Page 1690 - Hematology_ Basic Principles and Practice ( PDFDrive )

1508 Part VIII Comprehensive Care of Patients with Hematologic Malignancies

Comprehensive treatment
summary prepared
potential health risks
identified

Pre-clinic conference
screening and follow-up
recommendations prepared
by multidisciplinary team

Clinical interventions Multidisciplinary Patient education
as indicated clinical evaluation as indicated

Visit summary with
Specialty referrals diagnostic results and Diagnostic
as indicated recommendations evaluations
prepared and mailed as indicated
to patient and primary
healthcare provider

Fig. 93.1 ANNUAL COMPREHENSIVE MULTIDISCIPLINARY HEALTH EVALUATION FOR THE
CANCER SURVIVOR.

TABLE Monitoring for Potential Late Effects
93.5
Potential Late Effects Therapeutic Exposure Recommended Monitoring Suggested Interventions
Adverse psychosocial Diagnosis and treatment for Clinical interview: yearly Psychologic or social work consultation if
effects (e.g., hematologic malignancy indicated
depression, anxiety,
posttraumatic stress
disorder, limitations in
healthcare access,
risky behaviors,
psychosocial disability
due to pain, fatigue)
Dental abnormalities Chemotherapy Dental examination: every 6 months Professional dental cleaning every 6
(abnormal tooth Cranial irradiation months; use of fluoridated toothpaste;
development, TBI topical fluoride applications as
increased indicated; Panorex radiograph before
susceptibility to caries orthodontic or dental procedures for
and gum disease) patients treated before completion of
tooth development
Peripheral neuropathy Vincristine Neurologic examination if symptomatic Physical therapy if indicated; advise
Raynaud phenomenon Vinblastine patient to protect against precipitating
factors (e.g., cold environment)
Neurocognitive deficits Methotrexate (intrathecal, Formal neuropsychologic testing: baseline Referral for specialized educational
high-dose systemic) on entry to long-term follow-up; repeat services, curricular modifications, or
Cytarabine (high-dose systemic) as clinically indicated if evidence of vocational training programs if
Cranial irradiation impaired performance indicated
TBI Clinical interview yearly, including
assessment of educational and
vocational progress