Today's Practice: Changing the Business of Medicine National Edition Q1 2018 | Page 45

Cancer Survivorship
Manpreet Chadha, MD
crine dysfunction, family dysfunction, renal
dysfunction, anemia and arthritis should be assessed
thoroughly. Medications should be reviewed. Sleep
disturbances should be ruled out in contributing to
fatigue.
Loss of muscle mass has been associated with
deconditioning and fatigue in cancer patients.
Regular exercise including rebuilding exercise can
help attain a better muscle mass and reduce fatigue.
Adequate nutritional status should be encouraged.
Thyroid function and cortisol stimulation tests
should be done in relevant clinical scenario.
Pain
Pain is a common symptom in cancer patients and
survivors. New, acute pain points towards possibili-
ty of cancer recurrence. Neuropathy is one of the
most common pain symptoms that cancer patients
experience and is usually related to prior chemo-
therapy used specifically with taxanes and platinum
based regimens.
Non opioids are the most common medications
reviewed used for such pain syndrome. Use of
gabapentin and pregabalin is commonly done for
neuropathic pain. Duloxetine is also used for man-
agement of neuropathy pain. Opiods should be
reserved for refractory cases with use of lowest
appropriate dose and for shortest duration of time.
Patient with chronic pain may be well managed by
a pain specialist team. Physical therapy for desensi-
tization and cognitive therapy may help patients
with post radical neck dissection syndrome. Botuli-
num injections may be helpful for such patients.
Post mastectomy or post thoracotomy syndromes
can be managed with use of intercostal nerve
blocks. Use of non-pharmacological measures like
physical activity, heat /cold pack, aquatic therapy,
ultrasonic stimulation, massage, acupuncture, and
yoga have been explored for same.
Lymphedema
Lymphedema is commonly noted in patients have
had lymph node dissection and radiation for
various different cancers. Referal to lymphedema
specialist if available should be done early on in
the course. Compression garments like compres-
sion sleeves or stockings should be considered.
Progressive resistance training is helpful for reduc-
tion in lymphedema.
Sleep disorders
Lack of sleep and excessive sleepiness are both
noted in patients with cancer survivors. Sleep
disturbances can be attributed to other comorbidi-
ties like alcohol or substance abuse, cardiac
dysfunction, respiratory disorder, anemia and iron
deficiency, emotional distress or psychiatrist disor-
der. Hot flashes are the common symptoms of
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