希望之路 - 癌症康復座談會 Cancer Survivorship Conference for Chinese

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1 希望之路 - 癌症康復座談會 Cancer Survivorship Conference for Chinese Cancer Patients, Survivors, and Caregivers 如何護理癌症治療後的長期的副作用 How to manage long-term Side Effects after Cancer Treatment October 29, 2011 Sunnyvale Senior Center 葉錦富醫生 (Tin Tin Hla, M.D., M.B.A.)

2 恭喜 Congratulation! 激烈的治療已經結束! Intense treatment is over 癌症是終於得到控制 Cancer is finally under control

3 歐洲癌症存活率 European cancer survival rates The Telegraph-Friday 14 October 2011 英國癌症生存率在歐洲最低 UK cancer survival rate lowest in Europe

4 Center for Disease Control and Prevention Report 在美國,65% 的癌症倖存者至少活了 5 年 have lived at least five years since receiving their diagnosis, 40% 已經活了 10 年或以上 40 percent have lived 10 years or more 10% 已經活了 25 年或更長的時間 65 % cancer survivors 10 percent have lived 25 years or longer. Among all cancer survivors, 54.3% were female, and 45.7% were male. Approximately 1.1 million of the 11.7 million cancer survivors had lived with a diagnosis of cancer for 25 years; of those survivors, 75.4% were females. FIGURE 2. Estimated number of living persons ever diagnosed with cancer, by sex and period since diagnosis --- United States, January 1,

5 癌症倖存者 --- 美國疾病控制和預防中心 2007 報告 Cancer Survivors --- United States, 2007 Center for Disease Control and Prevention Report Weekly March 11, 2011 / 60(09); 癌症倖存者在短短 6 年增加約 20% Cancer survivors increased by about 20 percent in just 6 years 在 2007 年倖存者有 1 千 1 百 70 萬 (11.7 million in 2007) 在 2001 年倖存者有 9 百 80 萬 (9.8 million in 2001) 1971 年倖存者有 3 百萬 (3 million In 1971) FIGURE 1. Estimated number of living persons ever diagnosed with cancer --- United States, January 1, 1971, to January 1, 2007

6 癌症生存後時期 POST SURVIVAL PERIOD 癌症被征服了 Cancer is conquered. 許多問題仍然存在 Many issues remain 身體恢復功能 Functional recovery 精神的恢復 Mental recovery 情緒的穩定 Emotional stability 經常害怕癌症復發 / 發現第二種癌症 Fear of relapse and secondary cancer 長期看醫生 Long-term follow-up 經濟財務 Financial 恢復工作 Back to work

7 適應新的生活新的身體結構和症狀 New body structures and symptoms 不同的思考 Different thinking 新的生活意義 New meaning of life 新的日常生活形態 New normal life style 新的朋友圈 New circle of friends

8 癌症治療的長期影響 Long term effects of cancer treatment 身體的變化心理變化財務 Finances 與家人和朋友的關係 Relationship with family and friends 不安全感 - 擔心癌症回來的隱憂 Sense of insecurity- Hidden fear of cancer coming back 後續的醫療護理 follow up medical care

9 副作用 Side Effects 短期的副作用 Short Term side effects: 治療完成後會恢復的例如噁心, 嘔吐, 脫髮長期的副作用 Long Term side effects- 手術, 放療和化療後恢復緩慢或根本不會恢復的 After surgery, radiation and chemotherapy, side effects resolve slowly or not at all.

10 哪些癌症治療引起的副作用 Which Cancer Treatments cause side effects 手術治療 Surgical treatment: 切除 / 控制部分腫瘤 To removal of tumor for local control 短期和長期的副作用 Short term and long term side effects 化學治療 Chemotherapy 標靶治療 Targeted therapy 有針對性的癌症治療 Targeted specific sites of cancer 放射治療 Radiation therapy

11 放射治療 Radiation therapy 放射治療 Radiation therapy: 局部控制癌症 Local control of cancer 防止或減少癌症復發, prevent or reduce cancer recurrences 緩解癌症疼痛 To control cancer pain

