Survivorship and Long-Term Follow-Up Flashcards

A female cancer survivor treated with cyclophosphamide-based chemotherapy reports amenorrhea and hot flashes. These symptoms are most likely related to:

Answer: Premature ovarian insufficiency (POI) / chemotherapy-induced menopause

Alkylating agents (cyclophosphamide, ifosfamide) and platinum compounds are the most gonadotoxic chemotherapy drugs, causing premature ovarian insufficiency (POI) in premenopausal women through direct destruction of primordial follicles. POI manifests as amenorrhea, vasomotor symptoms, infertility, sexual dysfunction, and accelerated bone loss.

Bone health surveillance is especially critical for which category of cancer survivors?

Answer: Survivors receiving androgen deprivation therapy (ADT) or aromatase inhibitors long-term

Prolonged ADT (prostate cancer) and aromatase inhibitors (breast cancer) cause significant bone mineral density loss. DEXA scans, calcium/vitamin D supplementation, weight-bearing exercise, and bisphosphonate/denosumab therapy are indicated based on FRAX score and T-score to prevent fragility fractures.

Lymphedema education for breast cancer survivors should include which key preventive behaviors?

Answer: Avoid venipuncture and blood pressure measurement in the affected arm, practice skin care, and report early swelling

Lymphedema prevention education includes avoiding injury, infections, and constriction of the affected extremity; practicing meticulous skin care; avoiding venipuncture/BP cuffs in the affected arm; wearing compression garments for air travel and strenuous activity; and reporting new or worsening swelling promptly for early intervention.

Secondary malignancy risk is particularly elevated in survivors who received which type of treatment?

Answer: Alkylating agents and/or radiation therapy, which increase risk of therapy-related MDS/AML and solid tumors

Alkylating agents (cyclophosphamide, nitrogen mustard, melphalan) and topoisomerase II inhibitors cause therapy-related myelodysplastic syndrome (t-MDS) and acute myeloid leukemia (t-AML). Radiation exposure increases risk of secondary solid tumors in the radiation field (sarcoma, breast cancer after chest RT, lung cancer). Lifelong surveillance is essential.

Fertility preservation counseling is a standard of care recommendation that should be offered:

Answer: To all patients of reproductive age BEFORE initiation of potentially gonadotoxic therapy

ASCO and NCCN guidelines mandate that fertility preservation options (oocyte cryopreservation, embryo cryopreservation, ovarian tissue cryopreservation, sperm banking) be discussed with all patients of reproductive age BEFORE initiating gonadotoxic therapy, with urgent referral to reproductive endocrinology when indicated.

The primary tool used to formally screen cancer survivors for distress at regular intervals is:

Answer: The NCCN Distress Thermometer and Problem List

The NCCN Distress Thermometer (DT) with the accompanying Problem List is the most widely used validated rapid distress screening tool in oncology. A score ≥4 on the 0–10 scale indicates clinically significant distress warranting psychosocial evaluation. It screens across practical, family, emotional, spiritual, and physical domains.