Recovery and follow-up care
Follow-up care is essential; this entails consultations with your healthcare team once you are done with treatment. These check-ups may include bloodwork, as well as other tests and procedures that look for changes in your health or any problems that may occur due to your cancer treatment.
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Watching for signs of cancer is an important part of follow-up care. Your doctor will check for recurrence (cancer that comes back after treatment). Cancer can come back when very small areas of cancer cells are still in the body and can’t be seen on test results.
Tackling any difficult situation in life requires adjustment to expectations and goals. You and your family will look forward to the completion of therapy and mentally prepare yourselves for the treatment to finish. You’ll count the days, chemotherapy cycles, radiation sessions, months on hormone blockers or targeted therapy but once completed, you may feel isolated, alone, and afraid. You may feel you aren’t protected or part of the oncology family (doctors, nurses, radiotherapists, etc.) you started to know, love and trust as you aren’t in constant contact with your care team.
Seeing your doctor every three months may be daunting and going for tests before your next appointment can bring back memories of first receiving the news of cancer and cause a lot of anxiety.
It’s important for recovery to know what the goal of therapy is for the treatment of your cancer from the onset. It may be curative, but it may be to improve quality and quantity of life and cure may not be a possibility. Expectations need to be managed. Goals may change along the way and communication is key.
The media often propagates the theory of being disease free for five years as the sign of cure. As oncologists, we will talk about disease-free survival when quoting studies done in cancer. We will talk about relapse-free survival or median-overall survival. We will say that the probability of cure is good or that we aim for cure, but we generally don’t say to patients that they are cured. Saying the word cured also doesn’t change your life back to a pre-cancer diagnosis life. That has changed forever; your perspective of life and what is important will now be your new reality.
Recovery doesn’t only mean to recover from the toxicities of treatment. You will also mourn the loss of what you thought your life was going to look like. Society may expect you to just bounce back to who you were before, but you may have changed your priorities and goals in life. Your body image may have changed. You’ll be affected by the trauma you have witnessed watching other patients suffering from different diseases and you may have lost new friends you have made during therapy.
A healthy diet with fresh vegetables, fruit, and high protein is always advocated, but it’s important to enjoy what you have for meals and not to be too strict. If you love cheesecake, have a slice.
Exercise, such as walking regularly, is encouraged, especially if you live a sedentary life, and returning to exercise programmes if you were active prior to your diagnosis. Multiple studies done with cancer patients have shown that enough moderate exercise helps recovery and improves overall survival.
Rest, such as a good night’s sleep, is encouraged but prolonged rest that keeps you away from society, is discouraged.
Every cancer and every stage of cancer has different follow-up procedures and times. It’s best to talk to your oncologist regarding the frequency of tests and consultations. For example, ovarian cancer needs monthly cancer counts for the first six months after chemotherapy but only three-monthly consultations. Other cancers may require three monthly X-rays or CT scans.
At these follow-up appointments, oncologists check for recurrence of cancer, but it’s important to also be monitored for long-term side effects of therapy that may only manifest much later after completion of therapy.
Oncologists don’t only rely on tests to ensure remission but need to see you face-to-face to discuss any symptoms you may have. Cancer markers aren’t always reliable and not available for every type of cancer.
Very importantly, you may not always need to see your oncologist if you have been in remission for a long time, sometimes your treatment team needs to see that you are well to enable us to continue a rewarding but very tough profession.
Dr Daleen Geldenhuys is a specialist physician and medical oncologist who works at West Rand Oncology Centre at Flora Clinic. She treats patients with all types of cancer and enjoys clinical research, and is a member of SASMO, SASTECS, ESMO and ENE