Follow-up Care After Cancer Treatment

Cancer care does not end when you finish treatment. You will continue seeing your health care team for follow-up care. They will watch for signs of the cancer coming back, manage any side effects from treatment, and check your general health.

Planning your follow-up care after cancer

You and your health care team will work together to plan your follow-up care. Your plan will be designed just for you. It will guide your health care for the months and years after treatment. It will probably include regular physical examinations and medical tests.

A follow-up care plan is often based on the medical guidelines for your specific type and stage of cancer. Your doctor will also keep your needs and wishes in mind when planning follow-up care.

Having a follow-up care plan can help you feel more in control as you go back to your everyday life after treatment. When you have a medical support system in place, it can help you feel better physically and emotionally.

Who manages follow-up care after cancer?

After your cancer treatment ends, you might continue to see the cancer care team that managed your treatment. Or you might go back to your primary care doctor or other health care provider. You also might be sent to a survivorship clinic. Who you see depends on:

• The type and stage of cancer you were treated for
• The kind of treatment you had
• Any side effects you had or still have
• Your health insurance
• Your wishes

Watching for signs of cancer recurrence or a second cancer

Watching for signs of cancer recurrence (cancer coming back after treatment) is an important part of follow-up care. Even if test results don’t show any sign of cancer after treatment is complete, there might be very small areas of cancer cells still in your body . These cells might die on their own, or they might grow until they cause symptoms or show up on test results as a cancer recurrence.

The chance that a cancer will come back depends on the type of cancer you had and other factors. There is no way to know whether a cancer will come back or not. But a doctor who knows your medical history can talk with you about your risk and tell you if there are ways to lower it.

Your health care team will also watch for signs of a second cancer. A second cancer is a new, different cancer, not related to the first cancer that was found. Your risk of getting a second cancer depends on many factors.

During your follow-up visits, your doctor will ask questions about your health. You might also have blood or imaging tests based on:

• The type and stage of cancer you had
• The treatment you received
• If research shows testing could improve your health or help you live longer

Your doctor may ask you to watch for specific signs of cancer coming back. You might also need to have regular screening tests for other types of cancer, such as for cervical, breast, colorectal or lung cancer.

How are late and long-term side effects managed after cancer treatment?

Many people have side effects during cancer treatment. But side effects can also continue after treatment or start after treatment is finished.

• Long-term side effects begin during treatment and continue after treatment is done.
• Late side effects can start months or even years after treatment ends.

Long-term and late effects of cancer and cancer treatment can include both physical and emotional changes. 

Talk with your health care team about your risk of developing long-term and late side effects. Your risk will depend on the type of cancer you had, the treatment you received, and your overall health.

Your follow-up care should include a review of your symptoms, physical exam and other tests as needed. This might include blood tests to check your blood counts, and to see how your liver, kidneys and other body organs are working.

If you had a treatment that is known to cause certain late effects, your follow-up care might include certain tests. Examples include:

• A yearly thyroid gland examination if you had radiation therapy to the head, neck, or throat.
• Lung function tests if you received a drug called bleomycin (Blenoxane) or had a bone marrow (stem cell) transplant. Lung function tests show how much air your lungs can hold and how quickly air moves in and out of them.
• Regular electrocardiograms (EKGs) if your treatment included radiation therapy to your chest. EKGs are also used if you got chemotherapy that can affect how the heart works.
• Regular mammograms if you got radiation therapy to your chest when you were less than 40 years of age.

Ask your doctor about the most appropriate tests for you. Learn more about side effects of cancer treatments and ways to manage them.

Keeping copies of treatment summary and follow-up care needs

After you finish treatment, keep a record of your cancer diagnosis and the treatment. Records like a cancer treatment summary and a survivorship care plan will help any health care providers who you see in the future.

Cancer treatment summaries most often include:

• Date you were diagnosed
• The type of cancer you had, including where is started (tissue or cell type), stage, and grade (if known)
• A list of the treatments you received and the dates you received them, including the type of treatment, dose, and number of treatments or treatment cycles
• Any medical information from your time in treatment, such as the side effects you had and how they were managed
• The results of any tests you had

Survivorship care plans most often include:

• Any treatments for cancer that still need to be done
• How often you should have check-ups
• What tests you will need as a part of your check-ups
• What long-term or late effects you may have
• Ways to improve your overall health after treatment

Details about the treatments you got and your follow-up care needs will help your primary care provider or other health care professionals. There are forms that can be filled out to include details of your cancer, cancer treatment, and follow-up care needs.  A member of your cancer care team may be able to help you with this.

Having these forms can help guide the follow-up care given by the health care provider you see after treatment ends. This information is also helpful if you change doctors in the future.

Questions to ask your health care team

Consider asking your health care team these questions about your follow-up care.

• What is the chance of the cancer coming back? Are there symptoms I should watch for?
• What should I do if I notice one of these symptoms?
• What long-term or late side effects might I get?
• How can I get a copy of a treatment summary and follow-up care plan?
• Who will be in charge of my follow-up care? Do they have experience with cancer survivors?
• How often do I need follow-up visits?
• What screening tests do you recommend, based on my treatments?
• How long will I need these tests?
• Do I need to take any special medicines or eat a special diet?
• How can I lower my risk of the cancer coming back or of getting a second cancer?
• Who can I talk with if I am very anxious or worried about the cancer returning?
• What survivor support services are available to me? To my family?