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In 2022, it was estimated that 18.1 million US adults were cancer survivors. By 2032, this number is projected to increase to 22.5 million. All patients with cancer experience some degree of psychological distress associated with the diagnosis. This can include mental health conditions, most commonly anxiety and depression. Management of such conditions in cancer survivors begins with detection via screening. Commonly used screening tools include the National Comprehensive Cancer Network (NCCN) Distress Thermometer, the 7-item Generalized Anxiety Disorder (GAD-7) scale, and the Patient Health Questionnaire-9 (PHQ-9). Initial management involves patient education and psychotherapy. If needed, pharmacotherapy is similar to that for patients in the general population. Of note, several commonly prescribed antidepressants have been shown to decrease the effects of tamoxifen, which breast cancer survivors may be taking as adjuvant endocrine therapy. Integrative medicine therapies, such as music interventions, yoga, mindfulness meditation, and exercise, have shown benefit. Patients undergoing treatment should have outcomes assessed. Thoughts of self-harm or suicidal ideation are common among cancer survivors with mental health conditions. Clinicians should regularly ask patients about suicidal ideation. If present, this indicates the need for more intensive or altered treatment.

In the United States, prostate cancer is the most common nonskin cancer in men. Approximately 12.6% of US men will be diagnosed with this cancer in their lifetimes. Although the overall 5-year relative survival rate is high (96.8%), ethnic and racial disparities have been shown to affect survival. There also are genetic risks. If the family history of the patient includes familial cancers, the patient and family members should be referred for genetic counseling and testing for cancer-associated sequence variants. Prostate cancer treatments have significant long-term effects. After radical prostatectomy, 27% to 29% of patients experience urinary incontinence and 66% to 70% have erectile dysfunction. These effects also can occur after radiation therapy, though at lower rates. Mild urinary incontinence can be managed with incontinence pads. The most effective treatments are artificial urinary sphincter implantation and urethral sling procedure. Urinary incontinence after radiation therapy tends to decrease over time. Symptoms of urinary urgency or nocturia can be managed with anticholinergic drugs. Erectile dysfunction typically is managed with oral phosphodiesterase type 5 inhibitors and/or vacuum pump erectile devices. Androgen deprivation therapy increases cardiovascular risk by increasing insulin resistance and blood pressure. This therapy also is associated with osteoporosis, so patients with nonmetastatic cancer and one or more risk factors for fracture should be offered fracture risk assessment and bone mineral density testing.

Colorectal cancer (CRC) survival is influenced by numerous factors, including age, sex, race and ethnicity, familial cancer syndromes, stage and location of tumor, and comorbid conditions. The 5-year survival rate for patients with stage I CRC is 91%, but it is only 15% for patients with stage IV CRC. These survivors may experience multiple health issues. Gastrointestinal dysfunction is common, even years after treatment. This can include chronic diarrhea, occurring in approximately half of patients, and fecal incontinence, which is common after radiation therapy. Bladder dysfunction can occur due to surgical injury or radiation therapy. Many patients also experience sexual dysfunction. Standard therapies can be used to manage many of these symptoms and conditions. Patients with colostomy typically experience decreased quality of life. Referral to an ostomy therapist or wound, ostomy, and continence nurse may be beneficial. Pelvic radiation therapy can reduce bone mineral density (BMD) and increase fracture risk, so patients with rectal cancer who have received such therapy should undergo BMD monitoring. CRC survivors should undergo surveillance for recurrent CRC with interval colonoscopy, measurement of carcinoembryonic antigen levels, and computed tomography scan of the chest, abdomen, and/or pelvis. The intervals for and duration of surveillance depend on the cancer stage. Family physicians can help support CRC survivors through survivorship programs, shared care models, multidisciplinary interventions, and community partnerships.

