AOCNP Survivorship and Long-Term Follow-Up 2

Question 1

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

Accepted Answer

Premature ovarian insufficiency (POI) / chemotherapy-induced menopause

Answer

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.

Question 2

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

Accepted Answer

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

Answer

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.

Question 3

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

Accepted Answer

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

Answer

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.

Question 4

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

Accepted Answer

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

Answer

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.

Question 5

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

Accepted Answer

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

Answer

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.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Survivorship and Long-Term Follow-Up 2