The inaugural Cancer Survivorship Symposium, held in January 2016, drew more than 800 attendees across the cancer-care spectrum—far exceeding the goal of 500 attendees. As a way to continue the discussion from the meeting, several faculty members responded to questions from General Sessions 5 and 6: Multidisciplinary Approaches to the Cancer Survivor With Complex Medical Needs—Parts I and II, including the following individuals:
In the following article, these individuals address some of the unanswered questions from attendees that did not get asked during the time set aside for discussion.
Q: What options are there to detect treatment-induced subclinical cardiac damage? If detected early, what management options are there?
Dr. Henderson: The standard tools recommended for detection of subclinical cardiac damage are echocardiography or a multigated acquisition (MUGA) scan. Researchers are currently studying the utility of cardiac magnetic resonance imaging.
In terms of management of subclinical disease, patients can be referred to cardiologists who specialize in caring for cancer survivors. Some drug options, such as angiotensin-converting enzyme inhibitors, are available to provide cardiac support to the patient. However, no data from clinical trials definitively support a specific therapeutic agent to reduce cardiac morbidity and mortality. This may change in the future, because ongoing clinical trials are addressing prevention. For example, Saro Armenian, DO, MPH, of City of Hope, was recently awarded a research grant from the National Institutes of Health to conduct a clinical trial evaluating a drug intervention to prevent anthracycline-induced cardiac damage.
Aside from these strategies, we must encourage patients to maintain their ideal body weights; exercise on a regular basis; ensure that diabetes is being managed appropriately in affected individuals; and reduce any other cardiovascular risk factors they may have, given the increased cardiac risk posed by certain cancer therapies.
Q: Given its declining cost, do you foresee genetic testing becoming standard practice for patients scheduled to receive anthracyclines to determine if they are at risk for cardiomyopathy?
Dr. Bhatia: That is indeed our goal—that is, to identify individuals at diagnosis such that treatments can be personalized and we can reduce potential harm to patients while maximizing their chances of cure. Several single nucleotide polymorphisms (SNPs) have been linked to chemotherapy-induced cardiac complications. We plan to use these SNPs to develop a risk-prediction model, which would allow patients to be classified as at high or low risk for cardiac complications. This information will be used to decide the maximum dose of chemotherapy, the intensity of cardiac screening, and the pharmacologic interventions.
Q: As a medical oncologist, I encourage patients who struggle with postchemotherapy concentration issues while reading or who struggle with insomnia to limit their screen time with e-readers and other backlit devices and to use books and other paper items (ie, magazine articles that are shorter) to help alleviate these issues. Do you have any commentary or recommendations regarding this practice?
Dr. Recklitis: There is growing evidence that light from tablets and e-readers can interfere with sleep, so it is reasonable to suggest to anyone with insomnia that they limit these activities, especially in the evening before going to bed. That said, the degree to which these devices affect sleep and the amount of exposure necessary to affect sleep are not well understood. These devices are not the only ways for people to develop habits that interfere with sleep. An animated telephone call, worry about the next day, watching television, or even reading in the bedroom may all negatively affect sleep for those with insomnia, so it is very important that recommendations about e-readers are only one component of education about sleep hygiene. Moreover, for individuals who have notable chronic insomnia, it is likely that many factors are contributing to their condition; therefore, changing their exposure to e-readers alone may not be enough to dramatically improve their sleep. ■
Originally printed in ASCO Connection. © American Society of Clinical Oncology. “Clinical Conversations: Attendee Questions From the Cancer Survivorship Symposium”
Connection.asco.org. March 2, 2016. All rights reserved.