Priority 6 from the Living With and Beyond Cancer PSP

UNCERTAINTY: How can the short-term, long-term and late effects of cancer treatments be (a) prevented, and/or (b) best treated/ managed? (JLA PSP Priority 6)
Overall ranking	6
JLA question ID	0073/6
Explanatory note	Not available for this PSP
Evidence	There are studies into chemotoxicity and its effect on the brain but not everything is known about it yet. Similar with radiotherapy we know it can effect cognitive function but we don’t know how to manage it better. It is possible to have a profile of risks for each treatment but long term data is poor because clinical trials don’t collect a) the right data b) long term data. This is an issue to raise with the wider research community. Schagen SB, Muller MJ, Boogerd W et al. Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. J Natl Cancer Inst 2006;98:1742-5 Hermelink K, Untch M, Lux MP, et al. Cognitive function during neoadjuvant chemotherapy for breast cancer: results of a prospective, multicenter, longitudinal study. Cancer2007;109:1905-13 Lots of advances in radiotherapy to minimise toxicity, limiting doses Proton therapy, SABR therapy. Less known about managing effects. Publication pending on testosterone replacement therapy. Long-term effects of surgery are known. Getting assessment and referral to specialists are not done. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers 10.1002/14651858.CD012529.pub2
Health Research Classification System category	Cancer

Extra information provided by this PSP
Original uncertainty examples	How does one cope best with long term side effects, e.g fatigue, changed body shape etc? ~ Testosterone replacement therapy following testicular cancer and the way to cope with the ups and downs. ~ How can the possibility of small intestine bacterial overgrowth be avoided if you have had major surgery on your oesophagus / stomach and PPI medication switches off the stomach acid that keeps the normal healthy bacterial balance in your intestines? ~ Heart problems are well known to be related to chemo and radiotherapy but is there any research about CVA/TIAs post treatment, either incidence or prevention? ~ Are there alternatives to platelet transfusion for patients with chemotherapy-induced thrombocytopenia?
Submitted by	Individual survey submissions categorised by Healthcare professional, Patient, Relative/Carer, Other, and Unknown. For full details of the type of submitter for each individual question, please see the spreadsheet of data held on the JLA website.

Extra information provided by this PSP

Original uncertainty examples

How does one cope best with long term side effects, e.g fatigue, changed body shape etc? ~ Testosterone replacement therapy following testicular cancer and the way to cope with the ups and downs. ~ How can the possibility of small intestine bacterial overgrowth be avoided if you have had major surgery on your oesophagus / stomach and PPI medication switches off the stomach acid that keeps the normal healthy bacterial balance in your intestines? ~ Heart problems are well known to be related to chemo and radiotherapy but is there any research about CVA/TIAs post treatment, either incidence or prevention? ~ Are there alternatives to platelet transfusion for patients with chemotherapy-induced thrombocytopenia?

Submitted by

Individual survey submissions categorised by Healthcare professional, Patient, Relative/Carer, Other, and Unknown. For full details of the type of submitter for each individual question, please see the spreadsheet of data held on the JLA website.

PSP information
PSP unique ID	0073
PSP name	Living With and Beyond Cancer
Total number of uncertainties identified by this PSP.	54 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	11 June 2018