GU cancer

Lifelong follow-up recommended for survivors of gynaecological cancer

The Gynecologic Cancer InterGroup (GCIG) has provided a practical long term survivorship care plan for GPs, gynaecologists and other health professionals supporting women after cervical, vulvar, ovarian and endometrial cancer.

The plan is included in a consensus guideline and position paper developed by the GCIG symptom benefit committee which included members of the Australia New Zealand Gynaecological Oncology Group (ANZGOG) .

The statement, published in Cancer Treatment Reviews, recognises that the numbers of gynecological cancer survivors are increasing due in part to treatment advances in ovarian cancer which traditionally had poor outcomes and the increasing incidence of endometrial cancer.

It said about 50% of gynecological cancer survivors experience lingering health concerns and long-term side effects including neurologic symptoms, sleep disturbance, fatigue, sexual dysfunction, bowel and urinary problems, menopausal symptoms, osteoporosis and lymphedema.

In addition, it said women require lifelong follow up for their gynecological cancer as well as secondary and new primary cancers.

“Beyond the recognised long term issues associated with systemic chemotherapy, including hypertension, renal impairment and neuropathy, future attention should also be given to long term assessment of toxicity of the newer targeted therapies such as PARP-inhibitors (i.e. myelodysplastic syndrome, leukemia) and checkpoint inhibitors (endocrinopathies such as diabetes and hypothyroidism),” the statement said.

Coauthor and ANZGOG representative Dr Yeh Chen Lee told the limbic that women tolerated many symptoms during their treatment as “part of the deal”.

However, including the wide range of potential long term side effects on the plan’s checklist gave women permission to raise uncomfortable topics such as pelvic pain with their doctors.

Chronic pain affects one third of survivors and is often associated with poor quality of life, the consensus said.

“Now with better treatments we should concentrate on how to minimise toxicity and act on it with early intervention. For example, there is a lot of supportive care data coming through with acupuncture, increased activity and improved diabetes management to minimise neuropathy,” Dr Lee said.

The consensus recommended lifestyle counselling to maintain women’s general health and the offer of psychological counselling to manage mental health concerns including the fear of cancer recurrence.

Dr Lee, a medical oncologist at the Prince of Wales Hospital and Royal Hospital for Women and senior research fellow at the University of Sydney’s NHMRC Clinical Trials Centre, said GPs and other specialists weren’t expected to keep up to date with all the evidence within an area of subspecialisation.

The consensus and survivorship care plan however provided the clarity and documentation to help make caring for patients easier, especially after the first few years of intensive oncology follow-up.

“It has been a very strong joint effort among doctors as well as patient survivors. The document has been reviewed by the consumer research panel at ANZGOG to make sure it is relevant and meaningful for them.”

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