A minority of cancer survivors meet guideline recommendations for nutrition and physical activity. There is a high prevalence of obesity in adult cancer survivors. It has been shown to increase cancer recurrence risk and be associated with poorer survival. There also is a high prevalence of malnutrition in patients with cancer. Those at highest risk include older patients, patients with advanced cancer, and patients with cancers that affect organs and body systems involved in eating and digestion. All patients with cancer should be screened regularly for the risk or presence of malnutrition. The Malnutrition Screening Tool (MST) has been validated for such screening. Individualized counseling by a dietitian can help patients achieve optimal intake. Patients should achieve adequate caloric (25-30 kcal/kg body weight) and protein (more than 1 g/kg) intake, have vitamin and/or mineral deficiencies corrected, and consider taking fish oil or long-chain N-3 fatty acid supplements. Enteral nutrition is recommended if food intake is inadequate, and parenteral nutrition can be considered if enteral nutrition is not possible or adequate. Physical activity is recommended. Standard recommendations are for at least 150 min/week of physical activity, with 300 minutes/week considered ideal. In general, supervised exercise programs have been shown to be more effective for cancer survivors than home-based exercise programs. Behavioral interventions that provide methods or materials to support behavior change (eg, fitness tracking devices, fitness classes) tend to be most effective.

In adults, chronic cough is a nonproductive or productive cough lasting longer than 8 weeks. Coughing is a reflex to clear the lungs and airways, but repetitive, long-term coughing can cause chronic irritation and inflammation. Approximately 90% of chronic cough diagnoses have common nonmalignant etiologies, including upper airway cough syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis. In addition to history and physical examination, initial evaluation for chronic cough includes pulmonary function testing and chest x-ray to assess the lungs and heart and for fluid overload, and evaluate for neoplasm or lymph node enlargement. If the patient has red flag symptoms, such as fever, weight loss, hemoptysis, or recurrent pneumonia, or has persistent symptoms despite optimal drug treatment, advanced imaging with chest computed tomography scan is indicated. Management of chronic cough includes identifying and managing the underlying cause as outlined in the American College of Chest Physicians (CHEST) and European Respiratory Society (ERS) guidelines for chronic cough. In diagnoses of refractory chronic cough with uncertain etiology and a negative evaluation for life-threatening causes, cough hypersensitivity syndrome should be considered and managed with gabapentin or pregabalin and a trial of speech therapy.

Wheezing is a common presenting concern in the primary care setting, but its etiology can be elusive. Wheezing is associated with many disease processes, but most commonly, asthma and chronic obstructive pulmonary disease. Initial tests for wheezing typically include a chest x-ray and pulmonary function testing with bronchodilator challenge. Advanced imaging to evaluate for malignancy should be considered in patients older than 40 years with a significant history of tobacco use and new-onset wheezing. A trial of short-acting beta agonists can be considered while awaiting formal evaluation. Because wheezing is associated with reduced quality of life and increased health care costs, it is essential to develop a standardized evaluation of this common concern and expeditiously manage symptoms.

Hemoptysis is the expectoration of blood from the lower respiratory tract and has an extensive differential diagnosis that can be divided into pseudohemoptysis, infectious, neoplastic, vascular, autoimmune, and drug-related categories. Pseudohemoptysis is the expectoration of blood from a different source and needs to be ruled out. Clinical and hemodynamic stability must be established first. Chest x-ray is the initial imaging examination for all patients with hemoptysis. However, advanced imaging, such as a computed tomography scan, is helpful for further evaluation. Management aims to ensure patient stabilization. Most diagnoses are self-limited, but bronchoscopy and transarterial bronchial artery embolization can be used to manage massive hemoptysis.

Dyspnea is a common presenting symptom that may derive from pulmonary or extrapulmonary origins. Dyspnea may develop from exposure to drugs or environmental and occupational factors, so a thorough history and physical examination may help differentiate the cause. Chest x-ray followed by chest computed tomography scan if needed is recommended as the initial imaging test for pulmonary-related dyspnea. Nonpharmacotherapy options include supplemental oxygen, self-management with breathing exercises, and airway interventions with rapid sequence intubation in emergency situations. Pharmacotherapy options include opioids, benzodiazepines, corticosteroids, and bronchodilators. After the diagnosis is identified, treatment focuses on optimizing dyspnea symptoms. Prognosis depends on the underlying condition.