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Follow Up Care After Completing Treatment

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    Posted: Jan 20 2015 at 9:14am
Good morning all,

I will like to discuss follow up care after completing treatment.
Do you all know the benefits of doing this?
Could you post your thoughts on this subject. 
Let's share experiences.


With Love,
TNPTNAV
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math666 View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote math666 Quote  Post ReplyReply Direct Link To This Post Posted: Jan 20 2015 at 10:16am
                             Follow Up Information

Breast Cancer Follow-Up and Management After Primary Treatment: American Society of Clinical Oncology Clinical Practice Guideline Update

Published in Journal of Clinical Oncology, Vol 3, Issue 7 (March), 2013: 961-965
James L. Khatcheressian, Patricia Hurley, Elissa Bantug, Laura J. Esserman, Eva Grunfeld, Francine Halberg, Alexander Hantel, N. Lynn Henry, Hyman B. Muss, Thomas J. Smith, Victor G. Vogel, Antonio C. Wolff, Mark R. Somerfield, and Nancy E. Davidson



Purpose:

To provide recommendations on the follow-up and management of patients with breast cancer who have completed primary therapy with curative intent.

Methods:

To update the 2006 guideline of the American Society of Clinical Oncology (ASCO), a systematic review of the literature published from March 2006 through March 2012 was completed using MEDLINE and the Cochrane Collaboration Library. An Update Committee reviewed the evidence to determine whether the recommendations were in need of updating.

Results:

There were 14 new publications that met inclusion criteria: nine systematic reviews (three included meta-analyses) and five randomized controlled trials. After its review and analysis of the evidence, the Update Committee concluded that no revisions to the existing ASCO recommendations were warranted.

Recommendations:

Regular history, physical examination, and mammography are recommended for breast cancer follow-up. Physical examinations should be performed every 3 to 6 months for the first 3 years, every 6 to 12 months for years 4 and 5, and annually thereafter. For women who have undergone breast-conserving surgery, a post-treatment mammogram should be obtained 1 year after the initial mammogram and at least 6 months after completion of radiation therapy. Thereafter, unless otherwise indicated, a yearly mammographic evaluation should be performed. The use of complete blood counts, chemistry panels, bone scans, chest radiographs, liver ultrasounds, pelvic ultrasounds, computed tomography scans, [18F] fluorodeoxyglucose–positron emission tomography scans, magnetic resonance imaging, and/or tumor markers (carcinoembryonic antigen, CA 15-3, and CA 27.29) is not recommended for routine follow-up in an otherwise asymptomatic patient with no specific findings on clinical examination.

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Post Options Post Options   Thanks (1) Thanks(1)   Quote math666 Quote  Post ReplyReply Direct Link To This Post Posted: Jan 20 2015 at 10:18am

Follow-Up Care for Breast Cancer


To help doctors give their patients the best possible care, the American Society of Clinical Oncology (ASCO) developed evidence-based recommendations for follow-up care for patients with breast cancer. In 2012, ASCO reviewed the results of new research studies, and no changes to the recommendations were needed based on the current research findings. This guide for patients explains the ASCO recommendations.

Key Messages:

  • Follow-up care for breast cancer includes managing the short-term side effects of treatment and watching for long-term side effects or a return of the cancer.
  • ASCO’s recommendations for follow-up care include regular visits to your doctor and mammography.
  • People with breast cancer should talk with their doctors about a follow-up care plan and how to coordinate this care between the oncologist and their primary care or family doctor.

Background

After treatment for breast cancer, follow-up care is important to help maintain good health, which includes managing any side effects from treatment and watching for long-term side effects (called late effects) or signs of a cancer recurrence (cancer that comes back after treatment). A follow-up care plan may include regular physical examinations and other medical tests to monitor your recovery for the coming months and years. To help keep track of the cancer treatment you received and work with your doctor to develop a survivorship care plan, ASCO offers cancer treatment summary forms.

