This guide was a review of previous literature by multidisciplinary experts. Based on 237 articles, this guide was drafted to guide primary care physicians and other healthcare providers on the care of breast cancer survivors.
The guidelines are recommended in five aspects: monitoring breast cancer recurrence, screening for second primary cancers, evaluating and managing the long-term and late effects of breast cancer and treatment on the body and mind, health promotion, and coordinated care/practical significance.
How to monitor breast cancer recurrence?
According to the survivor’s age, diagnosis, and the treatment plan recommended by the oncologist, individualized clinical follow-up care will be developed; for the first 3 years after the basic treatment, checkups will be conducted every 3-6 months, including cancer-related medical history, physical examination, and Breast examinations will be performed every 6-12 months for the next 2 years, and once a year thereafter.
- Screening for local recurrence of breast cancer or new breast cancer
Survivors of unilateral mastectomy or breast-conserving surgery undergo a mammography examination once a year; according to the ACS guidelines, only high-risk survivors who meet the increased breast cancer surveillance standards undergo breast MRI examination.
- Auxiliary examination
For asymptomatic survivors, other auxiliary examinations, including laboratory examinations and imaging examinations, are not performed except for mammography.
Primary care doctors should inform and educate survivors about the symptoms and signs of local recurrence, fully evaluate the patient’s family history of cancer; provide genetic counseling for women with potential genetic risk factors, such as the family history of cancer (breast, colon, endometrial), Or triple-negative breast cancer ≤60 years of age.
Screening for secondary primary cancer
Routine screening of other cancers for survivors; annual gynecological evaluation for postmenopausal women treated with selective estrogen receptor modulators.
Pay attention to the physical and mental health of breast cancer patients
1. Concern about body image
Fully evaluate the survivor’s attention to body image, provide appropriate equipment such as breast prosthesis, wig, etc. when necessary, and provide patients with surgery and/or psychological care when appropriate.
2. Lymphedema
Inform and educate patients on how to prevent and reduce lymphedema, including recommending overweight women to lose weight; for patients with lymphedema, we recommend experienced therapists, such as physical therapists, occupational therapists, or lymphedema specialists.
3. Cardiotoxicity
Monitor the blood lipid levels of survivors as a monitoring of the cardiovascular system; educate survivors to live a healthy lifestyle, inform them of potential heart disease risk factors, and inform health care providers when related symptoms (shortness of breath or fatigue) occur.
4. Cognitive impairment
Ask women some questions about cognition; assess reversible factors; choose the best possible treatment; conduct neurocognitive assessment and rehabilitation for survivors of cognitive impairment, including collective cognitive training.
5. Distress, depression, anxiety
Assess the depression and anxiety of survivors, especially for high-risk survivors, such as young survivors, past psychiatric history, low socioeconomic status, etc. Provide consultation and medicine for survivors, and recommend suitable oncologists and psychologists to patients.
6. Fatigue
Assess survivors’ fatigue and possible causes, such as anemia, thyroid dysfunction, and cardiac insufficiency. Treat the factors that may affect fatigue, such as fatigue, mood disorders, sleep disorders, pain, etc. It is recommended that survivors exercise regularly and, if appropriate, undergo cognitive behavioral therapy.
7. Bone health
Bone scans of postmenopausal survivors with dual-energy X-ray absorptiometry (DEXA) at baseline, and DEXA scans for survivors taking aromatase inhibitors every 2 years; taking tamoxifen and/or gonadotropins Premenopausal women with hormone-releasing hormone (GnRH) agonists, chemotherapy-induced women, and women with early menopause should also be tested.
8. Musculoskeletal health
Fully evaluate the survivors' musculoskeletal symptoms, including pain, and provide them with appropriate interventions, such as acupuncture, physical activity, physical therapy, or rehabilitation.
9. Pain and neuropathy
Fully evaluate the pain, and if necessary, use acetaminophen, non-steroidal anti-inflammatory drugs, exercise, acupuncture, and other interventions; refer to relevant experts, such as lymphedema experts, occupational therapists, etc., according to different causes of pain. Fully evaluate the neuropathy of survivors, especially symptoms such as numbness and tingling of hands and feet, and encourage patients to exercise. When appropriate, duloxetine can be used to treat neuropathic pain, numbness, and tingling.
10. Infertility
Survivors of infertility during childbearing age seek medical advice from a reproductive endocrinologist.
11. Sexual health
Assess the symptoms and signs of sexual dysfunction in survivors; evaluate and treat the reversible factors of sexual dysfunction; provide non-hormonal, water-based lubricants and vaginal dry moisturizers when appropriate; choose psychological education support, group therapy, and sex when appropriate Counseling, marriage counseling, or intensive psychotherapy, etc.
12. Menopause/hot flashes
Provide selective serotonin-norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, or gabapentin for early menopausal women with vasomotor symptoms; suggest that they change their lifestyle and living environment.
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