SLEDENJE PO ZDRAVUENJU RAKA JAJČNIKOV asist. dr. Nina Kovačevič, dr. med. PONOVITEV BOLEZNI > KLINIČNO ► Bolečina, napihnjenost, izguba telesne teže... > BIOKEMIČNO ► Porast CA-125 > SLIKOVNA DIAGNOSTIKA PONOVITEV BOLEZNI > STADIJ 1:10% verjetnost ponovitve > STADIJ II: 30% verjetnost ponovitve > STADIJIH: 70 -90% verjetnost ponovitve > STADIJ IV: 90-95% verjetnost ponovitve > Mediano obdobje brez ponovitve bolezni (PFS) 18 mesecev 118 SLEDENJE ► EDUKACIJA BOLNIC o znakih in simptomih ponovitve bolezni ► SLIKOVNA DIAGNOSTIKA s kontrastnim sredstvom, če ni kontraindikacij ► OHRANITEV PLODNOSTI 119 TUMORSKIMARKER CA-125 >► Spremjanje CA-125, če je bil le ta ob diagnozi povišan Asimptomatske bolnice s porastom CA-125 takojšnje zdravljenje Ni daljšega preživetja Slabša kvaliteta življenja Median čas od asimptomatskega porasta CA-125 do nastopa kliničnih težav je 2-6 mesecev. 120 SLEDENJE g REDNE KONTROLE Na 4 mesece prvi 2 leti > Na 6 mesecev 2-5 let § g lx letno po 5. letih QC N i ° 1 § -j O CQ STADIJ l-IV • Klinični pregled, pregled medenice • CA-125 ali drugi tu morski markerji, če so bili ob diagnozi povišani 1 QC CQ o CL S £ CL S CQ O O PO PRIMARNEM ZDRAVLJENJU • Napotitev na genetsko svetovanje, če le-tega bolnica še ni opravila • Hemogram, biokemija ob indikaciji • CT prsnega koša, medenice, MR medenice, PET-CT, PET ob klinični indikaciji • RT G pc obindikaciji • Dolgoročni celostni pristop PONOVITEV BOLEZNI Naraščanje CA-125, brez predhodne KT Klinična ponovitev bolezni, brez predhodne terapije Klinična ponovitev bolezni, predhodna KT Naraščanje CA-125, predhodna KT Sliko vn e preiska ve: CT prsnega koša in trebuha MR medenice PET-CT ali PET ob klinični indikaciji Citologija ascitesa Molekularna diagnostika tumorja, če še ni bila narejena Zdravljenje ponovitve bolezni Zdravljenje ponovitve bolezni Odložitev zdravljenja do nastopa kliničnih znakov za ponovitev bolezni ali vključitev v klinične raziskave 121 KVALITETA ŽIVLJENJA >► Bolnice imajo lahko več ponovitev bolezni ► Več stranskih učinkov zdravljenja ► Vpliv na kvaliteto življenja Kontrola bolezni in ohranjanje kvalitete življenja 122 S3 >5 S ^ QC N O § —I O CQ S Ü QC CQ o CL cc CL CQ o Q O to National Comprehensive NCCN Cancer Network® NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Survivorship Version 1.2021 — February 24, 2021 NCCN.org NCCN Guidelines for Patients® available at www.nccn.org/patients Continue Version 1.2021, 02/24/21 © 2021 National Comprehensive Cancer Network» (NCCN*), All rights reserved. NCCN Guidelines* and this illustration may not be reproduced in any form without the express written permission of NCCN. NCCN V J National Comprehensive Cancer Network® NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Palliative Care Version 2.2021 — February 12, 2021 NCCN.org Continue Version 2.2021,02/12/21 © 2021 National Comprehensive Cancer Network® (NCCN'), All rights reserved. NCCN Guidelines* and this illustration may not be reproduced in any form without the express written permission of NCCN. 123 DOLGOROČNI CELOSTNI PRISTOP >► Zgodnje odkrivanje ponovitve bolezni ali pojav novega primarnega raka >► Preventiva >► Ocena psiho-socialnih in fizičnih zmožnosti >► Koordinacija med izbranim zdravnikom in specialisti >► Periodočna ocena pacientkinih potreb 124 g 5C g QC N O S -J 0 CQ S 1 QC CQ O CL e £ cl CQ o O O VPRAŠALNIK ZA BOLNICE SURVIVORSHIP ASSESSMENT (Patient Version) Please answer the following questions: Survivorship Concerns Survivorship Care Survey Cardiac Health 1. Do you have shortness of breath