Upload
others
View
5
Download
0
Embed Size (px)
Citation preview
Region Syd, jan 2020Peter Christensen, professor, overlæge, dr.med.
Klinik for bækkenbundslidelser, Mave Tarm Kirurgi
Aarhus Universitetshospital
Klinik for senfølger til kræft
i bækkenorganerne
Forbedret overlevelse | 40 års trend I overlevelse af endetarmskræft
Quaresma et al, Lancet 2015
% Survival
Senfølger efter kræft i endetarmen
Tarm SmerteSexBlære
Major Minor No
41%
Major Minor No
38% 13%43%
Major Minor No
Senfølger efter kræft i endetarmen
Tarm SmerteSexBlære
Major Minor No
41%
Major Minor No
38% 13%43%
Major Minor No
Multiorgan involvering | multidiciplinær behandling
Algoritmer for behandling
Fra ‘smart data’ til behandling | ressourceeffektiv hjælp
Strategisk satsningsområde 2017 | senfølger efter kræft
10 mio d.kr. over 3 år
Senfølger efter kræft i bækkenorganerne
AALBORG AALBORG
From Bench to Bedside to Healthcare Beyond CancerA
cro
ss
Pelv
icO
rgan
Can
cers
Cross sectional
Prospective Patophys. Clinical Trials PreventionSocioeconomy
Colon DCCG cohort Smart data DCCG Diarrhea,microbioma
Cancer seqv ClinicsTreatment Algorithm Two RCTs:BAM + diet
Impact and workrealtionQUALY and Cancer seqv Clinics
Rectum DCCG cohort Smart data DCCG HRM and LARSEmpty,Size mattersChronic pain
Cancer seqv ClinicsTreatment Algorithm Sex and cureTwo RCTs:Klyster vs TAI +Pain treatment
Impact and workrelationQUALY and Cancer seqv Clinics
Anal PROM development AUH, DACG
Dose vs function Size matters Cancer seqv ClinicsTreatment Algorithm
Dose vs toxicity
Bladder National surveyDBCG
Optional
Prostate National survey DPCG
Optional
Cervix National surveyDGCG
Monitor Chronic pain MonitorPain treatment
Dose vs toxicity Optional
Algorithms for treatment
From ‘smart data’ to treatment | resource effective help
1066 Invited
161 RC, 905 CC
864 included
Response rate: 81.1 %3, 12, 24, and 36 months response rates: 82.5, 84.5, 80.0 and 73.2 %
Age, median (range): 71 (21-98)
Males: 53.6 %
Online : 75.9 % (Age >80, 54.7 %)
systematic screening for late sequelae after colorectal cancer
16. apr 2018 – 9. sep 2019
RC 3m RC 3m After stomareversal
RC 12m RC Total CC 3m CC 12m CC 24m CC 36m CC Total
Surveys (n) 132 10 17 159 310 268 213 152 943
Patients contacted by phone (n, %)
37 (28 %) 4 (40 %) 4 (24 %) 45 (28 %) -- 47 (18 %) 46 (22 %) 25 (16 %) 118/633 (19%)
Patients referred (n, %)
23 (17 %) 3 (30 %) 1 (7 %) 27 (17 %) __ 23 (9 %) 23 (11 %) 13 (9 %) 59/633 (9 %)
Type of late sequelae*
Bowel: 6Urology: 6Pain:2Sexual: 13Stoma: 1Hernia:1
Bowel: 3Sexual: 1
Gyn:1 Bowel: 9Urology:6 Pain:2Sexual: 14Stoma: 1Hernia:1Gyn:1
___ Bowel: 20Fatigue:1Pain:2
Bowel: 19Urology:1Fatigue:1Bleeding:1Pain:3hemorrhoids:1
Bowel: 11Pain:1Fatigue:1
Bowel: 50Fatigue: 3Bleeding: 1Pain: 6hemorrhoids:1
Answers to surveys
Case 1
• 64 årig mand• Opereret for endetarmskræft med resektion og primær anastomose
i 2016 forudgået af kemo-strålebehandling• Han har nu ‘lav anterior resektions syndrome’, LARS
– 10-30 afføringer per dag, Bristol Stool Type 4– Bydende afførginstrang/urgency– Inkontinens– Fragmenteret afføring
• Ikke genvundet rejsningsevne og det går ham på• Er derudover træt, har svært ved at sove om natten
• Hvad skal man stille op?
Case nr 2
Som 31 årig, strålebehandlet for cervix cancer
Mave-tarmsymptomer siden da, mest diare, er nu 59 år
Set af et utal af kirurger og onkologer
Prøvet forskellige konservative regimer uden effekt
Hvad skal man stille op?
Nurse led clinics | ‘optimised’ conservative treatment
I can help! Optimised Conservative Treatment
Algorithm-based
Motivational interview
Individual goal – setting
List of medication
Lifestyle and habbits
Diet regulation (not always more fibres)
Loparomide
Rectal emptying with suppositories or
mini-enemas
Proposed treatment algorithm | major LARS
Consult a
gastroenterologist
in diarrhoea-like
stools
Work up by the Gastroenterologist |
What can I
do?
Sexuel dysfunction | gender depended algorithm
Bladder dysfunction |
> 400 patients evaluated, treated and monitored
https://www.auh.dk/om-auh/afdelinger/senfolger-efter-kraft-i-bakkenorganerne/
27
International perspective
PRO booklet translated: Holland, UK, USA,
Sweden?, Norway?, Portugal?
National perspective
Vision: all danish colorectal cancer patients screened
for late adverse effect and offered treatment.
Scale to all major cancer types
Live on National Television, Oct 2019 | late adverse effects following cancer
Magnus Heuniche
Danish Minister of Health
”thank you for bringing
this up…”
”kick in an open
door…”
”this needs to be
established in every
region in Denmark…”
The essential components in a pelvic rehabilitation centre |
AARHUSUNIVERSITY
@PeterCh12345