Follow-up beyond routine screening
| AFTER HODGKIN LYMPHOMA AND ACUTE LYMPHOBLASTIC OR MYELOGENOUS LEUKEMIA5,30,33,36 |
| Risks Subsequent neoplasms and recurrence Cardiac disease (after chest radiation) Oral cancer, osteonecrosis (after azathioprine or radiation to the jaw) Osteoporosis Chronic pain, peripheral neuropathy, Raynaud phenomenon Pulmonary fibrosis, interstitial pneumonitis (after mediastinal radiation and high doses of bleomycin) Cataracts (after high doses of radiation to head) Bladder fibrosis, hemorrhagic cystitis, impaired kidney function, bladder cancer (after abdominal radiation) Esophageal strictures, gastroesophageal reflux disease, enterocolitis, bowel obstruction Infections |
| Educate on sun exposure, signs of cancer, healthy high-fiber diet, avoidance of alcohol, smoking cessation, hand-washing, vaccination, avoidance of people with colds, need to report symptoms |
| Screen For skin cancer every year Mammography every 2 years for women age 50 to 7437 Colonoscopy every 5 years after age 35, or 10 years after abdominal radiation Echocardiography at baseline and periodically Annual liver screening with aspartate aminotransferase, alanine aminotransferase, and bilirubin for patients who received ≥ 3,000 cGy to upper abdomen, or received methotrexate, mercaptopurine, or thioguanine Dual-energy x-ray absorptiometry per World Health Organization recommendations |
| Vaccinate against pneumococcus (PCV 13 for immunocompromised individuals),38 influenza (inactivated); live-attenuated virus vaccines (eg, herpes zoster, influenza) can be used with caution and in close contacts of cancer survivors; consider prompt antibiotics to cover gram-positive organisms in those with hypogammaglobulinemia, compromised immunity |
| Monitor for relapse: computed tomography (CT) to evaluate response, then chest radiography or CT every 6 to 12 months for 2 to 5 years |
| Specialist evaluation as appropriate |
| FOR OLDER PATIENTS with chronic lymphocytic leukemia, acute myelogenous leukemia, multiple myeloma and non-Hodgkin lymphoma22,39 |
| Risks Early onset of diabetes (secondary to steroid use), hypertension (secondary to chemotherapy), osteoporosis (especially after multiple myeloma), cataracts (from steroids), and cardiovascular disease (especially with anthracycline and alkylating agent chemotherapy); reinforce healthy lifestyle, proper screening |
| AFTER ALL CANCERS33,34 |
| Address educational issues, emotional issues, financial issues, chronic pain, cognitive function, sleep disorders, immunizations, and healthy lifestyle (smoking cessation, weight management, diet, exercise) |