Region Syd, jan 2020Peter Christensen, professor, overlæge, dr.med.

Klinik for bækkenbundslidelser, Mave Tarm Kirurgi

Aarhus Universitetshospital

Klinik for senfølger til kræft

i bækkenorganerne

Forbedret overlevelse | 40 års trend I overlevelse af endetarmskræft

Quaresma et al, Lancet 2015

% Survival

Senfølger efter kræft i endetarmen

Tarm SmerteSexBlære

Major Minor No

41%

Major Minor No

38% 13%43%

Major Minor No

Senfølger efter kræft i endetarmen

Tarm SmerteSexBlære

Major Minor No

41%

Major Minor No

38% 13%43%

Major Minor No

Multiorgan involvering | multidiciplinær behandling

Algoritmer for behandling

Fra ‘smart data’ til behandling | ressourceeffektiv hjælp

Strategisk satsningsområde 2017 | senfølger efter kræft

10 mio d.kr. over 3 år

Senfølger efter kræft i bækkenorganerne

AALBORG AALBORG

From Bench to Bedside to Healthcare Beyond CancerA

cro

ss

Pelv

icO

rgan

Can

cers

Cross sectional

Prospective Patophys. Clinical Trials PreventionSocioeconomy

Colon DCCG cohort Smart data DCCG Diarrhea,microbioma

Cancer seqv ClinicsTreatment Algorithm Two RCTs:BAM + diet

Impact and workrealtionQUALY and Cancer seqv Clinics

Rectum DCCG cohort Smart data DCCG HRM and LARSEmpty,Size mattersChronic pain

Cancer seqv ClinicsTreatment Algorithm Sex and cureTwo RCTs:Klyster vs TAI +Pain treatment

Impact and workrelationQUALY and Cancer seqv Clinics

Anal PROM development AUH, DACG

Dose vs function Size matters Cancer seqv ClinicsTreatment Algorithm

Dose vs toxicity

Bladder National surveyDBCG

Optional

Prostate National survey DPCG

Optional

Cervix National surveyDGCG

Monitor Chronic pain MonitorPain treatment

Dose vs toxicity Optional

Algorithms for treatment

From ‘smart data’ to treatment | resource effective help

1066 Invited

161 RC, 905 CC

864 included

Response rate: 81.1 %3, 12, 24, and 36 months response rates: 82.5, 84.5, 80.0 and 73.2 %

Age, median (range): 71 (21-98)

Males: 53.6 %

Online : 75.9 % (Age >80, 54.7 %)

systematic screening for late sequelae after colorectal cancer

16. apr 2018 – 9. sep 2019

RC 3m RC 3m After stomareversal

RC 12m RC Total CC 3m CC 12m CC 24m CC 36m CC Total

Surveys (n) 132 10 17 159 310 268 213 152 943

Patients contacted by phone (n, %)

37 (28 %) 4 (40 %) 4 (24 %) 45 (28 %) -- 47 (18 %) 46 (22 %) 25 (16 %) 118/633 (19%)

Patients referred (n, %)

23 (17 %) 3 (30 %) 1 (7 %) 27 (17 %) __ 23 (9 %) 23 (11 %) 13 (9 %) 59/633 (9 %)

Type of late sequelae*

Bowel: 6Urology: 6Pain:2Sexual: 13Stoma: 1Hernia:1

Bowel: 3Sexual: 1

Gyn:1 Bowel: 9Urology:6 Pain:2Sexual: 14Stoma: 1Hernia:1Gyn:1

___ Bowel: 20Fatigue:1Pain:2

Bowel: 19Urology:1Fatigue:1Bleeding:1Pain:3hemorrhoids:1

Bowel: 11Pain:1Fatigue:1

Bowel: 50Fatigue: 3Bleeding: 1Pain: 6hemorrhoids:1

Answers to surveys

Case 1

• 64 årig mand• Opereret for endetarmskræft med resektion og primær anastomose

i 2016 forudgået af kemo-strålebehandling• Han har nu ‘lav anterior resektions syndrome’, LARS

– 10-30 afføringer per dag, Bristol Stool Type 4– Bydende afførginstrang/urgency– Inkontinens– Fragmenteret afføring

• Ikke genvundet rejsningsevne og det går ham på• Er derudover træt, har svært ved at sove om natten

• Hvad skal man stille op?

Case nr 2

Som 31 årig, strålebehandlet for cervix cancer

Mave-tarmsymptomer siden da, mest diare, er nu 59 år

Set af et utal af kirurger og onkologer

Prøvet forskellige konservative regimer uden effekt

Hvad skal man stille op?

Nurse led clinics | ‘optimised’ conservative treatment

I can help! Optimised Conservative Treatment

Algorithm-based

Motivational interview

Individual goal – setting

List of medication

Lifestyle and habbits

Diet regulation (not always more fibres)

Loparomide

Rectal emptying with suppositories or

mini-enemas

Proposed treatment algorithm | major LARS

Consult a

gastroenterologist

in diarrhoea-like

stools

Work up by the Gastroenterologist |

What can I

do?

Sexuel dysfunction | gender depended algorithm

Bladder dysfunction |

> 400 patients evaluated, treated and monitored

https://www.auh.dk/om-auh/afdelinger/senfolger-efter-kraft-i-bakkenorganerne/

27

International perspective

PRO booklet translated: Holland, UK, USA,

Sweden?, Norway?, Portugal?

National perspective

Vision: all danish colorectal cancer patients screened

for late adverse effect and offered treatment.

Scale to all major cancer types

Live on National Television, Oct 2019 | late adverse effects following cancer

Magnus Heuniche

Danish Minister of Health

”thank you for bringing

this up…”

”kick in an open

door…”

”this needs to be

established in every

region in Denmark…”

The essential components in a pelvic rehabilitation centre |

AARHUSUNIVERSITY

@PeterCh12345