Breast cancer survivors number more than 2,000,000 in the United States alone.1 Improvements in screening technology, increased uptake of screening, and advances in adjuvant therapy2 as well as the aging of the population are bound to lead to even greater numbers of breast cancer survivors over time. The Institute of Medicine report entitled From Cancer Patient to Cancer Survivor: Lost in Transition reported on the health, psychosocial, family, employment, and financial needs of survivors of cancer and provided recommendations for improving the quality of care and health outcomes of cancer survivors.3 Follow-up of the breast cancer survivor is one important aspect of survivorship care.
As described in preceding chapters, multimodality therapy of breast cancer is associated with acute side effects such as postoperative pain, skin toxicity from radiation, fatigue, alopecia, and anemia related to chemotherapy. As people recover from these effects, new issues requiring attention may arise (Table 98-1). The long-term and late effects of cancer and its treatment are addressed in other chapters of this section.
Table 98-1 Examples of Long-Term and Late Issues Among Breast Cancer Survivors ||Download (.pdf)
Table 98-1 Examples of Long-Term and Late Issues Among Breast Cancer Survivors
|Issues related to physical health after breast cancer and its treatment|
|Side effects of endocrine therapy|
|Risk of secondary cancers|
|Pregnancy after breast cancer|
|Disruption of cognitive function|
|Psychological and social aspects of survivorship|
|Concerns about recurrence|
|Impact of cancer on the family|
|Impact of cancer on employment and financial health|
Physicians who care for survivors of breast cancer—including surgeons, medical oncologists, radiation oncologists, primary care physicians, gynecologists, and mental health professionals— have the opportunity to address the concerns of breast cancer survivors and to intervene to improve functional status and quality of life. In addition, physical therapists, dieticians, sexual health therapists, and social work professionals provide care to survivors as described in earlier chapters. Coordinating the care of breast cancer survivors among multiple providers can itself become a challenge for patients. In addition, patients are often not clear about the purpose of follow-up care.4 Finally, the medical costs of breast cancer follow-up are substantial.5,6 In one study of 391 women, the average estimated costs per year per patient were $1800.6
There are several goals of scheduled follow-up care in breast cancer survivors7: detection and management of second primary breast cancers and locoregional breast cancer recurrences, detection and management of late and long-term effects of treatment, management of adjuvant endocrine therapy, recognition of genetic cancer syndromes, and promotion of healthy behaviors. Provision of information to survivors on the treatments they received and what they should expect during the months and years after treatment is important to achieve and preserve optimal health in survivors and their families.