12 癌症治療後的長期的副作用 Long-Term Medical Side Effects after Cancer Treatment 身體和生理紊亂 Physical and physiological disturbances 記憶減退 ( 化學腦 )Impaired Memory (Chemo-brain/radiation brain) 疼痛和神經病痛 Pain and Neuropathy 胃腸道問題 : 口乾, 麻煩吞嚥, 食慾不振, 腹瀉 / 便秘 GI problem- Dry mouth, trouble swallowing, loss of appetite, diarrhea /constipation 皮膚和腫脹 Skin and swelling 骨質疏鬆 Osteoporosis 心臟衰弱 Weak heart 婦產科 : 陰道乾澀和不孕症 Vaginal dryness and infertility, 男性 --- 性功能障礙 Sexual dysfunction

13 疲劳和累 Fatigue and tired 这是许多长期癌症幸存者挥之不去的副作用 It is a troubling, lingering side effect for many long-term cancer survivors. 长期癌症幸存者疲劳和累未被报告, 未被诊断 Long-term cancer survivor fatigue is under-reported, under diagnosed 研究表明 : 乳腺癌幸存者疲劳的患病率可高达 30%. Studies suggest that the prevalence of fatigue in breast cancer survivors may be as high as 30%, 疲劳程度可能保持, 甚至治疗后 5 年 Fatigue levels may stay even as long as 5 years after treatment.

14 疲劳的原因 Causes of Fatigue 疲劳的确切病因仍有争议 The exact etiology of fatigue is still debated. 运动功能减退 Hypokinesia 没有良好的睡眠, 睡眠障碍 Sleep disturbances 贫血 Anemia 甲状腺功能减退 hypothyroidism. 精神抑郁焦虑 Depression, anxiety 药物 Medications

15 改善运动功能减退 Hypokinesia 經常定期運動 : 中度的體育鍛煉, 舉重, 和瑜伽因而減少疲勞和降低疲勞睡眠衛生, 中午小睡休息不超过 30 分鐘藥物 : Methylphenidate

16 化疗和放射疗法对大脑的副作用 Side effects on brain and Nervous system 記憶力減退 Poor memory 易忘 Forgetful 認知功能障礙 Cognitive function impairment

17 改善腦功能 Improved brain function

18 口乾舌燥 Dry mouth 使用放射, 手術和化療, 治療頭部和頸部, 會造成, 口乾七預防的方式來緩解口乾舌燥 Seven preventive way to ease dry mouth 1. 喝大量的液體 : 每天 8 至 10 杯 Drink lots of liquid: 8 to 10 cups/day 2. 養成良好的口腔衛生飯前和飯後用軟牙刷刷牙 Brushing with a soft toothbrush before and after meals 使用無酒精漱口水 - use alcohol free mouthwashes 3. 使用唾液替代品 - Use saliva substitue

19 口乾舌燥 Dry mouth-2 4. 與肉汁和調味汁吃餐食 Eat your meals with gravies and sauces 每咬食品, 喝著液體也使得飲食更容易吃食品 Sipping on liquids after each bite of food also makes eating easier. 5. 吮吸糖果和棒冰治療 Suck on candies and frozen treats 冰凍的葡萄, 冰棍得到嘴需要額外的水分的好方法 6. 睡在房間睡放加濕器, 放了一杯水 Sleep with a humidifier and a glass of water #7: 提高您的睡眠 Improve your sleeping 如果睡時, 嘴打開或打鼾, 身體側睡. 看到一個睡眠專家.

