After completing the primary treatment for Non-Hodgkin’s Lymphoma, survivors usually visit a doctor or cancer care provider. In other words, they go 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 NHL has been completed, survivors usually visit a doctor or cancer care provider for regular check-ups and consultations. Follow-up is nothing but this. How often cancer survivors should contact the doctors or care providers depends on many factors, including:
- Firstly, Cancer type and stage
- Secondly, the kind of treatment received
- Thirdly, the need of the individual
- Lastly, the arrangements at the hospital where the follow up are provided.
Follow-up for cancer survivors is suitable and equally important for primary care. Increasingly, cancer is considered as a condition with both the acute and chronic stages. However, the treatment of the chronic stage of cancer is very similar to the treatment of other chronic diseases. But, he traditional focus in monitoring cancer recurrence has become a concern for recovery and well-being, which includes managing physical and psychosocial effects, promoting a healthy lifestyle, and care coordination of the health professionals involved.
In patients having remission after treatment with curative intent for non-Hodgkin’s lymphoma (NHL), the purpose of follow-up during the first 2-3 years is early detection of relapse for timely re-treatment to improve survival prospects. Moreover, follow-up visits usually include a review of symptoms, physical examination, full blood count and biochemical profile including serum LDH. Although, surveillance scans are performed routinely, in others this is done only as clinically directed (i.e. if relapse is suspected)1.
Types of follow-up care
There are various types of follow up care. For example, patients usually receive follow up care in a hospital. This usually takes place with someone from the cancer care provider or doctor. These appointments can be required every few months during the first year after treatment.
Patients may be asked for a blood test or scan before the visit. This will ensure that the results are available at the follow-up. If a patient is not sure if this is necessary, they can ask their doctor for advice.
Patients usually receive less screening after the first year. They may not have to go to the hospital in the future.
Patients can receive additional care over the phone with a professional counsellor rather than a clinic. They may also receive additional treatment from a doctor.
The cancer team will discuss further follow up with the patient. Together, they can decide what is best for the patient2.
Mentioned below is a detailed description of various types of follow up for cancer patients:
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 recurrence. In a study it was reported that more relapses were detected during unplanned patient-initiated visits (11/33 visits) than during routine visits (4/823 visits) and the 3-year event-free and overall survival were 86.4% and 93.6%, respectively3.
Assessment and management of long-term effects
Many cancer patients experience long-term physical and psychosocial effects from cancer and the associated treatment, which includes 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 treatment.
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. Doctors should be approach cancer survivor who, like those diagnosed with acute coronary syndrome, want to improve their health through counselling and lifestyle changes, in terms of health promotion and disease prevention.
The challenges faced by some cancer patients are best addressed using a multidisciplinary approach, although physicians are increasingly advocating medical follow-up for cancer survivors. 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 survivors4.
- 1.National Guideline Alliance (UK). Non-Hodgkin’s Lymphoma: Diagnosis and Management. Published online July 1, 2016. https://www.ncbi.nlm.nih.gov/pubmed/27466666
- 2.Cancer information and support. Follow-up care after treatment. Macmillan Cancer Support. Published 2020. Accessed March 2022. https://www.macmillan.org.uk/cancer-information-and-support/after-treatment/follow-up-care-after-treatment
- 3.Hong J, Kim J, Lee K, et al. Symptom-oriented clinical detection versus routine imaging as a monitoring policy of relapse in patients with diffuse large B-cell lymphoma. Leuk Lymphoma. 2014;55(10):2312-2318. doi:10.3109/10428194.2014.882505
- 4.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