Once primary treatment for oral and oropharyngeal cancer has been completed, survivors usually visit a doctor or cancer care provider for regular check-ups and consultations. There are various types of follow-ups for cancer patients, such as follow-up for surveillance and screening, assessment and management of long-term effects, health promotion, and care coordination.
Once primary treatment for oral and oropharyngeal cancer has been completed, survivors usually visit a doctor or cancer care provider for regular checkups and consultations. This is called follow-up. How often cancer survivors should contact the doctors or care providers depends on factors such as cancer stage and cancer type, type of treatment, patient’s requirement, and the hospital arrangement for follow up checkups.
The patients usually have to follow up appointments to check how they are and see whether they have any problems or worries. The appointments also give the patient’s the chance to raise any concerns they have about their progress1.
Follow up for surveillance and screening.
One of the most frequent concerns of cancer patients is the fear of cancer recurrence. Doctors in such cases should respond with careful examination and investigation to detect signs and symptoms of local and distant recurrence1.
Radical resection for early oropharyngeal cancer has a low complication rate. However, most patients undergoing surgery have advanced cancer and require complex and extensive surgery. Because most surgical site infections go away after discharge, special attention is paid to signs and symptoms of surgical site infections during initial follow-up. The sequence of surgical resections such as facial deformities, masticatory and swallowing disorders, speech disorders, and throat tightness requires constant attention during observation2.
Assessment and management of long-term treatment effects.
Many cancer patients experience long-term physical and psychosocial effects from cancer and the associated treatment, including pain, lymphedema, fatigue, and psychological discomfort. Risk factors for increased suffering include a history of depression or anxiety, poor social support, and young age. Physicians should look for these symptoms and carefully assess those at risk. Studies have reported that early diagnosis of distress using standardized screening tests improves outcomes, and recently published guidelines are a valuable resource for physicians to assess and manage the psychosocial consequences of cancer and its treatment1. In the case of oropharyngeal cancer, the cumulative dose of chemotherapy is generally not high, but the combined risk of early complications and late complications is considered in patients receiving radiation therapy. Patients with side effects from chemotherapy should have regular laboratory tests2.
The involvement of physicians is essential to ensure optimal follow-up care. Studies show that survivors who visit a primary care provider in addition to an oncologist are more likely to receive recommended preventive care as well as quality treatment for other illnesses. In health promotion and disease prevention, doctors should approach cancer survivors like those diagnosed with the acute coronary syndrome, who want to improve their health through counselling by modifying their lifestyle1.
Although physicians are increasingly advocating medical follow-up for cancer survivors, the challenges faced by some cancer patients are best addressed using a multidisciplinary approach. The physician should actively consider whether other healthcare professionals can assist the patient’s recovery and initiate referrals immediately. It starts with building relationships with local oncologists or doctors who focus on oncology, who can oversee cancer treatment and serve as an excellent resource for comprehensive care for cancer survivors1.
Follow up after palliative care.
For patients receiving palliative care only, management should focus on the quality of life during follow-up. If no new symptoms appear, follow-up can be reduced to 1 to 2 months after the end of treatment. Diagnostic imaging specifically applies only to the management of palliative symptomatic procedures for pain relief and airway maintenance. The palliative care team should coordinate monitoring for this patient group2.
- 1.Sisler J, Chaput G, Sussman J, Ozokwelu E. Follow-up after treatment for breast cancer: Practical guide to survivorship care for family physicians. Can Fam Physician. 2016;62(10):805-811. https://www.ncbi.nlm.nih.gov/pubmed/27737976
- 2.Kawecki A, Krajewski R. Follow-up in patients treated for head and neck cancer. Memo. 2014;7(2):87-91. doi:10.1007/s12254-014-0143-y