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Care after cancer: U program supports survivors' unique health concerns for a lifetime

Daniel Mulrooney, M.D., and Anne Blaes, M.D., lead the University-affiliated long-term cancer survivorship clinics. (Photo: Scott Streble)

Taryn Lambrecht, M.D., took note of her patient’s symptoms. The 30-something woman felt unusually tired and sluggish, and she’d gained some weight. Her muscles and joints ached.

Lambrecht, a primary care physician at Allina Woodlake Medical Clinic in Richfield, didn’t have to reach far to surmise what was going on. Because the patient had been treated for Hodgkin’s lymphoma 10 years earlier, she faced an increased risk for hypothyroidism.

This was one of the potential late complications of being treated with head and neck radiation, as described in a report Lambrecht received from the Long-Term Follow-Up Clinic at the University of Minnesota Masonic Cancer Clinic. Three of her patients are cancer survivors who visit the follow-up clinic for annual checkups.

“I receive a comprehensive medical summary of a patient’s diagnosis and treatment, any complications of treatment, and a nice outline of long-term management” for these patients, Lambrecht says. For example, she says, women who received chest radiation for childhood cancer are screened for breast cancer starting at a much younger age than other women.

More survivors, new research

The number of people who defeat cancer has increased significantly since the 1970s. Today, about 67 percent of adults and 77 percent of children diagnosed with cancer live at least five more years, according to the National Cancer Institute.

As cancer therapies improve and the population ages, the number of survivors is expected to grow. That’s why researchers across the country are devoting more attention to long-term outcomes and quality of life—which University researchers have been tracking for nearly 30 years.

Whether cancer strikes a child or an adult, the disease and its treatment can lead to a variety of long-term complications or “late effects.”

Nearly every organ system may be affected by treatments such as chemotherapy and radiation, notes Daniel Mulrooney, M.D., who directs the Long-Term Follow-Up Clinic’s childhood cancer program.

Complications may include heart, lung, bone, thyroid, and fertility problems, as well as an increased risk of a second cancer. Cancer survivors also may experience emotional, psychological, or social challenges, such as readjustment to school or work, anxiety or depression, and learning disabilities.

Kim Robien, Ph.D. As a pioneer in the field of cancer survivorship—thanks in part to the longtime support of Children’s Cancer Research Fund—the University’s Masonic Cancer Center serves as an important resource for both survivors and the medical community. The Cancer Outcomes and Survivorship Program is advancing the field through studies of everything from the basic biology of how late effects occur to prevention of cardiovascular complications in patients receiving a particular type of chemotherapy.

The latest findings are put into practice at the Long-Term Follow-Up Clinic. First established in 2005 for survivors of childhood cancer, the clinic expanded its services in 2008 to those who survived cancer as adults.

Both Mulrooney and Anne Blaes, M.D., director of the adult clinic, also conduct clinical studies focused on improving long-term outcomes for all cancer survivors.

Knowing what to watch for

Any cancer survivor, regardless of where he or she received initial cancer treatment, can make an appointment at the Long-Term Follow-Up Clinic. A typical visit includes a physical exam and counseling about recommended screening for possible long-term complications. Patients may also meet with a social worker, and some receive a neuropsychological assessment to check for memory problems or cognitive impairment.

After the visit, the patient receives a detailed treatment record and summary of recommendations. The report also goes to the person’s primary care doctor.

“Our goal is not to take patients away from the primary care physician, but to make sure the patient gets appropriate care,” says Blaes.

Lambrecht points out that primary care physicians often are the first to hear of a potential problem. “When patients aren’t feeling well, they’re not likely to go to their oncologist; they’re more likely to go to their primary care physician.”

Daniel Albright, M.D., an internal medicine/pediatric physician at Park Nicollet Clinic, relies on the University-affiliated follow-up clinic to understand the “maintenance issues” of his patients who’ve had cancer. “The blessing of our advances is that people are surviving and living better lives, but they need different care and different screening,” Albright says. “Awareness is important for physicians and patients.”

Educating survivors and providers

The Masonic Cancer Center hosts an annual conference for survivors. And this year the center, in collaboration with the Minnesota Cancer Alliance, will hold its first-ever survivorship conference for health professionals.

It’s designed to help bridge the “odd transition” survivors may experience when moving from cancer care back to general health care in the community, says Kim Robien, Ph.D., a cancer epidemiologist with the Masonic Cancer Center.

“Sometimes patients feel abandoned at that time,” she says.

Internal medicine and family medicine providers often are in the best position to track chronic disease issues in survivors, Robien says. “How do we exchange information so that cancer survivors get the best care going forward? We’re trying to encourage a team approach to making that happen.”

Learn More

Long-Term Follow-Up Clinic at the Masonic Cancer Clinic

For more information, visit www.umphysicians.umn.edu/Clinics/long-term-follow-up-clinic or call 612-672-7422.

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