Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.
PoCoG and CeMPED, School of Psychology SoURCe, Institute of Surgery, University of Sydney, Sydney, NSW, Australia.
Lancet. 2022 Apr 16;399(10334):1537-1550. doi: 10.1016/S0140-6736(22)00242-2.
Improvements in early detection and treatment have led to a growing prevalence of survivors of cancer worldwide. Models of care fail to address adequately the breadth of physical, psychosocial, and supportive care needs of those who survive cancer. In this Series paper, we summarise the evidence around the management of common clinical problems experienced by survivors of adult cancers and how to cover these issues in a consultation. Reviewing the patient's history of cancer and treatments highlights potential long-term or late effects to consider, and recommended surveillance for recurrence. Physical consequences of specific treatments to identify include cardiac dysfunction, metabolic syndrome, lymphoedema, peripheral neuropathy, and osteoporosis. Immunotherapies can cause specific immune-related effects most commonly in the gastrointestinal tract, endocrine system, skin, and liver. Pain should be screened for and requires assessment of potential causes and non-pharmacological and pharmacological approaches to management. Common psychosocial issues, for which there are effective psychological therapies, include fear of recurrence, fatigue, altered sleep and cognition, and effects on sex and intimacy, finances, and employment. Review of lifestyle factors including smoking, obesity, and alcohol is necessary to reduce the risk of recurrence and second cancers. Exercise can improve quality of life and might improve cancer survival; it can also contribute to the management of fatigue, pain, metabolic syndrome, osteoporosis, and cognitive impairment. Using a supportive care screening tool, such as the Distress Thermometer, can identify specific areas of concern and help prioritise areas to cover in a consultation.
早期检测和治疗的改进导致全球癌症幸存者的比例不断增加。护理模式未能充分解决癌症幸存者身体、心理社会和支持性护理需求的广泛性。在本系列论文中,我们总结了管理成年癌症幸存者常见临床问题的证据,以及如何在咨询中涵盖这些问题。回顾癌症病史和治疗情况突出了潜在的长期或迟发性影响需要考虑,并建议进行复发监测。特定治疗的身体后果包括心脏功能障碍、代谢综合征、淋巴水肿、周围神经病和骨质疏松症。免疫疗法会引起特定的免疫相关影响,最常见于胃肠道、内分泌系统、皮肤和肝脏。应筛查疼痛,并需要评估潜在的原因和非药物和药物管理方法。常见的心理社会问题,如对复发的恐惧、疲劳、睡眠和认知改变,以及对性和亲密关系、财务和就业的影响,都有有效的心理治疗方法。需要审查包括吸烟、肥胖和饮酒在内的生活方式因素,以降低复发和第二癌症的风险。锻炼可以提高生活质量,并可能改善癌症的生存情况;它还可以有助于管理疲劳、疼痛、代谢综合征、骨质疏松症和认知障碍。使用支持性护理筛查工具,如痛苦温度计,可以确定具体的关注领域,并帮助确定咨询中需要涵盖的领域。
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