**2. Role of primary care providers (PCPs) in breast cancer survivors**

Depending on number of survivor's, primary care physicians should have access to the evidence and be able to provide care and follow up. Breast cancer prevalence rates are alarming due to the growth and aging of the population [27]. Women are able to survive with breast cancer after treatment that follows up routinely to detect any recurrence and manage late and long-term outcomes of treatment [28]. Breast cancer survivors are growing in number with increase in cost for their well-being, follow up and other medical care facilities [29]. The role of primary care providers is increasingly being taken up for follow-up care and same should be maintained as we have limited secondary care facilities [30]. There should be a systematic registry and data maintenance that follow up is being done and breast cancer survivors are effectively treated in primary care [3]. There is a short and long term side effect on health of breast cancer survivors including physical, emotional, sexual and social consequences such as pain, depression, fatigue, weakness [31]. The loss of confidence in leading a normal life is one of the increasing factors which is treated by primary care system and are involved more as compared to control patients [32]. It is important that PCPs should provide good and maximum care to cancer survivors and need of patient's should be satisfied. PCPs prefer to guide on disease recurrence and risk management involved in cancer treatment and survival of patient [32]. The evidence based recommendations are provided to PCPs for cancer survivors and are available for clinical practice guidelines [32]. Most of the recommendation is available on how recurrences occurs in a breast cancer patient and are concerned with diagnosis [3, 33]. Mammography has been recommended to breast cancer patients on follow-up in five guidelines and physical examination of breast in three of them [3, 33]. Ultrasound is recommended in one of the guideline while undergoing mammography [33]. All these guidelines advise genetic counseling for risk factors and patients are educated enough to know about signs and symptoms of recurrence or any other underlying cause and sign, how to resolve it and inform your medical advisor [3, 33].

observed physical and emotional features in breast cancer survivors, such as adjustment disorder, cognitive dysfunction, or other vasomotor symptoms, psychosocial distress, and

> Lymphedema Neurological disorder

Skin color change Asymmetric breast Sexual disturbance Ataxia telangiectasia-

normal

Neural dysfunction lymphedema

Difficulty in breath fibrosis Cardiovascular disease

Osteoporosis/osteopenia

heart failure) with chemotherapy Leukemic malignancies at increased risk with alkylating agents, anthracyclines, other

topoisomerase II inhibitors

premenopausal women

fracture

Mental depression, tension, headache, unpleasant behavior, social distress, physically un well, pain, end of life bad dreams, death fear, social difficulties, sexual problems,

Breast volume not same in both affected and

Breast Cancer: Management and Survivorship http://dx.doi.org/10.5772/intechopen.82297 21

Second primary cancers arise of soft-tissue thorax, cervical, shoulder, lung cancer

Cardiovascular risk factors at increased level increased risk of (cardiomyopathy, congestive

Increased cardiovascular diseases, cervical cancer, blood clotting, bone malformation in

Osteoporosis, bone malformation, bone

**Treatment type Long-term shortcomings Late shortcomings**

Skin is sensitive to pain

change. Sexual disturbance. Impaired movement. Motion poor weakness

Impaired pain or weakness of the

Gain of body weight and mass, fat accumulation increases, neurological disorders, weight gain, oral, hair loss

Surgery Loss of dermal sensation. Body shape

Weakness

Pain Pneumonitis Poor dressing sense Breast atrophy Lymphedema

Impaired pain

upper limb

Chemotherapy Sexual disturbance fertility decreased

Weakness

Tamoxifen Hot flashes, menstrual cycle irregular, mood swings

Aromatase inhibitors Vaginal dryness, sexual dysfunction,

Trastuzumab Cardiac arrest, cardiac dysfunction

Ovarian dysfunction

Increased triglycerides

cholesterol increased

muscle pain, neurological disorder,

relations problems, financial shortcomings

**Table 1.** Long term and short term short comings of breast cancer therapeutic interventions.

fatigue and insomnia.

Radiation therapy to the breast including chest adjacent wall lymphatic

nodes

*Hormonal therapy*

*Targeted therapy*

Psychosocial long-term and late shortcomings
