Managing Late and Long-Term Effects of Gynecologic Cancer and Its Treatment

A recent review article, published online in Seminars in Oncology Nursing, outlined relevant recommendations from existing clinical practice guidelines on the assessment, prevention, and management of long-term and late effects of diagnosis-specific gynecologic cancer and its treatment.

These recommendations included regularly scheduled surveillance for recurrence, as well as screening for the development of multiple primary cancers and second cancers, which may vary depending upon whether the patient has a known deleterious germline mutation.

For most survivors of gynecologic cancer, general recommendations related to the maintenance of a healthy lifestyle included: weight management through healthy diet and physical exercise involving 150 minutes of moderate or 75 minutes of vigorous activity per week for most patients; a diet low in sugar, saturated fat, and red/processed meat and high in fruits and vegetables; no use of tobacco-based products; and minimal alcohol intake.

The authors identified fatigue, general psychosocial concerns, peripheral neuropathy, sleep disturbance, and memory problems as some of the most common long-term problems among survivors of gynecologic cancer. While noting that these problems are common among cancer survivors in general, they also described the epidemiology and characteristics of other problems more specific to survivors of gynecologic cancer, such as psychosocial concerns relating to sexuality and loss of fertility, as well as lymphedema, urinary dysfunction, bowel problems, and post-treatment pain syndromes.  Detailed recommendations for the medical management of these and other late and long-term effects experienced by women with a history of gynecologic cancer, which have been integrated from existing survivorship and clinical practice guidelines, were provided and included selective serotonin reuptake inhibitor, anxiolytics, antidepressants, local estrogen treatment, topical vaginal therapies, manual lymphatic drainage, and botulinum toxin.

“Nurses need to aware of the current guidelines for post-treatment surveillance and health promotion recommendations for survivors of gynecologic cancers. Early identification of long-term and late effects of treatment followed by coordinated medical interventions and self-management education is essential to improve quality of life,” the authors concluded.

Reference

Campbell G, Thomas TH, Hand L, Lee YJ, Taylor SE, Donovan HS. Caring for survivors of gynecologic cancer: Assessment and management of long-term and late effects [published online March 11, 2019]. Semin Oncol Nurs. doi: 10.1016/j.soncn.2019.02.006