Primary Care Management of Late and Long-Term Effects of Oncological Treatments in Uterine Cancer Survivors

The population of uterine cancer survivors in the United States is continuously increasing, due to both a slight increase in incidence and to impressive survivorship statistics. The rising incidence could be attributed to increases in the aging and obese populations, as both age and obesity are established risk factors for uterine cancer (SEER, 2013). An estimated 61,380 cases of uterine corpus cancer are diagnosed annually, (Siegal, Miller, Jemal, 2017); of these patients, 82% can expect to live five years and 79% survive ten years or more following diagnosis (Hudson et al., 2016). The simultaneous increase in incidence and in anticipated survival result in a high volume of uterine cancer patients requiring follow up (Elit and Reade, 2015), while the number of available oncology appointments is expected to increase much more modestly (Yang et al., 2014). Due to this imbalance, a higher proportion of follow-up care is expected to shift to primary care providers and/or general gynecologists (Elit and Reade, 2015). Thus, primary care providers, especially nurse practitioners, must be prepared to understand and address the specific needs of the uterine cancer survivor population and the lasting effects of the various treatments patients may have received.

Long-term needs of uterine cancer survivors vary depending upon oncologic treatment, which can consist of any combination of surgery, radiation, and chemotherapy. The standard-of-care treatment for uterine cancer is based upon staging, but generally includes surgical removal of the uterus, with or without the fallopian tubes, with or without the ovaries (NCCN, 2017). External-beam radiation or vaginal brachytherapy may be used in addition to surgery (NCCN, 2017). Finally, if the cancer is identified through pathology to be high-risk (serous carcinoma, clear cell carcinoma, carcinosarcoma), chemotherapy is considered as an adjuvant treatment. Initial chemotherapeutic regimens include a combination of medications, each of which has a different mechanism of action. Carboplatin and paclitaxel or cisplatin and doxorubicin are common initial pharmacotherapeutic treatments.

Nurse practitioners serving as primary care providers are in a unique position to provide long-term symptom management for uterine cancer survivors. This poster summarizes the common concerns of uterine cancer survivors and suggests possible symptom management and treatment options for both the late and long-term effects associated with various oncological therapies mentioned above.