Follow-up Care and Monitoring

Executive Summary

Follow-up care for breast cancer refers to the after-treatment protocols conducted by the healthcare team to look after any recurrence, manage the side effects, and monitor the patients’ overall health. Both medical and physical examinations are included in the follow-up care of breast cancer. Watching the recurrence of breast cancer are seen in test reports of follow-up care. Annual mammograms are also recommended after a diagnosis of breast cancer. The doctor will propose checks and testing to check for late effects based on the sort of breast cancer treatment the patient underwent, mainly involving surgery such as mastectomy or lumpectomy. Managing the side effects while receiving treatment is a critical follow-up care approach. Personalizing the follow-up care plan is essential for patients with breast cancer conducted by the medical care team. Effective communication with the doctor regarding the long term effects of all the treatments will be effective in the upcoming future.

Follow-up Care for Breast Cancer

The Follow-up Care and Monitoring for people diagnosed with cancer does not end when the treatment ends. Your medical team will continue to check that the cancer has not returned, manage side effects, and monitor your general health. It is called follow-up care. Your follow-up care may include regular checkups, medical tests, or both. Doctors want to monitor your recovery over the coming months and years. Follow-up care is also needed to screen for other types of cancer.
In some cases, patients can visit a survival clinic specializing in the post-treatment needs of people diagnosed with breast cancer ^​1​. Cancer rehabilitation may be recommended, which means many services, such as physical therapy, career counselling, neurocognitive testing, pain management, nutritional planning, and emotional counselling. Rehabilitation aims to help people regain control over many aspects of their lives and stay independent and productive.

Monitoring for Recurrence

One follow-up care and monitoring goal are to check for recurrence, which means cancer has returned. In situ or early stage, breast cancer treatment is given to remove as many cancer cells in the body as possible. However, cancer comes back because small areas of cancer cells that do not respond to treatment may not be detected in the body. Over time, these cells can increase in number until they show up on test results or cause signs or symptoms.

A doctor who knows your medical history can provide you with personalized information about your risk of recurrence during Follow-up Care and Monitoring. Understanding the risk of recurrence and treatment options can help you better prepare if your cancer comes back and help you make decisions about your treatment. Breast cancer can come back in the breast or other parts of the body. 

Usually, relapse is when a person has unusual symptoms or results during a physical exam. Annual mammograms are also recommended after a diagnosis of breast cancer ^​2​. Symptoms depend on where cancer has recurred and may include –

• A lump under the arm or along with the chest wall Pain that is persistent worsens and does not get better with over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDs)
• Bone, back, neck or joint pain, fracture, bone or swelling are possible signs of bone metastases. 
• Headache, convulsions, dizziness, confusion, personality changes, loss of balance, nausea, vomiting or blurred vision are possible signs of brain metastasis. 
• Chronic cough, shortness of breath, or difficulty breathing, are possible symptoms of lung metastasis 
• Abdominal pain, itchy skin or rash, or yellowing of the skin and eyes due to a condition Jaundice may be related to liver metastases. 
• Changes in energy levels, such as feeling unwell or extremely tired 
• Loss of appetite and weight loss
•  Nausea or vomiting
• Rash or skin changes on the breast or chest wall
• Change in shape or size of breast or swelling of the breast or arm

Your surgeon must explain what your breasts will look like after surgery and when radiation therapy is used. Over time, breasts will soften and change. But knowing what your breasts look like can help you understand what’s “normal” and what isn’t. If you have any questions or concerns about a symptom, you should talk to your doctor. Your doctor will ask you specific questions about your health during follow-up appointments. Recommendations for regular follow-up care depend on several factors, including the type and stage of diagnosed cancer and the types of treatment given. Before taking a follow-up test or waiting for test results, anticipation can be stressful for you or a family member. It is sometimes called “scanxiety.”

Managing long-term and late side effects

Most people expect to experience side effects when they receive treatment. However, survivors are often surprised that some side effects persist beyond the treatment period. These are called long-term side effects. Other side effects called late effects may appear months or even years later. The long-term and late effects can include physical and emotional changes. Talk to your doctor about the risk of developing such side effects depending on which type of cancer, your treatment plan, and your general health. If you have had a treatment known to cause specific late effects, you may have certain physical exams, tests, or blood tests as part of follow-up care to help find and manage them.

Also Read: How Exercise Reduces Cancer Risk

Long-term effects of surgery

After a mastectomy or lumpectomy to treat early- or late-stage breast cancer in situ, the breasts may be scarred and have a different size or shape than before surgery. Or the area around the surgery may become hard. If lymph nodes are removed as part of surgery or affected during treatment, lymphedema in the arm, chest wall or breast can occur even years after treatment. It is a lifelong risk for survivors.

Long-term effects of radiation therapy

Some survivors experience shortness of breath, dry cough, or chest pain 2 to 3 months after radiation therapy ends. It is because radiation therapy can cause swelling and stiffness or thickening of the lungs called fibrosis. These symptoms may seem similar to pneumonia but do not go away with antibiotics. Symptoms are cured with medications called steroids. Most people recover completely with treatment.
Talk to your doctor if you develop any new symptoms after radiation therapy or if the side effects don’t disappear—long-term results of trastuzumab or chemotherapy. People already receiving trastuzumab or certain types of chemotherapy called anthracyclines may have an increased risk of heart problems.
Talk to your health care professional about the best ways to check for heart problems. And about the Follow-up Care and Monitoring. Patients receiving chemotherapy are also at increased risk for other long-term side effects, such as symptoms of menopause, fatigue, chemotherapy, permanent numbness, and tingling in the fingers and toes.

Long-term effects of hormone therapy

Women taking tamoxifen should have an annual gynaecological exam, as this medicine may slightly increase the risk of uterine cancer. This risk increases with the duration of hormone therapy. Let your doctor or nurse know if you notice any unusual vaginal bleeding or other new symptoms, as you may need some more tests to learn more about the cause. Women taking an IA, such as anastrozole, exemestane, or letrozole, should have their bone density checked periodically during treatment, as these drugs can cause bone weakness or bone loss.

Additionally, in situ women recovering from early-stage or late-stage breast cancer may have other side effects that may persist after treatment. However, they can get controlled with medication or other options. Women recovering from early or late-stage breast cancer in situ may also experience the following long-term effects:

• Menopausal symptoms, such as hot flashes 
• Joint pain
• Fatigue 
• Mood swings 
• Depression and Anxiety 

Vaginal dryness and decreased sex drive are common side effects during or after early and in situ breast cancer treatment. Talk to your doctor about these or other sexual health problems. Treatment is individualized for each patient and type of cancer and can best be managed by a gynecologists’ who works with your oncologist.

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