Page 1689 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 93 Late Complications of Hematologic Diseases and Their Therapies 1507

PROVIDING CLINICAL CARE TO SURVIVORS TABLE
93.4 Comprehensive Treatment Summary
A summary of cancer treatment and a survivorship care plan are
critical components of care provision for survivors of hematologic Topic Specific Information to Include
malignancies (see box on Survivorship Care Plans). Guidelines for Demographics Name
long-term follow-up of survivors of hematologic malignancies and Record number or patient identification number
those who underwent HCT in childhood, adolescence, or young Date of birth
82
adulthood have been developed by the Children’s Oncology Group Sex
and are available at http://www.survivorshipguidelines.org; HCT Race or ethnicity
long-term follow-up guidelines have also been developed by an
83
international group of transplant experts. In order to provide risk- Diagnosis Date or age at diagnosis
based guideline-directed follow-up care, a comprehensive treatment Referring physician or institution
summary is needed (Table 93.4) and a copy should be given to each Treating physician or institution
survivor with instructions to share this information with all healthcare Presenting symptoms
providers. Survivors should undergo annual comprehensive, multi- Past medical history
disciplinary health evaluations (Fig. 93.1) with special attention to Family history (including cancer in first- or
the detection of potential late effects specific to the patient’s diagnosis second-degree relatives)
and treatment history (Table 93.5). Because certain late effects have Physical examination findings at presentation
prolonged asymptomatic intervals before becoming clinically evident Initial diagnostics (complete blood cell count,
(e.g., late-onset CHF as a result of anthracycline-induced cardiomy- chemistry panel, radiographic studies)
opathy), ongoing evaluation is important to identify and provide Diagnostic procedures (biopsies, cytologic
early intervention for these potential complications. Health educa- studies)
tion regarding potential health risks and risk-reduction measures Pathology (morphology, histology, cytochemistry,
should be provided to each survivor. Targeted health education flow cytometry)
materials related to potential late complications of therapy during Cytogenetics
childhood, adolescence, or young adulthood have been developed by Central nervous system status (if applicable)
305
the Children’s Oncology Group and are available at http://www. Stage (if applicable)
survivorshipguidelines.org. After completion of each annual evalua- Metastatic sites (if applicable)
tion, identified late effects should be systematically recorded, and Initial response to therapy (e.g., RER, SER,
recommendations for any additional testing and for health mainte- date first complete remission achieved)
nance and promotion should be shared with the patient and his or Relapse(s) dates, age at relapse(s), relapse
her primary healthcare provider. To optimize future follow-up care site(s)
for all survivors, patients should be invited to participate in any rel- Treatment Date of initial treatment (initiated and
evant research studies for which they are eligible (see box on Late completed)
Effects Research: What Is Needed). Date(s) for treatment of relapse (initiated and
completed)
Final off-therapy date
FUTURE DIRECTIONS Chemotherapy agents received, including route
of administration (list all)
2
Better understanding of treatment-related toxicity has not only Cumulative doses (in mg/m ) and age at
guided the design of less toxic therapies, but also the development of treatment for all alkylators, anthracyclines,
and heavy metals
Dose ranges for cytarabine and methotrexate
(e.g., standard dose vs. high dose >1000 mg/
2
m )
Survivorship Care Plans Radiation fields, doses, shielding, age at
treatment
Survivorship care plans have been identified by the Institute of Medi- Surgical procedure(s)
cine 309,310 as an important tool to facilitate follow-up care. Survivorship Transfusion(s), including all blood or serum
care plans should include both a summary of cancer treatment and a
follow-up plan that can be used to enhance communication between products
care providers, coordinate care, and encourage health monitoring and Stem cell transplantation(s), including donor
promotion. 306 Specific elements of the survivorship care plan should source, preparative regimen, GVHD
include: prophylaxis or treatment
• Diagnosis, including histologic subtype and stage if relevant. Acute complications Significant therapy-related complications (e.g.,
• Contact information for all cancer care providers and institutions
where care was received. tumor lysis, septic shock, typhlitis, acute
• Surgical procedure(s) with dates. GVHD)
• Chemo/biotherapy drugs received and completion dates for each. Significant treatment required for complications
• Radiation treatment dates with anatomical area(s) treated. (e.g., hemodialysis, amphotericin,
• Ongoing toxicities or treatment side effects. aminoglycosides)
• Genetic/hereditary risk factors or predisposing conditions, if Complications after Significant complications after completion of
relevant, including genetic testing results if performed.
• List of potential late and/or long-term effects. therapy therapy (e.g., herpes zoster, acute life-
• List of possible symptoms of cancer recurrence and surveillance threatening infection after splenectomy)
testing schedule. GVHD, Graft-versus-host disease; RER, rapid early response; SER, slow early
• Follow-up visit schedule, including who will provide care, and response.
schedule of recommended screening/testing as indicated. Modified from Children’s Oncology Group Summary of Cancer Treatment, 2013.
• Recommendations regarding general health maintenance/ http://www.survivorshipguidelines.org
promotion.
• Information regarding common survivorship issues (e.g.,
emotional, financial, work/employment).