Vaginal lubricants are recommended to treat vaginal dryness. Vaginal estrogen creams are effective in patients with nonhormone-dependent gynecologic cancer without risk of breast cancer. The FDA approved the selective estrogen receptor modulator ospemifene for treating dyspareunia in postmenopausal women without risk of breast cancer. 1 Oral phosphodiesterase-5 inhibitors, such as sildenafil, vacuum erection devices, penile prosthesis, and intracavernous injections, have shown to be effective in treating male erectile dysfunction (ED). 19
Cardiovascular risk should be estimated in all patients with ED, because most of these patients will have common risk factors and need to be referred to a cardiologist before treating ED. 1
Chronic Pain
Patients may also experience chronic pain as a late complication of chemotherapy, radiation, and surgery. 1 More than one-third of cancer survivors experience pain, and it is often ineffectively managed due to lack of training, fear of AEs, and addiction. 20 The goals of pain management are to increase comfort and improve quality of life. Short-acting and long-acting opioids remain an important treatment for cancer pain. Drug selection should be guided by previous exposure and comorbidities. 15 Opioid therapy AEs, such as constipation, sleep apnea, and hypogonadism, should be recognized and treated. Antidepressants and anticonvulsants, such as gabapentin and pregabalin, may be used to manage neuropathic pain. A multidisciplinary approach using pharmacologic therapy, psychosocial therapy, behavioral interventions, exercise, and physical therapy is recommended. 15 Patients with refractory pain are treated with interventional approaches, such as a neuronal blockade.
Survivorship Resources
Survivorship resources were developed by various cancer societies, such as NCCN, ASCO, Livestrong, and the Children’s Oncology Group. These resources help providers develop and deliver a quality survivorship care program (Table 2). 5 The NCCN provides a template to help create cancer treatment summaries; guidelines for follow-up care for different cancers; and information for patients on legal and employment issues, smoking cessation, nutrition, and weight loss. In addition, the NCCN provides tools to assess anthracyclineinduced cardiac toxicity, anxiety, depression, cognitive dysfunction, pain, sexual dysfunction, and fatigue.
The CAVHS has several resources to develop a survivor ship progr am: It offers complementary and alternative therapy (a multidisciplinary approach) to help veterans with chronic pain and psychological distress. This resource incorporates acupuncture, yoga, hypnotherapy, biofeedback, mind-body approaches, stress management, nutritional counseling, physical therapy, and other mental and behavioral health support.
In addition, VA is implementing a patient-centered care and cultural transformation program to help veterans establish a relationship with their health care providers. 21 The patient-centered approach along with the complementary and alternative therapy program, mindfulness program, and telehealth exercise motivation program can be incorporated to develop a multidisciplinary survivorship program.
Survivorship Research
Survivorship is an emerging field, and there is need for research to improve the implementation of quality survivorship care. Cancer survivorship research encompasses the physical, psychosocial, and economic sequelae of cancer diagnosis and its treatment among both pediatric and adult survivors of cancer. It also includes issues related to health care delivery, access, and follow-up care.
Mayer and colleagues reported that there were 42 published studies of SCPs in adult cancer survivors. 22 Eleven studies reported that SCP use was limited and that < 25% of oncology providers never used an SCP. Research also showed that oncologists who have had training in long-term AEs of cancer and those who have used the EHRs were more likely to use SCPs. 23 An integrated review of studies of SCPs recommended areas of research for survivorship. Thus the quality and quantity of SCP research are limited, and there is more need for quality research in survivorship to endorse the effective use of SCPs.
