1.What is a follow-up visit? Why is it very important?
Follow-up visit means regular medical examination is needed, which includes medical history review and physical examination; the examination methods are imaging methods (showing the health status of internal organs)
Why is it important? The reason is that it can help to identify changes in health status; the purpose of follow-up is to check for recurrence (reappearance of tumor at the site of the primary tumor) or metastasis (spread of cancer to other sites); for prevention or early detection of other types of tumors, to address ongoing problems caused by the tumor itself or by tumor treatment, to evaluate somatic and psychological effects (which may begin after the end of treatment or at the time of disease diagnosis and persist for months to years). In conclusion, all cancer survivors or cancer patients should be followed up.
2. What information should the patient tell the doctor during the meeting with the doctor at the follow-up visit?
At each follow-up visit, the patient should tell the doctor some information such as
Any symptoms that the patient believes may be signs of tumor recurrence or metastasis
Any pain that bothers the patient
Any physical discomfort that interferes with daily life or bothers the patient, such as weakness, difficulty urinating or defecating, limited sex life, difficulty concentrating, impaired memory, sleep disturbances, weight gain or loss, etc.
Need to tell the doctor about any medications, vitamins or herbs (the patient) is taking, and any other treatments the patient is receiving.
Tell the doctor about any psychosomatic problems (the patient) is currently experiencing, such as anxiety, or depression, sadness, etc.
（Any changes in health status in (the patient’s) family history, including new cancer patients.
It is important to understand that recurrence or metastasis of cancer is not always detected at the time of follow-up. Many times, patients often suspect recurrence or find recurrence themselves in between follow-up visits. Therefore, it is very important for patients to detect changes in their health status and report any suspicious problems to their doctors in a timely manner. The doctor will be able to make a judgment on the problems that arise and determine whether they are related to cancer or cancer treatment, or perhaps they are not related to cancer at all.
3.How is the periodicity of follow-up visits scheduled and determined?
The frequency of follow-up visits, or how often they should be performed, is determined by a combination of the different types of tumors and treatments received, as well as the patient’s overall health status (including problems caused by treatment). The biological behavior of a particular tumor is a very important factor. Generally speaking, patients need follow-up appointments every 3-4 months for 2-3 years after the end of treatment. After that, follow-up appointments are made 1-2 times a year.
During the follow-up visit, the doctor will recommend tests to see if there is a recurrence or to screen for new other types of tumors; these recommendations are made based on the patient’s tumor type. Current evidence does not clearly indicate which specialized tests done at follow-up will improve survival or quality of life. It is for this reason that it is important for physicians to help patients develop an appropriate follow-up plan, as there is no evidence, so the value of experience in this is important. If the patient appears to be in good health and is asymptomatic, there may not be a need for any excessive laboratory tests. It is essential for the patient to have adequate communication with the physician about the treatment plan for the follow-up visit, including their questions or concerns.
When planning a follow-up visit, patients should consider which physician will provide follow-up services and which physician will be able to provide other medical care. A physician should be chosen who the patient feels comfortable and trusted with. Usually, the doctor who provides follow-up services is the doctor who provided the patient’s cancer treatment. For other medical care needs, patients should seek professional guidance and assistance from a physician in the relevant specialty.
Sometimes patients can also choose a doctor they consider trustworthy, not necessarily the doctor who treats them. Sometimes, health insurance can also limit the group of doctors that patients can choose from. Therefore, when making a follow-up plan, patients should check with their health insurance to find out if they are restricted.
4. Is there a doctor or clinic that specializes in providing follow-up services?
In foreign medical systems, there are clinics that specialize in providing long-term follow-up for adult or pediatric cancer survivors.
5.What should patients discuss with their doctors at the end of cancer treatment?
At the end of treatment, every cancer patient should ask their doctor to provide them with a treatment summary and follow-up plan. It is only logical that patients should be able to discuss the following issues with their doctors. Having this discussion will help the patient understand the need for follow-up care and the tests and costs that may be required, prepare for them, and help the patient set reasonable expectations.
What kind of treatment did I (the patient) receive and what medications did I use?
How often should I be followed up?
Which doctor should or can I choose to provide follow-up services for me during the follow-up?
How likely is it that my cancer will recur? Or, how likely am I to develop a different type of cancer?
What tests or labs, if any, might I need to have done at my follow-up visits?
How often do I need to have these tests done?
What symptoms should I be alert for or watch for?
If I notice any symptoms, how should I seek help from my doctor?
What are the common late complications or long-term complications of the treatment I am receiving?
Will my job or health status be affected by the cancer?
Are there organizations I can turn to for support or help?
Many patients will find it helpful to write down these questions, or take notes, or videotape discussions with their doctors, especially after discharge.
6. How should patients deal with their emotional problems after treatment is over?
During or after cancer treatment, it is easy to experience emotional problems such as stress, sadness and anxiety. Many patients find it helpful to talk about their feelings with their family, friends or doctors, other patients, chaplains, or psychological counselors. Participating in organizations can help patients better share their feelings. Some relaxation methods, such as guided imagery, slow rhythmic breathing, etc., can help calm bad thoughts and emotions. Helping others by participating in volunteer activities will make patients feel stronger and more in control. If the patient continues to experience emotional depression, they need to seek help from their doctor to help them find the cause of the change and deal with it in a positive way.
7. What medical information should patients keep?
It is very important to keep records of cancer treatment. Ideally, the summary and follow-up plan provided by the doctor after treatment is completed should be kept. Since the patient may always see the same doctor for follow-up, this information is helpful to another doctor. Some of the information mentioned below is of particular interest.
Any diagnostic test results
The specific type of tumor (pathological findings) The date the tumor was diagnosed
Details of the tumor treatment, including the hospital where it was treated, the date of treatment (e.g., date and method of surgery, name and dose of medication, site and total amount of radiation therapy, etc.)
Contact information for physicians, including those who provided treatment and those who provided follow-up services or other medical needs
Records of adverse reactions that occurred during and after treatment
Supportive treatment received (e.g., pain management, treatment for nausea, vomiting, emotional support, nutritional support, etc.)
If the patient is participating in a clinical trial, the trial number should also be remembered.
8.What other helpful services are included in the follow-up service?
Other helpful services are not only helpful in treatment, but also in follow-up. They include: support groups, couples counseling, genetic counseling, fertility counseling, guidance on home care services, nutritional counseling, physical therapy, pain management, vocational counseling, etc. Some patients may also need financial help and support. Most of the time, these issues require seeking professional help and paying additional fees.