SURVIVORSHIP AND FOLLOW-UP CARE
Successfully surviving a diagnosis of lung cancer requires a program of follow-up that will enable the patient and their family to go forward whether the eventual outcome is a normal lifespan, recurrence of the cancer, metastasis, or early death. Providing information that is accurate but hopeful is one way healthcare personnel can help patients and their families make informed choices about how to proceed after curative treatment for lung cancer.
It is normal to experience fear and anxiety after receiving a diagnosis of lung cancer, even when the treatment has provided an encouraging outcome. Counseling or psychotherapy can help cancer survivors and their circle verbalize fears and concerns and learn mechanisms to deal with negative ideas. Focusing on wellness is a positive approach that allows patients to take part in their survival program with actions that will improve their health and participate in a multidisciplinary approach.
Nutrition, exercise, adequate sleep, awareness of symptoms, and risk reduction are areas where the patient can be given knowledge and support to deal with issues that can complicate postoperative or post-therapy progression. Registered dieticians, physical therapists, occupational therapists, sleep specialists, and counselors may be brought into the patient’s sphere if their primary care provider believes this will help to facilitate a better recovery period for the patient.
An essential part of survivorship is the management of long-term complications of lung cancer treatments. Symptoms that may ensue from these treatments are pain, infection, nausea and vomiting, skin burns, and nutritional deficits as a result of other side effects that are inadequately treated.
SURVIVORSHIP CARE PLANS
Survivorship care plans (SCPs) previously were mandatory for cancer survivors, but they are no longer required due to certain barriers in successfully implementing SCPs. SCPs were time consuming to prepare, there was no clarity regarding who should complete and maintain the information, and there was a lack of reimbursement for the completion and distribution of the SCP.
The current recommendation for SCPs is that the survivorship program team suggest available services and referrals and that usage of these be documented every year (Blaes et al., 2020).
Symptoms That Require Attention
Surveillance of patients with lung cancer in the postacute phase is essential for the survivor’s well-being, especially given the high rates of recurrence. It is recommended that the patient report the following symptoms to their primary caregiver, or surgeon if the patient is postoperative, to determine recurrence or metastasis:
Body System | Symptoms |
---|---|
(Verywell Health, 2021) | |
Local or in lymph nodes near the original tumor |
|
Bones |
|
Brain |
|
Liver |
|
Routine Follow-Up Care
Patients should undergo surveillance imaging and a physical examination with their primary care giver frequently after the acute phase of lung cancer. Usually a CT scan is performed; this is to assess for recurrence or metastasis. The recommended frequency is every six months for the first two years, and then annually for detection of new primary lung cancers.
Brain magnetic resonance imaging (MRI) is not used for routine surveillance in stages I–III NSCLC but may be used every three months for the first year and every six months for the second year in patients with stages I–III SCLC who have undergone curative-intent treatment to assess for metastasis to the brain (Schneider, 2019).
Health and Wellness Recommendations
To promote a healthy lifestyle after active lung cancer, the American Lung Association makes the following recommendations for survivors of lung cancer:
- Stop smoking.
- Avoid secondhand smoke.
- Use psychological support services.
- Manage stress.
- Conserve energy to prevent fatigue.
- Eat nutritiously.
- Exercise.
- Develop and use a support system.
- Use helplines. (See “Resources” at the end of this course.)