Follow-Up Care for Non-small cell lung cancer

Individuals with non-small cell lung cancer undergo effective treatment that removes and destroys tumor cells in the body. Moreover, non-small cell lung cancer patients may find relief from the treatment after going through all the treatment protocols. Fear of relapse is also normal. Some of the patients are never free from the cancer symptoms. Meanwhile, some of them opt for regular chemotherapy, radiation therapy, and other to control cancer for a longer duration. Hence, follow up care is necessary.

Cancer patients need to undergo regular follow-ups, and their diagnostic process never ends, although the active treatments have finished. The healthcare team is responsible for regularly checking the cancer symptoms. They also check whether they have gone or returned among the patient, determining the side effects, and monitoring overall health. Therefore, this is follow-up care ^​1​. The follow-up care mainly includes conducting regular physical examinations, medical tests, or both. The doctors are also responsible for keeping the record of every recovery phase of the patients months and years ahead. 

Cancer rehabilitation recommends physical therapy, career counselling, pain management, nutritional planning, and emotional counselling. The primary aim of cancer rehabilitation is to help the patients regain control of their lives and remain independent. 

The classic approach towards the post-treatment management of non-small cell lung cancer patients involves the integration of radiologic evaluations. It is still controversial in the follow-up care of non-small cell lung cancer ^​2​. The patients receiving intent-to-cure treatment and history and a physical examination need to do it within every 3-6 months during the initial two years and after every 6-12 months and later following the radiological evaluations during the provided period.

Recurrence of non-small cell lung cancer:

One of the primary goals of follow-up care is the regular check for recurrence, ensuring that cancer has come back or not, since, cancer recurrence occurs due to small regions of cancer cells that may remain undetected within the body. These cells tend to increase with time until they show any signs and symptoms after the test results. The follow-up involves the doctor’s familiarity with the patients’ medical history, providing personalized information regarding the risk of recurrence.

The individual moreover, goes through blood tests or imaging tests, part of regular follow-up care. Still, the testing recommendations depend upon several factors, mainly involving the type and stage of cancer first diagnosed and the types of treatment given. The non-small cell lung cancer patients have been at higher risk of developing second cancer of non-small cell lung cancer. Therefore, the doctors need to recommend a future diagnostic approach for determining both a recurrence and any new lung cancer ^​3​. 

The follow-up for recurrence and new lung cancer depends upon the type of non-small cell lung cancer that patients already had, its particular stage and related treatment provided to the non-small cell lung cancer patient. Scene I and stage II non-small cell lung cancer have been effectively treated with or without chemotherapy. Following the follow-up for the same, the doctors have recommended physical examination and chest CT scan for the patient every six months for 2-3 years, then every year ^​4​.

In case the person is suffering from stage I or II non-small cell lung cancer with the treatment option to be radiation as the primary one, the doctors and related healthcare provider recommends a physical exam and a chest CT scan for every 3-6 months for three years and every six months for two years. After continuing this for five years, the annual follow-up for the same can be continued. If the patients had stage III or IV NSCLC, the doctors recommend a physical examination and chest CT every 3-6 months for three years and then every six months for two years and then after five years which can follow annually later. 

The American Society of Clinical Oncology (ASCO) has recommended that the individuals successfully treated for stage I to stage III NSCLC undergo imaging scans every six months for the first two years after treatment to check for the recurrence. The preferable testing for the same is the chest CT scan. Later, after two years of the diagnosis, the NSCLC patients must undergo a low-dose chest CT scan once every year.

Also, ASCO has recommended not to use the PET-CT scans with fluorodeoxyglucose (FDG), blood tests, or brain MRI as routine tests for checking the cancer recurrence. The protocol of the follow-up tests results in waiting for the test result for the patient and their families, and this condition is known as scanxiety. The efficacy of the standardized follow-up programmed after integrating towards the resection of bronchial carcinomas leads towards the detection of recurrences at a treatable stage. The research studies have revealed no difference in the survival between the intensive and less-intensive follow-up in resected patients ^​5​. 

Management of long-term and late side effects:

Most individuals are expected to have significant side effects while receiving the treatment during NSCLC. It proves to be quite surprising to the survivors that some of the side effects stay even after the treatment, known as the long-term side effects ^​6​. The other side effects are the late side effects that may develop in months or even afterwards. Long-term and late side-effects majorly involve physical as well as emotional changes. Hence, there is a need for communicating with the doctor towards the risk of developing the side-effects based on the NSCLC type, the treatment plan as per the patient’s medical history, and determining the patient’s overall health.

If the particular treatment tends to show late effects, the doctors recommend physical examinations, scans, or blood tests to help find and manage them. The most common post-treatment health issues among the patients include pain, fatigue, and shortness of breath among NSCLC patients. The doctors, nurses and other related healthcare team members help manage such health issues that may persist even after the treatment. Individuals with smoking habits are at higher risk of heart disease, stroke, emphysema, chronic bronchitis, and cancer treatment may increase the risk.

Maintaining the personal health records:

The patients and the doctors need to develop a personalized follow-up care plan. Concerns regarding the confirmation of future physical and emotional health need to be ensured. The ASCO has recommended maintaining the forms for keeping track of cancer treatment for receiving and developing a survivorship care plan after the complete treatment. 

Also, effective communication needs to be maintained with the patient and the doctors regarding the leading of the follow-up care. Some of the survivors tend to visit their oncologist regularly while the others transition back to the supervision of their primary care doctor or another health care professional. The decision entirely depends on several other factors involving the type and stage of cancer, side effects, health insurance rules, and patients’ personal preferences.

The doctors who are not entirely involved in the primary cancer care of the patient may lead the follow-up care. Therefore, it is essential to share a summary of the cancer treatment and survivorship care plan forms while referring to future health care providers. The detailed information regarding cancer treatment has been considered crucial for the healthcare professionals who are supposed to provide care to the patients throughout their lives.

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