or chest pain after physical activities (eg, climbing stairs) or exercise? Yes/No 2. Do you have shortness of breath when lying flat, wake up at night needing to get air, or have persistent leg swelling? Yes/No Anxiety, Depression, Trauma, and Distress 3. In the past two weeks, have you been bothered more than half the days by little interest or pleasure in doing things? Yes/No 4. In the past two weeks, have you been bothered more than half the days by feeling down, depressed, or hopeless? Yes/No 5. Has stress, worry, or being nervous, tense, or irritable interfered with your life? Yes/No Cognitive Function 6. Do you have difficulties with multitasking or paying attention? Yes/No 7. Do you have difficulties with remembering things? Yes/No 8. Does your thinking seem slow? Yes/No Fatigue 9. Do you feel persistent fatigue despite a good night's sleep? Yes/No 10. Does fatigue interfere with your usual activities? Yes/No 11. How would you rate your fatigue on a scale of 0 (none) to 10 (extreme) over the past week? 0-10 Lymphedema 12. Since your cancer treatment, have you had any swelling, fatigue, heaviness, or fullness on the same side as your treatment that has not gone away? Yes/No Hormone- Related Symptoms 13. Have you been bothered by hot flashes/night sweats? Yes/No 14. Have you been bothered by other hormone-related symptoms (ex, vaginal dryness, incontinence)? Yes/No Pain 15. Are you having any pain? Yes/No 16. How would you rate your pain on a scale of 0 (none) to 10 (extreme) over the past month? 0-10 Sexual Function 17. Do you have any concerns regarding your sexual function, sexual activity, sexual relationships, or sex life? Yes/No 18. Are these concerns causing you distress? Yes/No Sleep Disorder 19. Are you having problems falling asleep, staying asleep, or waking up too early? Yes/No 20. Are you experiencing excessive sleepiness (ie, sleepiness or falling asleep in inappropriate situations or sleeping more during a 24-hour period than in the past)? Yes/No 21. Have you been told that you snore frequently or that you stop breathing during sleep? Yes/No Healthy Lifestyle 22. Do you engage in regular physical activity or exercise, such as brisk walking, jogging, weight/resistance training, bicycling, swimming, etc.? Yes/No *■ 22a. If you answered "Yes," how often? 23. Excluding white potatoes, do you eat at least 21/2 cups of fruits and/or vegetables each day? Yes/No 24. Do you have concerns about your weight? Yes/No 25. Do you take vitamins or other supplements? Yes/No Immunizations and Infections 26. Have you received your flu vaccine this flu season? Yes/No 27. Are you up to date on your vaccines? Yes/No/Don't know Emplyoment/ Return to Work 28. Do you have concerns about how cancer and/or cancer therapy has affected your ability to work? YES/NO 125 DOLGOROČNI CELOSTNI PRISTOP >► Natančna seznanitev bolnice >► S potekom dosedanjega zdravljenja ► S sledenjem ► Vlogo onkologa, izbranega zdravnika, ostalih specialistov >► Zgodnjimi in kasnimi posledicami zdravljenja ► Zdrav življenjski slog 126 PALIATIVNA OBRAVNAVA INDIKACIJE Izčrpano specifično onkološko zdravljenje Napredovala bolezen z visoko stopnjo smrtnosti Številne pridružene bolezni Neobvladjivi simptomi Zaskrbljenost bolnice/svojcev glede poteka bolezni Slabšanje prognoze Psiho-socialne potrebe Ne zavedanje se razsežnosti/resnosti bolezni OCENA in UKREPI Želje in pričakovanja bolnice Kako se soočati z boleznijo Podučitev o poteku bolezni Koordinacija z ostalimi zdravstvenimi delavci/ustanovami Lajšanje nastalih simptomov 127