Cancer Survivorship in Primary Care - Psycho-oncology …：癌症幸存者在初级保健心理肿瘤学….pptVIP

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2018-06-30 发布于浙江
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Cancer Survivorship in Primary Care - Psycho-oncology …：癌症幸存者在初级保健心理肿瘤学….ppt

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Guidelines NCCN- ASCO- L Journey F Barriers to Survivorship care Finances Educated and dedicated providers Lack of acceptance and/or integration with disease based or general oncology programs Space Complexity of survivorship care Lack of clear, evidence based guidelines on proper management Limited knowledge of evolving management of co-morbidities Next Steps... Coordination of care Medical Home EHR Education Research Quality of Life:Psychosocial Control Anxiety Depression Enjoyment/Leisure Cognition/attention Distress of diagnosis Fear of recurrence Control of treatment Quality of Life:Social well being Family distress Roles and relationships Affection/sexual function Appearance Enjoyment Isolation Finances Work Quality of Life:Spiritual well being Meaning of illness Religiosity Transcendence Hope Uncertainty Inner strength Treatment related Toxicities:Long term and Late effects Long term-effects that persist after completion of treatment Late-occur after treatment has completed Long and late effects can be tumor, treatment or host related. Late effects Occur months to years following treatment Related to organ injury that occurred from treatment Failure of repair mechanisms over time and organ age More prevalent as treatments have become more complex. Tumor Related Factors Direct tissue effects Tumor related organ dysfunction Mechanical effects Treatment Related Factors Chemotherapy-agent, dose schedule and intensity Radiation Therapy-Total dose and fraction size, radiated field surgery-site and technique Host Related Factors Genetic predisposition Inherent tissue sensitivities and capacity for normal tissue repair Function of organs not effected by treatment Co-morbid conditions Pre treatment psychosocial status Surgery organ impairment Secondary side effects loss of function Chemotherapy Effects all organs- systemic therapy Most side effects can resolve within 3-6 months of completing therapy Cardiotoxicity Neuropathy Fatigue Pain Sexual dysfunction