Patricia Ganz, MD, a medical oncologist who has studied the late effects of cancer treatment, delivered the 2011 Komen Distinguished Lecture at the University of Maryland School of Nursing (UMSON), emphasizing that greater attention should be paid to the consequences associated with the improved rate of survival for women with breast cancer.
She spoke on April 14 in the UMSON auditorium, and her remarks were simulcast with the support of the Maryland Affiliate of Susan G. Komen for the Cure for viewing by UMSON nursing students at the Universities at Shady Grove in Rockville, Md., and by nursing students at Bowie State University in Bowie, Md., and Coppin State University in Baltimore.
The decline in breast cancer mortality means that for many women "cancer is now a chronic disease," said Ganz, director of cancer prevention and control research at the , Jonsson Comprehensive Cancer Center, University of California, Los Angeles. For cases of early-stage breast cancer, the five-year survival rate exceeds 90 percent, and continued improvement is expected. "But there is a cost to women and their families in the form of time, money, and human, interpersonal, and existential costs," Ganz said.
The lecture was made possible by a grant to UMSON from the Komen Maryland Affiliate to advance education and practice in the treatment of breast cancer. Principal investigator of the grant is Sandra McLeskey, PhD, RN, a professor at UMSON and co-director of the Komen Maryland Affiliate Nursing Partnership along with Deborah McGuire, PhD, RN, FAAN.
McLeskey, left, is shown in the photo with Ganz, center, and McGuire, a professor at UMSON who will be the next principal investigator. McGuire introduced Ganz as "a pioneer" in studying quality of life of cancer patients and survivors.
Breast cancer treatment now includes use of combined modality therapy and prolonged adjuvant and/or maintenance therapies, such as endocrine therapies that are given for about 10 years to many women, Ganz said. The risk of second malignancies is greatly reduced. However, benefits may need to be weighed against harm, Ganz said, as she and other researchers attempt to learn why some women appear susceptible to certain late effects after treatment.
Breast cancer survivors report premature menopause, infertility concerns, body image changes, and lymphedema, which is swelling in the arm on the side of their breast cancer surgeries. These findings came from a study in which Ganz and colleagues interviewed 1,100 women in the Washington, D.C., and Los Angeles areas about their experiences as breast cancer survivors.
Along with early detection, advances in drug therapies have increased longevity. Yet these treatments are often linked to long-term physical effects, including symptoms of persistent fatigue. Ganz said post-treatment fatigue remains under-reported and under-treated in breast cancer survivors despite its severity.
In a follow-up of the women in their study five years after diagnosis and treatment, researchers found that one-third reported persistent fatigue. Many also were experiencing pain, sleep disturbances, mood disruptions, menopausal symptoms, and cognitive dysfunction that may have been related to early menopause. Associated medical conditions included anemia, cardiovascular disease, and cardio-respiratory disease.
"It [the fatigue] is like being wiped out by a bad flu," and so pervasive that women "don't have energy to do any kind of leisure activity," said Ganz. She said it is unlike an ordinary feeling of being tired and may be linked to biologic characteristics of the patient, or to the treatment.
"In terms of its impact on quality of life, this is one of the most distressing symptoms that patients report, behind only pain and nausea, and can interfere with the ability to work, to care for their families, and their concerns about fighting the cancer," she added.
"Attention to symptom management means there can still be a good life after cancer," Ganz told an audience made up primarily of nursing students, educators, and health care practitioners. She suggested that breast cancer survivors must be questioned about symptoms and treated proactively. Despite what she called "substantial disruptions in their quality of life," women may not expect relief once the cancer is under control. "If we don't ask, they may not bring it up," Ganz said.
Strategies to cope with these late effects include recommending moderate exercise, suggesting that those with cognitive issues avoid distraction, and treating when appropriate for anxiety, insomnia, and depression, among other conditions. Women of childbearing age may want their eggs to be harvested prior to therapy in the event they become infertile after treatment.
McLeskey announced that the Komen Maryland Affiliate has awarded the School a sixth year of funding to advance education and practice. This additional support of $204,738 will continue a multi-pronged initiative that includes the two partner institutions and will expand to a third - Salisbury University - in June.
The Komen Maryland Affiliate Nursing Partnership has previously grown to include the School of Social Work and the School of Pharmacy. Starting in June, new partners will include the University of Maryland Marlene and Stewart Greenebaum Cancer Center and the University of Maryland Medical Center.