20 神經病理性疼痛 Neuropathy 手指和腳趾麻木 Numbness of fingers and toes 神經性疼痛 Nerve Pain 原因 Causes: 化療 : 紫杉醇 Taxol, Oxaloplatin, 希羅達 xeloda, 長春新鹼 vincristine 感染 Infections, 如帶狀皰疹 Herpes Zoster 營養缺乏 Nutritional deficiency, 如維生素 B12, 神經被壓迫 Pinched Nerve ( 神經卡壓或神經壓縮 )Nerve Entrapment or Nerve Compression

21 神經病理性疼痛的護理 Management of Neuropathy 避免手指和腳趾外傷或受傷可以使用非鴉片類消炎藥 (non steroid): 如 Aleve 或布洛芬 Motrin 鴉片類麻醉藥物 (Narcotics) 外用止痛貼劑 Skin patch 如利多卡因 (Lidocaine skin patch) 按摩 / 針灸 Massage /Acupuncture 局部類固醇注射 (Steroid injection) 用利多卡因 (lidocaine) 或酒精的神經堵塞 Nerve block

22 淋巴水腫疼痛 Pain from lymphedema 淋巴系統 Lymphatic drainage

23 淋巴水腫的治療 Treatment of lymphedema 淋巴水腫袖套 Lymphedema sleeve 按摩和運動 Massage and exercise 睡覺時手臂的支持 Pillow support of arm at night 不要過度使用或重複動作 Do not overuse or repetitive movements 可採取止痛藥

24 淋巴水腫的護理 - 淋巴水腫袖套 Management of lymphedema 淋巴水腫袖套

25 淋巴水腫的護理 -2 Lymphedema Wrapping

26 淋巴按摩 Lymphatic massage

27 Seated Exercises Ball Squeeze Elbow Flexion

28 Floor exercises Elbow Extension Shoulder Horizontal Adduction

29 Lymphedema- Standing Exercises Shoulder Flexion Shoulder Abduction Pole Walking

30 淋巴水腫的護理 Lymphedema 治療乳腺癌的腋窩淋巴結清掃後的手臂和手指腫脹 Swelling of arm and fingers after axillary lymph node dissection for breast cancer 原因是淋巴引流受損 Cause is impaired lymphatic drainage. 避免手臂重複的動作 Avoid repetitive movements on that arm 避免在手術那邊的手臂上抽血 Avoid taking blood drawn on that arm 避免手術那邊的手臂上測量血壓. Avoid taking blood pressure measuring on that arm 避免手術那邊的手臂上針灸 Avoid acupuncture on that arm 一旦手臂受傷或有感染, 傷口癒合不易

31 乳腺隆胸和重建 Breast reconstruction and augmentation

32 乳房切除後使用的胸罩和義乳 Mastectomy Bras and Prosthesis

33 LOS ANGELES, Sept. 23 (UPI) -- U.S. actress and comedian Wanda Sykes says she underwent a double mastectomy after she was diagnosed with breast cancer in

34 乳房按摩 Breast Massage

35 乳房按摩 Breast Massage-2

36 皮膚的變化皮膚乾燥和皮疹 Dryness of skin and skin rahses 皮膚龜裂和裂痕 SKIN CRACKS AND FISSURES 皮膚表皮脫落和皮膚灼傷, 特別是放射治療後 SKIN EXCORIATION AND SKIN BURNS ESPECIALLY AFTER RADIATION THERAPY : 治療方法 : 溫和的肥皂護膚霜, 類固醇藥膏, 抗菌霜或防曬油

37 腸胃道癌症治療的副作用 Side effects from Gastro intestinal cancer treatment 腸切短或胃大部切除術, 全胃切除手術或結腸手術, 消化不良, 腹脹痛, 每天多次排便如果有乳糖不耐症要避免乳製品 Avoid dairy products, if lactose intolerance 避免產生氣體的食物 Avoid gas producing food 按排便和腹脹來滴進食品 Titrate food with bowel movement and abdominal distension

38 結腸癌和結腸造口護理 Colon cancer and Colostomy

39 結腸造瘻袋 Colostomy bags

40 結腸造瘻袋蓋子 Colostomy bag covers

41 骨骼健康和骨質疏鬆症 Bone health and Osteoporosis

42 對骨骼的副作用 Side effects on Bone 一些長期的藥物可能會導致骨質疏鬆症, 例如因淋巴瘤服用類固醇 Some long term medications can cause osteoporosis Such as steroids (prednisone) for lymphoma 因乳癌而服用的藥物 Femara(letrazole), Arimidex, Aromacin 治療前列腺癌的藥如 Lupron

