Moffitt Cancer Center Survivorship Program

1. Moffitt Cancer
Center Survivorship
Program
Smitha Pabbathi, MD, FACP

2. To provide consistent, evidence-base care to patients
living with, through and beyond a cancer diagnosis via
health promotion, education, rehabilitation, and early
intervention of late and long term side effects in
addition to surveillance care.
Purpose

3.  General Survivorship Clinic model
 924 unique patients
 55% breast, 25% GU and 3.7% GI
Background

4.  Dr. Bognar and Dr. Pabbathi
 Sonya Pflanzer PA
 Ione Townsend ARNP (colorectal
survivorship) at 0.6 FTE
Survivorship currently staffed by….

5.  Detailed treatment summary
 Care plan personalized to individual
a) long term late effects of treatment for their disease
b) Surveillance plan for recurrence
c) Surveillance for second primary
d) Comorbidities
e) Assess for distress and psychosocial needs
f) Healthy living
Survivorship Care Plan (SCP)

6.  ASCO template
 Meets Commission of Cancer standard 3.3 for
accreditation
 Endorsed by the Institute of Medicine
(2 copies given to patients along with resources
to share with PCP)
SCP

7.  Contact Information
 Medical Oncologist: Minton MD, Susan
 Medical Oncologist: Dr. Gaddis (Jacksonville, FL)
 Sullivan ARNP, Laurie
 Surgeon: SMITH MD, PAUL D
 Staging (ST):
 Breast cancer, right - 01/01/94
 General
 Cancer Type: Breast
 Pathologic Stage: I
 Primary Tumor (T)
 Primary Tumor (T) Pathologic: T1c
 Laterality: right
 Tumor Size: 1.2 cm
 Regional Lymph Nodes (N)
 Regional Lymph Nodes (N) Pathologic: N0
 Distant Metastasis (M)
 Distant Metastasis (M) Pathologic: M0
 TO OUR PATIENTS:This treatment summary is for the use of both the patient and health care
providers. You are being given a copy for your personal use, and to provide to outside
physicians who may be involved in your future care. Sometimes medical jargon can be
confusing or worrisome if you are not familiar with the terminology. If anything in this record
causes you concern or is inaccurate, be sure and bring this to the attention of your doctor or
nurse practitioner. Thank you for your participation in the Survivorship Clinic at the Moffitt
Cancer Center.
Survivorship Treatment Summary

8.  Surgery:
 1994: Patient underwent a lumpectomy and complete axillary lymph node dissection at an
outside facility for a 1.2-cm infiltrating ductal
 cancer with 14 negative lymph nodes.
 1999: Patient developed a second primary and underwent completion mastectomy at an
outside facility for an 8-mm residual invasive ductal cancer that was estrogen receptor
positive. At that time, she underwent tissue expander placement and eventual permanent
implant of the right breast. Additionally, she had a subcutaneous mastectomy on the left
side in the nipple areolar area while remaining intact as well as some breast tissue remaining
intact with an implant placed.
 02/2000: Total abdominal hysterectomy and bilateral salpingo-oophorectomy with cervix
intact performed at an outside facility.
 05/2007: Bilateral deep flap reconstruction and Bilateral nipple reconstruction.
 09/29/2008: Bilateral nipple areolar tattooing.
 Chemotherapy:
 1994: As per report, patient had six cycles of Cytoxan, Adriamycin, and 5-FU at an outside
facility.

 Radiation Therapy:
 1994: As per report, patient had localized radiation therapy at an outside facility.
 Hormonal Therapy: Tamoxifen for 4 years and then started Femara; discontinued Femara
due to bone pain and elevated liver enzymes.
Summary

9.  Follow-up: Annual H& P with clinical breast exam.
 Potential late effects of treatment Potential Long Term and Late Effects from Breast Cancer
Treatments
 Anthracyclines (Adriamycin/doxorubicin, epirubicin), alkylating agents
(cyclophosphamide)
 Cardiotoxicity (Heart damage)
 · Left ventricular dysfunction (how well the heart contracts) can occur in 3 to 6% of
patients who receive anthracycline-based regimens with clinically significant congestive
heart failure in 0.5 to 1%
 · The risk increases with higher doses and can occur months or years after
completion of therapy The risks may be increased in women who have coexisting
comorbidities (heart disease, high blood pressure, etc.) at the time of administration and
who also receive left chest/breast radiation. The peak occurrence is usually cumulative
doses above doxorubicin 450 mg/meter squared. Epirubicin is less cardiotoxic than
doxorubicin with maximum dosages at 900mg/meter squared although it is unclear at what
dosages damage may present a risk.
 Second malignancies (cancers), such as myelodysplastic syndrome and acute leukemia
 · The cumulative incidence of leukemia is <1% in the majority of standard
anthracycline-based regimens
 · Cyclophosphamide has potential low risk for leukemia and bladder cancer but
usually at dosages > than 50gms. Patients may have hemorrhagic cystitis
 Taxanes can cause neuropathy during treatment, but usually improve once completed
Plan

10.  Since concern for this is low, surveillance (heart testing) should be symptom driven
as there are no randomized controlled studies that have evaluated routine screening
for second cancers or heart damage. Most patients have a routine complete blood
count as part of their usual care through their primary providers. If you have
symptoms of shortness of breath or unusual tiredness, tell your health care providers
 Sexual intimacy issues and Menopausal symptoms: Hot flashes, night sweats and vaginal
dryness may occur. Use of a lubricants or moisturizers can help prevent or improve
vaginal symptoms. Usage of oral or systemic estrogens/progesterones is discouraged
 Radiation:
 Low risk for scarring of the lung tissue and low risk for skin cancers (similar to bad sun
burn).
 There is also a low risk for possible distortion of the shape and texture of the breast
 Cardiac toxicity low risk with shielding and newer techniques but is slightly increased
in left breast cancer
 Call your doctor if you have any new, unusual and/or persistent symptoms should be
brought to the attention of your provider.
Plan cont…