Many survivors feel worried or anxious that the cancer will come back after treatment. While it often does not, it’s important to talk with your doctor about the possibility of the cancer returning. Most breast cancer recurrences are found by patients between doctor visits. Tell your doctor if you notice any of the following symptoms, as they may be signs of a cancer recurrence:

  • New lumps in the breast
  • Bone pain
  • Chest pain
  • Abdominal pain
  • Shortness of breath or difficulty breathing
  • Persistent headaches
  • Persistent coughing
  • Rash on breast
  • Nipple discharge (liquid coming from the nipple)

Recommendations

ASCO recommends the schedule of tests and procedures listed below after treatment for breast cancer. About a year after diagnosis, you may continue to visit your oncologist or transfer your care to a primary care doctor. Women receiving hormonal therapy should talk with their oncologist about how often to schedule follow-up visits for re-evaluation of their treatment.

Medical history and physical examination. Visit your doctor every three to six months for the first three years after the first treatment, every six to 12 months for years four and five, and every year thereafter.

Post-treatment mammography. Schedule a mammogram one year after the first mammogram that led to your diagnosis. However, if you have had radiation therapy, wait six months after your last treatment. Obtain a mammogram every six to 12 months thereafter.

Breast self-examination. Perform a breast self-examination every month. This procedure is not a substitute for a mammogram.

Pelvic examination. Continue to visit a gynecologist regularly. Because the drug tamoxifen (Nolvadex) increases the risk of uterine cancer, women taking this drug should tell their doctors about any abnormal vaginal bleeding.

Genetic counseling. Another important part of follow-up care is to tell your doctor if you have a history of cancer in your family because you may benefit from genetic counseling. The following risk factors may indicate that breast cancer could run in the family:

  • Ashkenazi Jewish heritage
  • Personal or family history of ovarian cancer
  • Any first-degree relative (mother, sister, daughter) diagnosed with breast cancer before age 50
  • Two or more first-degree or second-degree relatives (grandparent, aunt, uncle) diagnosed with breast cancer
  • Personal or family history of breast cancer in both breasts
  • History of breast cancer in a male relative

The following tests are not currently recommended by ASCO for regular follow-up care because they have not been shown to lengthen the life of a person with breast cancer. Learn more about why these tests may not be recommended.

What This Means for Patients

The recommendations for follow-up care for breast cancer include regular physical examinations, mammograms, and breast self-examinations. The follow-up care may be provided by your oncologist or primary care doctor, as long as your primary care doctor has talked with your oncologist about appropriate follow-up care and the possible late effects. In addition, patients with a possible or known family history of breast cancer may want to visit a genetic counselor. Use these guideline recommendations to talk with your doctor about an appropriate follow-up care plan for you.

Questions to Ask the Doctor

To learn more about follow-up care for breast cancer, consider asking your doctor the following questions:

  • What follow-up care plan would you recommend for me?
  • What is the chance that the cancer will recur?
  • What tests do you recommend? Why?
  • Based on my personal and family medical history, do I need to visit a genetic counselor?
  • Where can I find more information about follow-up care?
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TNPTNAV View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TNPTNAV Quote  Post ReplyReply Direct Link To This Post Posted: Jan 20 2015 at 10:33am
Clap Great post, thank you for this information!! Clap
With Love,
TNPTNAV
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Lorene View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lorene Quote  Post ReplyReply Direct Link To This Post Posted: Jun 12 2015 at 3:27pm
I thank you as well.  Very helpful.

Lorene
dx10/01@age59,IDC TNBC, St.IIB,Gr3,2.5cm,3+nodes, epirubicin,5FU,cytoxan,33Rads,No recurrence, 2016
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jun 12 2015 at 6:15pm
I know most oncs do not believe in routine scans.  This is just my personal experience.  My first onc didn't follow the standard guidelines.  She liked to scan her TNBC patients yearly for the first 3 years.  So 13 months after finishing chemo, I had a routine PET scan that found my recurrence to a regional node (stage 3).  I was feeling great, no symptoms at all, blood work normal, tumor markers normal.  If I had waited till I had symptoms, I'm sure my prognosis would have been much more grim.  

Donna
DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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