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Breast Cancer Survivors: What Your PCP Needs to Know

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Breast Cancer Survivors
Breast Cancer Survivors

The Commission on Cancer has developed some new and very specific standards of care that cancer centers—if they want to receive their accreditation and be known as an NCI-designated cancer center—must follow.

These new standards are tied to survivorship care, and among them is the importance of demonstrating that the cancer center has given a treatment summary and a survivorship care plan to the cancer survivor. The rules further dictate that the cancer center must also send copies of these documents to your primary care physician (PCP). Why? Because the descriptions of your treatment and of the current plan for your care will provide much-needed guidance for both you and your PCP in how to monitor you going forward. These documents are meant to describe

  • how your physician can now monitor you for recurrence
  • how you can adopt healthier behaviors to reduce your risk of recurrence
  • how your screening and surveillance appointments will be arranged from now on

But these documents don’t get you completely off the hook. You will still need to inform your PCP about certain things that aren’t on these papers. Here are a few common bits of information that you might need to include in your discussions with your PCP during your annual or semi-annual visits:

Menopausal symptoms

Your menopausal symptoms are directly impacting your quality of life and, in order to get relief from them, you believe should be allowed to resume taking hormone replacement therapy (HRT) as you used to. HRT, however, will not be what is recommended nor should it be, since it can increase your risk of recurrence. Instead, you will be taught to use other methods—wearing cotton clothing in layers, avoiding spicy foods or very hot beverages, investing in a cool pillow that remains cool all night to reduce night sweats. The drug Effexor is a prescription that your doctor might decide to give you, since one of its side effects is the elimination of hot flashes. (Go figure.) Or, she might recommend something different. But, in any event, HRT is notthe solution.

Cancer in a first-degree relative

Your sister just got diagnosed with ovarian cancer. Oh my. When we see breast cancer and/or ovarian cancer diagnosed within a family on the same side of the family tree, that’s a red flag that an unsavory breast cancer gene might be at work. This revelation about your sister’s condition would then warrant a referral for both of you to see a genetics counselor. Though surveillance monitoring can be done for breast cancer, no such procedure has been perfected for ovarian cancer, so by the time symptoms appeared in your sister, it could actually be too late for her to have a chance of long-term survival.

You have gained 10 pounds since you last saw your PCP

You likely don’t have to tell her about this one, since her medical assistant weighed you when you came in the door. You will want to talk with her, however, about this new problem because it can impact your health in many ways—increasing risk of heart disease, diabetes, high blood pressure, and yes, the return of your cancer or even the appearance of a new primary cancer in another organ site. So work with her on an exercise and dietary program that you can live with, and remember that small changes over time are far more successful than trying to leap into a strict diet and an aggressive exercise program that you will not be able to sustain for more than a few weeks.

You’ve developed new aches and pains that you cannot explain

Once someone has had cancer, new symptoms can sometimes become guilty by association. Don’t assume, however, that the cancer is back and has spread. Your PCP will be able to determine if you need a referral back to your oncologist, if some x-rays need to be done, or if your discomfort is a late effect from the cancer treatment you had in the past. Some drugs and treatments may not manifest their late side effects until years later.

Vaccinations

We commonly go to our PCP when we don’t feel good, and we don’t go when we’re feeling fine. If this describes you, be sure to discuss with your PCP what vaccinations you need and when. If you aren’t able to take off from work to get them at her office, ask her if it’s okay to get them at your local pharmacy. Flu, shingles, and even the pneumonia shot are available all day and into the late evening at most chain-store pharmacies across the country.

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