Case Study

Screening

Diagnosis

Treatment

Survivorship

Diagnosis•Stage IIIA ER+ HER2- Cancer of the Left Breast

Screening

Diagnosis

Treatment

Survivorship

Treatment•Left mastectomy with bilateral DIEP reconstruction

•Right prophylactic mastectomy and left axillary node dissection

•Chemotherapy Taxol/Carbo

•Antihormonal Therapy 5 years

Screening

Diagnosis

Treatment

Survivorship

12 months later…

•Range of motion complications <30%

•Chronic discomfort 54%

•Infertility <50%

•Cardiovascular disease <30%

•Lymphedema 15-20%

•Chronic fatigue 99%

•Anxiety & depression >70%

•Financial burden 43%

Screening

Diagnosis

Treatment

Survivorship

Distress Screening•If additional information was obtained…

•Marital status

•Employment history

•Personal history

•Family history

Screening

Diagnosis

Treatment

Survivorship

Survivorship Program

Screening

Diagnosis

Treatment

Survivorship

•Distress Screening

•Multidisciplinary Team

•Transitions consult

•Surveillance

Key PlayersGenetic

Counseling •Family history

Rehab •Rotator cuff issues

Medical Oncology

•Neoadjuvantchemotherapy

Plastic Surgery

•Staged reconstruction

Fertility •Family planning

Cardiology •Vessel salvage

Elements of Success•Maintained range of motion

•Fertility preserved

•Successful CABG

•Improved fatigue

•No radiation effects

•No chronic pain

•Ability to work

•Survivor mentor

Screening

Diagnosis

Treatment

Survivorship

Multidisciplinary Team

Communication is key!

Transitions Consult•Education

•Health promotion

•Surveillance

•Care plan & treatment summary

•Support services

Screening

Diagnosis

Treatment

Survivorship

12 months later…•Anxiety

•Difficulties at work

•Body image

•Sexual dysfunction

•Coping mechanisms

•Fear of recurrence

Screening

Diagnosis

Treatment

Survivorship

What can be done?•Patient education

•Physician communication

•Psychosocial support

•Health promotion

THANK YOU