brotons (2010) Pathogenetic mechanisms in radiation fibrosis Radio & Oncol 97 (149-161 )

Chemotherapy late effects Cardiac dysfunction ,[object Object],[object Object],[object Object],[object Object],Cell loss Cardio-myopathy Remodelling ,[object Object],[object Object],[object Object],Death Monsuez J et al (2010) cardiac side effects of cancer chemotherapy 144 3-15

Common long term late effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical signs for breast cancer late effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Effect of radiotherapy on mortality from causes other than breast cancer EBCTCG 2006: Preliminary results. S Darby et al 2009 Darby et el, Lancet Oncol 2005; 6: 557-65

Cardiac problems ,[object Object],[object Object],[object Object],[object Object],[object Object]

Women at risk ,[object Object],[object Object],McGale P & Darby S (2008) International Journal of Epidemiology 519-523 ,[object Object]

Pelvic late effects ,[object Object],[object Object],[object Object],[object Object],[object Object],Denton, A., et al. Clinical Oncology, 2000. 12(347-353).

Pelvic GI late effects Stricture Fistula Telangectasia and bleeding Second cancers Severe problems for 5 -10% after 10 years; >10% after 20 years Andreyev J (2007) Clinical Oncology 19: 790-799

Gastrointestinal symptoms are under reported Al-Albany et al. (2002) Acta Oncol 41: 532-542 Bergmark K et al. (2004) Acta Obstet Gynecol Scand 81: 443-450 Symptom Prostate 2.5-5 yrs (21%0 Cervix 5 yrs (30%) Urgency 21% 26% Loose stool 22% 30% Constipation 21% 8% Incontinence 21% 13% Rectal bleeding 21%

Radiotherapy to the prostate (EBRT & Brachytherapy) Voiding symptoms: dysuria, nocturia, frequency, incontinence Sexual symptoms, erectile dysfunction, ejaculation and libido Bowel symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Comparative studies ,[object Object],[object Object],[object Object],[object Object],[object Object]

Differences ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Litwin et al 2007 Cancer 109 2239-47

And long term....at 15 years ,[object Object],[object Object],[object Object],Franson P & Widmark A (2007) Acta Oncologica 46 517-524

Correlation between urinary symptoms & QOL over time (186 men)

Identifying men’s unmet needs Country of survey Areas of un meet needs Australia: Smith et al. (2007) J. Clin. Onc 25 2560-2566 Majority of men had some un meet needs Steginga S et al (2001) Psycho-Oncology 1 66-75 Greatest unmet need in relation to sexuality and psychological issues USA Boberg (2003) Pt. Educ. Couns.49 233-242 Un meet needs related to knowledge of side effects and issues related to recurrence Canada Fitch (1997) Can. J Urol 4(2) 359-365 Identified men’s difficulty with coping with treatment side effects UK Lintz (2001) Psycho-Oncology 12(8) 769-783 87% of men had some unmet needs

Recent population survey ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ream , Faithfull et al. (2008) BJC 98 1903-1909

Predictors of unmet need ,[object Object],[object Object],[object Object]

Approaches to managing LUTS ,[object Object],[object Object],[object Object],[object Object],[object Object],Cockle Hearne J & Faithfull S (2010) Psycho oncology : DOI 10.102.pon

Gastrointestinal interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],McGough C et al Br J Cancer 2004 90 2278-87

Short comings of intervention evidence base ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Principles of late effects management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Scale of effect SCA L E SEVERITY / COMPLEXITY

Large target population for assessment and management

Future challenges ,[object Object],[object Object],[object Object],[object Object],[object Object]

MON 2011 - Slide 28 - S. Faithfull - Spotlight session - Consequences of cancer treatment

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MON 2011 - Slide 28 - S. Faithfull - Spotlight session - Consequences of cancer treatment