Deck 48: Cancer Survivorship in Adult Primary Care

Question 1

The following are all components of cancer survivorship as outlined in the Institute of Medicine report From Cancer Patient to Cancer Survivor: Lost in Translation except:

A) Prevention and detection of new and recurrent cancers
B) Surveillance for cancer spread, recurrence, or second cancers
C) Provision of palliative care
D) Intervention for consequences of cancer and its treatment

Answer 1

C

Question 2

Models for cancer survivorship care include:

A) Shared care; nurse-led care
B) Primary care
C) Oncology provider
D) All of the above

Answer 2

D

Question 3

Every cancer survivorship should have a cancer survivorship care plan.

Answer 3

True

Question 4

Lifestyle modifications that may decrease risk of recurrence, manage treatment effects, and improve quality of life include:

A) Exercise-recommend 150 minutes of moderate aerobic exercise per week
B) Smoking cessation
C) Improving nutrition and limiting sun exposure
D) All of the above
Questions 5-7
Betty is a 43-year-old female with a history of ER+ breast cancer diagnosed at the age of 28 s/p right lumpectomy/axillary lymph node dissection, chemotherapy with Adriamycin and Cyclophosphamide every 2 weeks x 4 cycles followed by Paclitaxel every 2 weeks x 4 cycles and completed radiation therapy in 1999. She had a local recurrence in 2003 and was treated with re-excision and completed 10 years of endocrine therapy with Letrozole and Goserelin in 2014. Her family history is significant for a paternal aunt with breast cancer, paternal cousin with BRCA2 mutation and breast cancer at age 30. She presents to you with worsening, intermittent left rib pain for the past 6 months in spite of nonsteroidal anti-inflammatory drugs (NSAID) use or massage.

Question 5

What in her medical history is the biggest risk factor for recurrence of her cancer?

A) Already had a recurrence
B) History of cancer alone
C) BRCA2+ in family history
D) Estrogen-positive breast cancer (late recurrence risk)

Question 6

What diagnostic tests would you consider?

A) No tests indicated yet
B) CT or PET/CT
C) Ribs films
D) Pulmonary function tests

Question 7

Why should you refer her to genetics?

A) History of ER+ breast cancer
B) Family history of BRCA mutation
C) Recurrent disease under the age of 50
D) b and c

Question 8

32-year-old male computer program recently relocated to the Bay Area here to establish care with you. He has a history of depression, alcoholism (in recovery for 10 years without relapse), and testicular cancer at age 28, s/p a right orchiectomy and lymph node dissection, which he reports was negative for malignancy. He has had annual urology follow-up with "tumor markers," chest and abdominal x-rays. You request his medical records and note that his testicular cancer was a stage 1 nonseminomatos tumor with negative lymph nodes.
-What kind of cancer surveillance does this patient need?

A) Genital exam
B) Tumor markers, which include beta hCG, alpha-fetoprotein (AFP), lactate dehydrogenase (LDH) every 6 months
C) Abdominal and pelvic CT scan
D) CXR

Question 9

32-year-old male computer program recently relocated to the Bay Area here to establish care with you. He has a history of depression, alcoholism (in recovery for 10 years without relapse), and testicular cancer at age 28, s/p a right orchiectomy and lymph node dissection, which he reports was negative for malignancy. He has had annual urology follow-up with "tumor markers," chest and abdominal x-rays. You request his medical records and note that his testicular cancer was a stage 1 nonseminomatos tumor with negative lymph nodes.
-Is he at risk for other cancers?

A) Yes. Personal history of cancer increases risk for other cancers.
B) No, he is cured.

Question 10

32-year-old male computer program recently relocated to the Bay Area here to establish care with you. He has a history of depression, alcoholism (in recovery for 10 years without relapse), and testicular cancer at age 28, s/p a right orchiectomy and lymph node dissection, which he reports was negative for malignancy. He has had annual urology follow-up with "tumor markers," chest and abdominal x-rays. You request his medical records and note that his testicular cancer was a stage 1 nonseminomatos tumor with negative lymph nodes.
-How often should he see his oncologist?

A) Every 6 months until 5 years then yearly visits
B) Every 3 months for the first 2 years, then every 6 months for 2 years, then annually
C) Yearly
D) No need for oncology. He can be followed in primary care.