AOCNP Survivorship and Long-Term Follow-Up 1 — Questions and Answers
Question 1: According to the ONCC AOCNP framework, survivorship care planning begins at which point in the cancer continuum?
- Only after the patient is declared cancer-free
- At the time of diagnosis and continues throughout treatment and beyond (Correct answer)
- After 5 years of disease-free survival
- Only when the patient transitions off active treatment
Correct answer: At the time of diagnosis and continues throughout treatment and beyond
The Institute of Medicine (2006, 'From Cancer Patient to Cancer Survivor') established that survivorship care begins at diagnosis. The survivorship care plan (SCP) should be developed throughout treatment and provided at treatment completion to guide ongoing surveillance and late effect management.
Question 2: Chemotherapy-induced peripheral neuropathy (CIPN) most commonly occurs with which drug class?
- Anthracyclines (doxorubicin)
- Platinum compounds (oxaliplatin, cisplatin) and taxanes (paclitaxel) (Correct answer)
- Alkylating agents (cyclophosphamide)
- Topoisomerase inhibitors (irinotecan)
Correct answer: Platinum compounds (oxaliplatin, cisplatin) and taxanes (paclitaxel)
CIPN predominantly affects the peripheral sensory (and less commonly motor) nerves and most commonly results from platinums (particularly oxaliplatin causing acute cold dysesthesia and chronic sensory loss) and taxanes (paclitaxel causing dose-dependent sensory neuropathy). Vinca alkaloids primarily cause motor neuropathy.
Question 3: Aromatase inhibitor (AI)-induced arthralgias affect a significant percentage of breast cancer survivors. Which intervention has the strongest evidence for relieving AI-associated musculoskeletal symptoms?
- Opioid analgesics scheduled around the clock
- Aerobic and resistance exercise programs (Correct answer)
- Switching to a different aromatase inhibitor as the first intervention
- Routine NSAIDs scheduled daily
Correct answer: Aerobic and resistance exercise programs
Exercise interventions, both aerobic and resistance training, have the strongest evidence base for reducing AI-associated arthralgia severity and improving functional status in breast cancer survivors. Physical therapy and acupuncture also have supporting evidence. Vitamin D optimization is also recommended.
Question 4: Post-treatment surveillance guidelines for breast cancer survivors typically include clinical examination every 3–6 months for the first 3 years, then annually, combined with:
- Annual PET/CT scan
- Annual mammography of remaining breast tissue (Correct answer)
- Annual CA 15-3 serum marker measurement
- Semi-annual CT chest/abdomen/pelvis
Correct answer: Annual mammography of remaining breast tissue
ASCO and NCCN surveillance guidelines for breast cancer survivors recommend annual mammography as the primary imaging tool, along with clinical history and physical examination. Routine tumor markers (CA 15-3, CA 27-29) and CT/bone scans are NOT recommended for asymptomatic survivors due to lack of survival benefit and harms of overdiagnosis.
Question 5: Cancer-related cognitive impairment (CRCI or 'chemo brain') is characterized by which cluster of symptoms?
- Frank dementia with loss of long-term memory
- Subtle deficits in memory, attention, processing speed, and executive function (Correct answer)
- Severe aphasia and motor dysfunction
- Psychosis and personality changes
Correct answer: Subtle deficits in memory, attention, processing speed, and executive function
CRCI (chemotherapy-related cognitive changes/chemo brain) presents as subjective and objective deficits primarily in attention, working memory, processing speed, and executive function. It is distinct from dementia and may be subtle but significantly impacts quality of life and occupational function. Assessment tools include FACT-Cog.
Question 6: Which organization provides the standardized Survivorship Care Plan template most widely recommended by oncology professional bodies?
- CDC (Centers for Disease Control)
- ASCO (American Society of Clinical Oncology) (Correct answer)
- ONCC (Oncology Nursing Certification Corporation)
- NCCN (National Comprehensive Cancer Network)
Correct answer: ASCO (American Society of Clinical Oncology)
ASCO developed and promotes use of the Survivorship Care Plan, which includes treatment summary, surveillance schedule, late effects information, and resources. ASCO's Cancer Treatment and Survivorship Care Plans tool (based on IOM recommendations) is the most widely endorsed template.
AOCNP Survivorship and Long-Term Follow-Up 1
According to the ONCC AOCNP framework, survivorship care planning begins at which point in the cancer continuum?