AOCNP Survivorship and Long-Term Follow-Up 4 — Questions and Answers
Question 1: A breast cancer survivor treated with doxorubicin 5 years ago presents with dyspnea on exertion and reduced ejection fraction. Which screening tool is most appropriate for ongoing cardiac surveillance?
- Annual ECG only
- Echocardiogram every 1-2 years (Correct answer)
- Stress test every 6 months
- Serum troponin level annually
Correct answer: Echocardiogram every 1-2 years
Echocardiogram is the preferred method for surveillance of anthracycline-induced cardiomyopathy in long-term survivors.
Question 2: A 45-year-old male survivor of Hodgkin lymphoma treated with mantle field radiation is at highest risk for which late effect?
- Hepatocellular carcinoma
- Coronary artery disease (Correct answer)
- Renal cell carcinoma
- Colorectal cancer
Correct answer: Coronary artery disease
Mantle field radiation exposes the heart and great vessels, significantly increasing the risk of coronary artery disease as a late effect.
Question 3: Which survivorship intervention has the strongest evidence for reducing cancer-related fatigue in post-treatment survivors?
- High-dose vitamin D supplementation
- Aerobic exercise programs (Correct answer)
- Scheduled daytime napping
- Pharmacologic stimulants as first-line
Correct answer: Aerobic exercise programs
Aerobic exercise is the most evidence-based non-pharmacologic intervention for reducing cancer-related fatigue in survivors.
Question 4: A survivor of childhood ALL treated with high-dose methotrexate presents with learning difficulties and memory problems. This neurocognitive late effect is best described as:
- Peripheral neuropathy
- Leukoencephalopathy (Correct answer)
- Ototoxicity
- Radiation necrosis
Correct answer: Leukoencephalopathy
High-dose methotrexate and cranial radiation can cause leukoencephalopathy, manifesting as neurocognitive deficits including memory and learning impairment.
Question 5: Under the Affordable Care Act, insurance companies are prohibited from denying coverage to cancer survivors based on:
- Income level
- Pre-existing conditions (Correct answer)
- Geographic location
- Employment status
Correct answer: Pre-existing conditions
The ACA prohibits insurers from denying coverage or charging higher premiums based on pre-existing conditions, including a history of cancer.
Question 6: A female survivor of pelvic radiation for cervical cancer reports vaginal dryness and dyspareunia. The MOST appropriate first-line intervention is:
- Systemic hormone replacement therapy
- Topical vaginal estrogen cream (Correct answer)
- Vaginal dilator use alone
- Referral to pelvic floor physical therapy only
Correct answer: Topical vaginal estrogen cream
Topical vaginal estrogen is the first-line pharmacologic treatment for genitourinary syndrome of menopause in gynecologic cancer survivors, with minimal systemic absorption.
Question 7: Which component is REQUIRED in a comprehensive survivorship care plan according to ASCO guidelines?
- Genetic testing results for all family members
- Summary of treatments received and schedule for recommended follow-up (Correct answer)
- Employment history during treatment
- Insurance coverage details
Correct answer: Summary of treatments received and schedule for recommended follow-up
ASCO mandates that survivorship care plans include a treatment summary and a follow-up care plan outlining surveillance schedules and management of late effects.
AOCNP Survivorship and Long-Term Follow-Up 4
A breast cancer survivor treated with doxorubicin 5 years ago presents with dyspnea on exertion and reduced ejection fraction.
Which screening tool is most appropriate for ongoing cardiac surveillance?