Overview of long term care of breast cancer survivors

Breast cancer, the most common cancer in women in developed countries, has a generally excellent prognosis, therefore long-term survivors living with the consequences of breast cancer (‘survivors’) and its treatment are an increasing group in clinical practice. This review discusses the complex issues relevant to survivorship care, including current recommendations for ongoing adjuvant hormonal therapy (tamoxifen and aromatase inhibitors), and the management of side effects of cancer treatment (such as menopause, arthralgia, and lymphoedema). Annual mammography screening is advised for detection of second breast cancers, and symptom-directed assessment is warranted where there is suspicion of distant recurrence or (in women using tamoxifen) of endometrial cancer. Management of menopausal symptoms, including treatment-induced premature menopause, is a key issue for many survivors, and can be challenging to manage as conventional hormone replacement therapy is contraindicated in most of these women. Specific therapeutic options for hot flushes and vaginal symptoms are discussed. The review also emphasises the need for survivorship care to include optimisation of general health, including psychosocial and sexual health, bone health and the evaluation of lifestyle-related risk factors and genetic factors. The review provides guidance on the management of many of these issues, and highlights areas requiring further evidence and research.