AOCNP Survivorship and Long-Term Follow-Up 5 — Questions and Answers
Question 1: A male survivor of testicular cancer treated with bleomycin reports progressive dyspnea and a dry cough. Pulmonary function testing reveals reduced DLCO. The most likely etiology is:
- Cisplatin-induced pulmonary fibrosis
- Bleomycin-induced pulmonary toxicity (Correct answer)
- Radiation pneumonitis from abdominal field
- Etoposide hypersensitivity reaction
Correct answer: Bleomycin-induced pulmonary toxicity
Bleomycin is well-known for causing pulmonary fibrosis, characterized by reduced DLCO and restrictive ventilatory defects as a late toxicity.
Question 2: A survivor of colorectal cancer asks about surveillance colonoscopy timing. According to ASCO guidelines, when should the first post-treatment colonoscopy be performed after curative resection?
- 6 months post-surgery
- 1 year post-surgery (Correct answer)
- 2 years post-surgery
- 5 years post-surgery
Correct answer: 1 year post-surgery
ASCO recommends a colonoscopy 1 year after curative resection of colorectal cancer to detect metachronous lesions.
Question 3: A breast cancer survivor on long-term tamoxifen therapy is at increased risk for which gynecologic late effect requiring surveillance?
- Cervical dysplasia
- Endometrial cancer (Correct answer)
- Ovarian cysts
- Vaginal intraepithelial neoplasia
Correct answer: Endometrial cancer
Tamoxifen's partial estrogen agonist activity on the uterine endometrium increases the risk of endometrial cancer, requiring vigilance for abnormal uterine bleeding.
Question 4: In a survivor who received cisplatin-based chemotherapy, which audiologic late effect should the AOCNP specifically monitor for during follow-up?
- Central auditory processing disorder
- High-frequency sensorineural hearing loss (Correct answer)
- Conductive hearing loss
- Tinnitus with normal audiogram
Correct answer: High-frequency sensorineural hearing loss
Cisplatin-induced ototoxicity typically manifests as high-frequency sensorineural hearing loss that can be permanent and progressive.
Question 5: A 10-year survivor of breast cancer presents with arm swelling, heaviness, and pitting edema after a recent air travel. The MOST likely diagnosis is:
- Deep vein thrombosis
- Lymphedema (Correct answer)
- Cellulitis
- Radiation fibrosis
Correct answer: Lymphedema
Lymphedema is a common late effect following axillary lymph node dissection and/or radiation, and can be triggered or worsened by air travel.
Question 6: When addressing return-to-work concerns in cancer survivors, which factor is MOST strongly associated with successful reintegration into the workforce?
- Having a desk job rather than manual labor
- Employer flexibility and workplace accommodation (Correct answer)
- Completion of chemotherapy over radiation
- Age under 40 at time of diagnosis
Correct answer: Employer flexibility and workplace accommodation
Workplace accommodation and employer flexibility, including modified duties and flexible scheduling, are the strongest predictors of successful return to work for cancer survivors.
Question 7: A survivor reports persistent fear of cancer recurrence (FCR) that impairs daily functioning 3 years post-treatment. The FIRST-LINE psychological intervention recommended by oncology guidelines is:
- Long-term benzodiazepine therapy
- Cognitive behavioral therapy (CBT) (Correct answer)
- Peer support groups only
- Watchful waiting for spontaneous resolution
Correct answer: Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy is the most evidence-based psychological intervention for clinically significant fear of cancer recurrence in survivors.
AOCNP Survivorship and Long-Term Follow-Up 5
A male survivor of testicular cancer treated with bleomycin reports progressive dyspnea and a dry cough.
Pulmonary function testing reveals reduced DLCO.
The most likely etiology is: