Survivorship Care Plan
This page represents your personalized treatment summary and survivorship care plan. Now that you have completed cancer treatment, this plan will help you navigate the survivorship phase of your journey, which includes recommended monitoring for recurrence, management of long-term treatment-related side effects and promotion of a healthy lifestyle.
Healthy Lifestyle Behaviors
Several lifestyle behaviors can affect your ongoing health, including the risk for the cancer coming back or developing another cancer. Some tips for staying healthy include the following:
Health and Well-Being Maintenance
Cancer Survivors are encouraged to:
- Exercise
- Eat a balanced diet
- Maintain a healthy weight
- Avoid tobacco
- Limit the amount of alcohol you drink
These simple steps can improve your quality of life and smoother your transition into survivorship. Do what you can and make changes slowly. Easing into a healthy diet or regular exercise will make it more likely that you will stick with these changes for the rest of your life.
Stay Healthy
Maintain a healthy weight.
- Eat well – 5 or more servings of fruit and vegetables daily
- Exercise – as much as you are able, if you can, at least 150 min of moderate activity every week
- Muscle strengthening activities 2 or more days per week
- Tobacco cessation (smoking, chewing)
- Your VA provider is ready to prescribe you medicine to help you quit
Alcohol in moderation or none
- For men – no more than 1-2 drinks per day
- For women – no more than 1 drink per day
Maintain a regular bedtime and waketime every day.
- Engage in regular physical activity in the morning and afternoon. Avoid moderate to strenuous physical activity within 3 hours of bedtime
- Increase exposure to bright light during the day
- Reduce exposure to bright light (example: computer, phone screens, light sources close to the eye) within a few hours before bedtime and at night
- Avoid heavy meals and limit fluid intake within 3 hours of bedtime
- Avoid alcohol and nicotine too close to bedtime
- Limit caffeine consumption and avoid caffeine consumption at least 4 hours before bedtime
- Enhance sleep environment (dark, quiet room, comfortable temperature)
- Avoid looking at the clock when awake during the night
- If necessary, limit to one short nap daily in the afternoon (no longer than 30 min)
- Turn on electronics and light-emitting sources at bedtime
Primary Care Physician
Patient with a history of cancer do better if they maintain regular connection with their primary care physicians. Please see your primary care physicians at least once a year to review routine health maintenance recommendations.
Preventative Practices
Ask your healthcare provider which screening tests are right for you.
- Colonoscopy screening – every 10 years in all adults aged 45-75 (maybe sooner if high risk)
- Fecal occult blood test (FOBT) – every year
- Sigmoidoscopy – every 5 years
- Digital rectal exam (DRE) – every year
- Pap test – every 3 years for ages 21-29 and every 5 years for ages 30 to 65
- Pelvic exam – every year
- Low-dose computed tomography for adults aged 50 to 80 years with a 20 or more pack-year history and currently smoke or have quit within the past 15 years and have a life expectancy of more than 5 years
Immunizations
- Flu vaccine every year in fall or winter
- Pneumococcal vaccine as recommended
- Tetanus booster every 10 years
Additional Health Monitoring
- Routine blood pressure, cholesterol, and glucose monitoring
- Bone health: Bone density testing as appropriate
- Dental health: Routine dental examinations
- Routine sun protection
General Resources
American Cancer Society
The American Cancer Society provides information for cancer patients, families, friends, survivors, professionals, and volunteers.
www.cancer.org
Inova Life with Cancer
Helping You and Your Loved Ones Live Well with Cancer Life with Cancer Inova Life with Cancer - Helping You and Your Loved Ones Live Well with Cancer | Our mission is to enhance the quality of life of those affected by cancer by providing education, information and support.
www.lifewithcancer.org
Cancer Care
Education on survivorship issues, counseling, support groups, and financial assistance.
www.cancercare.org
Cancer Family Care
Provide education, support, services such as legal and financial form filing, advanced care planning, and financial assistance to patients, and families with cancer. www.cancerfamilycare.org
Cancer Hope Network
Access to free and confidential one on one support to cancer patients and their loved ones. Online chat and support groups. Volunteer opportunities.
www.cancerhopenetwork.org or (800) 738-4673
Cancer Support Community
International nonprofit organization dedicated to providing free support, education, and hope for people with cancer and their loved ones. Sites offer group activities, support and therapy groups, educational and wellness classes.
www.cancersupportcommunity.org
CenterWatch Clinical Trials Listing Service
Listing of open research sites, active research trials and studies available. Also, information on new drug therapies or recently FDA approved medications.
www.centerwatch.com or (866) 219-3440
Journey Forward
www.journeyforward.org
Livestrong
To inspire and empower cancer survivors and their families through providing support to guide people through the cancer experience.
www.livestrong.org or (855) 220-7777
Meditation Headspace
App for phone/tablet, 1-2 times per day
The Oncofertility Consortium
A national, interdisciplinary initiative designed to explore the reproductive future of cancer survivors.
www.oncofertility.northwestern.edu
Smoking Cessation
Palliative Care Program/Services
Provides patients with relief from the symptoms, pain and stress of their ailment – whatever the diagnosis. Services provided include:
- Assistance with difficult conversations
- Pain and symptom management (including dyspnea, anxiety, nausea, delirium, etc.)
