Page 8 - Mecklenburg_Medicine_October-2017

Feature
Survivorship Clinic ... What Is It?
By James B. Hall, MD, Levine Cancer Institute
“Mrs. Jones, your biopsy is positive for cancer.”
These are words that begin a cascade of
feelings, fears and actions. This dreaded
sentence also often signals a sense of total time. It’s important to consider these questions in order to address
loss of control of life for the patient. New physicians, who she hasn’t
met, begin to order tests, schedule surgery and/or recommend
starting chemotherapy or radiation ... and she just goes where she’s
told to go, reacting simply out of fear. Alternatively, she can look at
the diagnosis as the start of getting better from the symptoms she’s
been having and of healing. Survivorship starts with the diagnosis
of cancer.
The Levine Cancer Institute survivorship clinic is a relatively
new initiative. Patients who have gone through their diagnosis and
What have been treatment, and have then
underappreciated are
the very real issues, moved on to the next phase
of follow-up, are candidates
for this clinic. Historically,
the recommendations for
and often consequences, follow-up, based on NCCN
of the long-term effects guidelines, have been
of treatments, which,
although often life- primarily for monitoring
saving, also have left cancer patients for five
years prior to pronouncing
patients with toxicities them to be cancer-
that have not gone away. free. What have been
underappreciated are the
very real issues, and often
consequences, of the long-
term effects of treatments,
which, although life-saving,
also have left patients with toxicities that have not gone away.
Post-operative surgical changes, such as colostomies, often are
obvious, but effects such as cognitive changes from chemotherapy
(“chemo brain”) or permanent neuropathies or cardiac changes
from chest radiation are not visible, yet are very real and can cause
long-term consequences. Additionally, once patients have had one
malignancy, they are at greater risk for a secondary malignancy —
either due to genetics or even as a consequence of prior treatments.
The genetic component is evolving, as recent advances in what can
be studied and even what findings now may mean to the patient,
from a clinical perspective, are truly in a dynamic state. We often
find the limited genetic studies done as recently as 2010 may
be totally inadequate. In addition, it is important to re-visit the
question of family members who may have had a recent diagnosis
of a genetically associated malignancy, which now may warrant
re-testing the patient to address new risks with them or their
family members. Likewise, prior treatments can present new risks.
Patients are living longer, and we are seeing long-term side-effects
of chemotherapy and/or radiation. For example, one of the long-
8 | October 2017 • Mecklenburg Medicine
term risks of primary radiation treatment of cervical cancer is the
development of a sarcoma in the uterus. Additionally, significant
quality-of-life changes relative to sexual function can occur over
them with patients.
This clinic has been established to meet very real needs of patients
that previously often have not been recognized or addressed. Pain
is one concern being addressed by palliative care or integrative
medicine, through healing touch or acupuncture, which has been
researched and found to have real benefit. Other onsite services
include consultations for psychiatry, neuro-psychology, senior
oncology, cardio-oncology, integrative oncology, cancer rehab,
nutrition counseling, massage therapy, sleep classes and meditation/
yoga classes, etc. Many of these services are offered at no cost to the
patient and are funded through the Foundation.
What is the value of all this to patients? One of the first patients
seen at the LCI survivorship clinic explains the “why” in very real and
tangible terms. A presentation was made by Michael Richardson, MD,
to primary care physicians, one of whom referred a patient who had
been treated and cured of a lymphoma more than 20 years ago, but
now, based on recent NCCN guideline recommendations relative to
chest radiation and the potential effects on the heart, was seen and sent
for cardiac evaluation. Even though the patient was asymptomatic, the
evaluation demonstrated the anterior wall of the heart was dysfunctional
and a subsequent cath identified significant coronary disease, which
could have resulted in sudden death at some further point.
Declan Walsh, MD, a medical oncologist by training, was recruited
from the Cleveland Clinic to become the Chair of Medical Support
Services. His seminal work in nutrition and palliative care in the
cancer setting became the basis of his interest in patients going
through cancer treatment and the resulting toxicities. As the editor
of a number of medical journals, including his recent appointment
as editor in chief of the British Medical Journal Supportive and
Palliative Care, he brings both his clinical expertise and his interest in
research and clinical trials to patients in our service area. Dr. Walsh
summarizes the intent of the program: “The survivorship clinic is
one of a portfolio of supportive oncology clinical services, designed
to deliver on a vision of whole-person cancer care, as part of the
medicine of the 21st century.” His concept of the program perfectly
fits that of Beth York, administrative director of the Center who
stated, “The Cancer Survivorship Clinic at The Center for Supportive
Care and Survivorship is providing a wonderful opportunity for
patients in the Charlotte metro area to have a medical visit with a
physician specializing in survivorship. Given the many intricacies of
cancer treatments and the continued advancements in risk reduction
strategies, it’s helpful to have such a resource readily available.”
A cancer diagnosis is the beginning of a journey to wellness and
celebrating survivorship — no longer a death sentence.
For consultations and referrals, call 980-442-2000.