43 骨質疏鬆症的階段 Stages of osteoporosis

44 骨質疏鬆症的預防和護理 Prevention and Care osteoporosis 運動 -Exercise

45 骨質疏鬆症的預防和護理 Prevention and Care osteoporosis 藥物治療 Medications Alendronate (Fosamax) Actonel 35 mg weekly Bonivar 150 mg monthly IV/ PO Bonivar monthly 保健品 Supplements 鈣片 Calcium mg/day 維生素 D Vitamin D unit a day

46 椎體壓縮性骨折的治療 Treatment of Vertebral Compression Fracture 後凸成形術 Kyphoplasty 椎體成形術 vertibroplasty 背部支撐 Back support Vertebroplasty Kyphoplasty

48 癌症倖存者指引 Cancer Survivor guidelines 繼續保持良好的健康 Maintain good health 保持其他癌症的篩檢 Cancer screening 早期檢測癌症復發 Early detection of recurrent disease 保持與醫生作持續性的定期檢查 Close medical follow up

49 注意十項癌症症狀 (Symptoms & signs) 不明原因的體重減輕不尋常的疲勞不尋常的出血不尋常的痛腫脹 / 腫塊 / 腫瘤腸胃習慣的變化, 飲食出問題語音變化, 聲音沙啞咳嗽 / 呼吸困難不易癒合的潰瘍 / 皮膚改變黃疸

50 癌症自我檢查自行決定, 每月一次從頭部到腳趾, 觀察看看, 有或沒有身體變化皮膚改變, 黃疸, 貧血,, 口腔, 聲音沙啞, 頸部腫脹, 乳房自我檢查 : 乳房腫塊或疼痛腹部不尋常的疼痛, 腫脹, 便秘或腹瀉持續咳嗽, 腿部水腫糞便和尿液顏色

51 預防癌症 - 體能運動英一項研究稱多運動每週兩個半小時的運動, 能夠降低 40% 乳腺癌患者的死亡風險或癌症復發降低 30% 左右前列腺癌患者的風險或死於此病減少淋巴水腫重建肌肉力量避免發胖專家提醒說, 運動前先詢問您的醫生

52 美國癌症協會對飲食, 營養和預防癌症的準則 1. 勿吸煙! 勿用煙草產品. 2. 食用各式各樣植物類健康食品. * 每天至少吃 5 種水果和蔬菜 * 選擇全穀類而非精製的穀類 * 控制紅肉的食用量特別是加工過高脂肪的紅肉 * 選擇能維持健康體重的食物

53 美國癌症協會對飲食, 營養和預防癌症的準則 3. 培養活躍的體能生活. * 成人 : 一周至少五天做 30 分鐘的中度活動 * 兒童和青少年 : 每周至少有五天做 60 分鐘的中度至激烈的體能活動 4. 一生維持健康體重 * 以體能活動平衡熱量的攝取 5. 限制飲酒

54 NCCN 的生存護理指南 NCCN GUIDELINES FOR SURVIVALSHIP CARE 保持健康的體重 Maintaining a healthy weight 身體健康的生活方式 Physical healthy life style 營養 Nutrition 禁止吸煙或酗酒 No smoking or alcohol abuse 骨骼健康 Bone health 篩檢和護理 Screening and follow up care 疫苗接種 Vaccination

55 生存健康計劃 Survival Wellness Plan 後續照顧和篩查指南 Follow up care and screening guidelines 保存醫療記錄 keep good medical record 變化生活方式 Life style changes 知道自己的身體和精神的生活限制, 避免進一步的傷害 Living with own limitation and avoid further injury 要有積極的態度, 那是我還是幸運地活著 On positive attitude- I am lucky to be alive.

56 預防癌症 - 注意飲食多吃蔬菜和水果少吃含動物脂肪的食物

UTI (Urinary Tract Infection) - Traditional Chinese

UTI (Urinary Tract Infection) Urinary tract infection, also called UTI, is an infection of the bladder or kidneys. Urethra Kidney Ureters Bladder Vagina Kidney Ureters Bladder Urethra Penis Causes UTI