cancers may require amputations or limb-sparing procedures that interfere with mobility (Hoffman et al., 2002).


The following brief site-specific summaries of late effects of cancer and its treatment are based on selected reviews and literature to which the reader is referred for more detailed information. Information on interventions that are available to ameliorate these health effects are also described, as are available clinical practice guidelines (CPGs) for the management of late effects. CPGs are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances” (IOM, 1990).

Female Breast Cancer3

The experience of survivors of breast cancer has been the most extensively researched. Women with a history of breast cancer are the largest group of cancer survivors, representing 22 percent of the survivorship population (see Chapter 2 for a description of breast cancer survivors). The evolving nature of breast cancer treatment has generated a heterogeneous group of breast cancer survivors (Box 3-3). Elderly survivors treated 20 to 30 years ago, for example, had fewer treatment options and likely experienced mastectomy. The issues of concern to those women were often linked to late effects of surgery such as lymphedema and body image. Younger cohorts of women, in contrast, have benefited from a wider range of options, but may be concerned about a broader set of late effects related to their treatment.

Quality of Life

At the conclusion of primary treatment for breast cancer, women generally report good emotional functioning, but decreased physical function-


Much of this section is based on recent comprehensive reviews relating to breast cancer treatment and late effects (Burstein and Winer, 2000; Shapiro and Recht, 2001; Partridge et al., 2001, 2003; Emens and Davidson, 2003; Hurria and Hudis, 2003; Kattlove and Winn, 2003; Harris et al., 2004; Mrozek and Shapiro, 2005). Literature was identified by searching PubMed for articles published in English since 1994 with the MeSH heading “breast neoplasms” and an additional search term, including “survivors” [MeSH], “lymphedema” [MeSH], “menopause” [MeSH], “heart diseases” [MeSH], “weight gain,” “cognitive impairment,” “fatigue,” and “late effects.” Articles relating to childhood cancer survivors were excluded.

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