Today's Practice: Changing the Business of Medicine National Edition Q1 2018 | Page 46

P R A CT I CE M A NA GE M E NT Cancer Survivorship sleep disturbance in patients with breast and pros- tate cancer. Caffeine intake and review of medica- tions including supplements should be done. Coping strategies including relaxation techniques and meditation have been helpful. Patient with chronic symptoms should be referred to sleep specialist for sleep studies. There is no current evidence to support the use of weight loss supplements and cancer survival. Patient should be screened for vitamin deficiencies based on their cancer treatment and these deficien- cies should be corrected interpreted as needed. Vitamin D replacement for adequate bone health is consider it in many cancer survivors. Healthy Lifestyles Cancer survivors should be encouraged to achieve and maintain healthy weight to improve overall health and quality of life. In some cancers, this has been associated with reduced risk of cancer related death and risk of recurrence. Patient should be encouraged to engage in physical activity regularly and to maintain a healthy body weight throughout life. At least 150 minutes of moderate or 75 min- utes of vigorous activity per week should be done spread out over the course of the week. Two to three sessions per week of strength training including major muscle group should be done. Stretching of major muscle groups on a regular basis is helpful as well. Immunizations Use of inactivated vaccines is considered safe in most cancer survivors. Vaccination schedules can be reviewed at CDC website. Certain cancer vaccine such as live attenuated viruses are contraindicated in actively immunosuppressed individuals specifically in survivors with lympho- ma and other malignant neoplasm affecting bone marrow or lymphatic system or history of immune deficiency. Vaccine should ideally be administered approximately two or more weeks before cancer treatment and three or more months after cancer chemotherapy. Inactivated influenza vaccine can be administered during cancer treatment. Live virus vaccines can be administered for two more weeks before cancer treatment or three or more months after chemo- therapy is completed. In patients who receive anti-B cell antibody therapy, vaccination should be delayed for at least six months after therapy. Patients with hematopoietic stem cell transplants need special guidance from their transplant physi- cians on timing and safety of vaccinations. Nutrition habits should be discussed and reviewed regularly. Calorie intake is helpful in maintaining a healthy BMI. “Prudent diet “has been associated with reduced risk of cancer recurrence.” Limited intake of red or processed meat, and it is recom- mended to use lean proteins like poultry, fish, legume, low-fat dairy and nuts. Fat sources such as olive or canola oil, avocados, nuts and fatty fishes are encouraged. Fruits, vegetables, whole grains and legumes should be the main source of carbohy- drates. Fat should be no more than 20 to 35% of total intake, with saturated fat being less than 10% and trans fat less than 3%. Carbohydrate should be 45 to 65% of dietary intake with high intakes of fruit, vegetables and whole grains. Protein should contribute 10 to 35% of total intake with the goal of 0.8 grams per kilogram. 45 Manpreet Chadha, MD Screening for other cancers Routine surveillance for cancer recurrence is typically done per US preventive task force guide- lines for all cancer survivors. However second cancers can be noted in cancer survivors at higher rate than in general population because of genetic susceptibility like cancer syndromes, common predisposing factors like smoking, obesity and carcinogen exposures and/or mutagenic effects of cancer treatment (like secondary leukemia). TODAY ’ S P R A C T I C E: C H A N G I N G T H E B U S INES S OF M EDI C I NE