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However, Nekhlyudov said that information about survivorship has not been uniformly transferred to community and academic health care settings. Ganz added that although some public attention is paid to the concerns of cancer survivors, many survivors remain unaware of their risk of recurrence and late efects, and have no plan for follow-up care. In discussing the need for survivorship care plans, Ganz indicated that clinicians can beneft from knowing the types of cancer treatment the survivor had, the potential late efects associated with those treatments, and their expected time course. For example, if a survivor had radiation directed to the chest, any clinician seeing the survivor needs to know about the risk of cardiac late efects. The risks of late efects need to be communicated to the survivor as well, in a way that he or she can understand, said Ganz. Recommendation 2: Patients completing primary treatment should be provided with a comprehensive care summary and follow-up plan that is clearly and effectively explained. Recommendation 3: Health care providers should use systemically developed evidence-based clinical practice guidelines, assessment tools, and screening instruments to help identify and manage late effects of cancer and its treatment. Existing guidelines should be refned, and new evidence-based guidelines should be developed through publicand private-sector efforts. Recommendation 8: Employers, legal advocates, health care providers, sponsors of support services, and government agencies should act to eliminate discrimination and minimize adverse effects of cancer on employment, while supporting cancer survivors who have shortand long-term limitations in ability to work. Recommendation 9: Federal and state policy makers should act to ensure that all cancer survivors have access to adequate and affordable health insurance. Insurers and payors of health care should recognize survivorship care as an essential part of cancer care and design benefts, payment policies, and reimbursement mechanisms to facilitate coverage for evidence-based aspects of care. New research initiatives focused on cancer patient follow-up are urgently needed to guide effective survivorship care. She said an important fnding in From Cancer Patient to Cancer Survivor was that the Chronic Care Model applies to the care of cancer survivors because nearly all of them need chronic monitoring and follow-up. The model posits that the quality of care benefts from an interaction between the community. Ganz noted that the advent of many electronic tools should make these communications easier than they were more than a decade ago.

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Note that glycyrrhizin had no effect on addition, the potassium-depleting effect of liquorice would be endogenous cortisol levels in 7 control subjects without adrenal expected to be additive with loop and thiazide diuretics. Nevertheless, in patients with poorly Experimental evidence controlled blood pressure it may be prudent to ask about liquorice Several experimental studies have found that glycyrrhizin and consumption to establish whether this could be a factor. Deglycyrrhizinated liquorice would not be In vitro, glycyrrhetinic acid (the aglycone of glycyrrhizin), expected to have these effects. Licorice-induced hypertension and syndromes of apparent acid may slightly delay the clearance of hydrocortisone and mineralocorticoid excess. Dexamethasone appears to attenuate the mineralocorticoid effects Importance and management of glycyrrhizin because it suppresses endogenous cortisol secretion Evidence appears to be limited to one case. Any herbal preparation that can reduce Importance and management potassium levels would be expected to increase the risk of digoxin the clinical importance of these observations is uncertain. However, note that, if prednisolone and markedly potentiated the cutaneous effects of these laxatives are used as recommended (at a dose producing a hydrocortisone. Glycyrrhizin induces mineralocorticoid activity through alterations in cortisol metabolism in the human kidney. Effect of glycyrrhizin on the pharmacokinetics of prednisolone following low dosage of prednisolone hemisuccinate. Liquorice + Iron compounds Clinical evidence An 84-year-old man taking digoxin 125micrograms daily and the interaction between liquorice and iron compounds is based furosemide 80mg daily complained of loss of appetite, fatigue and on experimental evidence only. Potassium loss caused by a enhance the bioavailability of medicinal iron, but further study is combination of the liquorice, rhubarb and diuretics exacerbated the needed to assess the clinical relevance of this. Bioavailability of glycyrrhizin from Shaoyao-GancaoTang in laxative-treated rats. Evidence and mechanism (a) Additive potassium depletion Liquorice root may cause water retention and potassium depletion. Note that a similar combination laxative of liquorice with rhubarb caused mild hypokalaemia and digoxin toxicity, see Liquorice + Digoxin, the interaction between liquorice and ulcer-healing drugs is page 274. Chinese medicine containing liquorice (gancao), of which glycyrImportance and management rhizin is a major constituent. There appear to be no clinical data regarding an interaction between Importance and management liquorice and ulcer-healing drugs. The findings of the single-dose experimental study suggested that the clinical efficacy of shaoyaothe possible additive potassium depletion in patients given liquorice gancao-tang in peptic ulcer disease might be reduced by the and anthraquinone-containing laxatives (such as senna and rhubarb) L concurrent use of antibacterials used to eliminate Helicobacter is a theoretical interaction, but bear it in mind in patients who are pylori infection. However, the multiple-dose study suggests that, taking liquorice and who are regular users/abusers of anthraquinonewith repeated doses of the herbal medicine, the interaction might not containing substances. Mu Y, Zhang J, Zhang S, Zhou H-H, Toma D, Ren S, Huang L, Yaramus M, Baum A, increased its clearance by 57%.

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