- Advance Care planning
- Family conferences
- Spiritual support
- Care coordination and discharge planning
Symptoms to Watch For
Psychosocial
Getting back to a more normal life may be challenging after cancer treatment. For some survivors, “normal” might mean adjusting to a new version of daily living. Treatment can have an impact on your emotional, spiritual, physical, and social well-being. Many cancer survivors experience some levels of stress, depression, anxiety and/or fear of recurrence that can impact relationships. Friends, family, your cancer care team and support services can be resources to help you work through these concerns.
Fatigue
Fatigue is when your body and/or brain feel tired. It means you don’t have the energy to do the things you want or need to do. The fatigue that comes with cancer is different from the fatigue of daily life. Cancer-related fatigue tends to be worse, causes more distress and often does not improve with rest. Please notify your cancer physicians if you are experiencing cancer-related fatigue. Symptoms may include tiredness/sleepiness, headache, no motivation to do activities, sore or aching muscles, slowed responses and impaired decision making or judgement.
Pain
Chronic pain can be a serious, negative consequence of surviving cancer. Multiple medication and non-medication treatment options are available, with goal of both decreasing pain and improving function.
Cognitive Deficits
Many individuals notice a mental cloudiness that can occur prior to the diagnosis of cancer but may worsen with some treatments such as chemotherapy and radiation. These vague mental changes may decrease the ability to remember certain things, cause problems with finishing tasks or learning new skills. These subtle changes can have an important impact on everyday life and often can cause difficulty in returning to work.
Sleep
Sleep problems include difficulty falling asleep, staying asleep, excessive sleepiness, frequent snoring and pauses in breathing. Sleep disturbances are common in patients with cancer and survivors. If you have sleep problems lasting longer than a few days, talk with your cancer care provider.
Sexual Health
Cancer treatment, especially hormonal therapy and therapy directed towards the pelvis, can often impair sexual function. If you are experiencing any sexual concerns, please inform your cancer care provider.
Functional Limitations
Cancer treatment such as surgery, radiation, and chemotherapy can cause physical changes that can make daily activities more difficult. Patients may have reduced motion in areas such as the neck, shoulder, back, and hip. Reduced strength, pain, and spasm can also reduce physical functioning. Many patients have reduced physical and cardiovascular endurance from their cancer treatment. Cancer rehabilitation is often helpful in reducing or eliminating these problems. Notify your cancer provider is you have any new or worsened physical issues that need to be addressed with therapy.
Cardiovascular
As a result of your history of chest radiation, you are at increased risk of developing coronary artery disease. Please report any symptoms of chest pain, chest tightness or shortness of breath, especially if symptoms are triggered by physical activity. It is very important to get regular physical activity and adopt healthy eating habits.
Endocrine
If you have had radiation to the head/neck/chest, or surgery to the thyroid gland, you may be at increased risk of thyroid dysfunction. It is important to have thyroid levels monitored regularly.
Elevated Blood Sugar/DM
Individuals with a history of abdominal radiation or who are currently on long-term steroids, or certain targeted chemotherapy agents, may be at increased risk of high blood sugars or diabetes. Eating a healthy diet, getting regular exercise and keeping your weight in the healthy range can help with this issue.
Vasomotor
Your cancer treatment may cause you to have symptoms of menopause such as night sweats, hot flashes and trouble sleeping. Notify your cancer provider if you are experiencing any of these symptoms as treatment options are available.
Fertility
Some cancer treatments such as chemotherapy may increase your risk of infertility and can continue months or years after treatment has ended. There are many ways to increase your ability to have a child in the future. Discuss with your cancer care provider your risk of infertility once treatment is completed.
Peripheral Neuropathy
Numbness and tingling of the hands and feet (peripheral neuropathy) can occur after certain cancer treatments such as chemotherapy, surgery and/or radiation therapy and medical conditions such as diabetes. If you are experiencing these symptoms, it is important to take precautions to avoid falls and injury to your hands and feet.
- For your feet – wear supportive shoes, examine your feet daily for areas of skin breakdown, use handrails/extra caution when walking as you are at an increased risk of falling.
- For your hands – wear oven mitts when handling hot food, garden gloves when working outside, and make sure your water heater is set at 110 degrees Fahrenheit or below to make sure water isn’t too hot before washing or bathing.
Talk with your cancer care provider if you are experiencing these symptoms as treatments are available to help.
Bone Health
Certain cancer treatments such as aromatase inhibitors, anti-estrogen and anti-androgen medications, as well as certain surgeries and pelvic radiation therapy may affect your bone health. Discuss with your cancer provider if a DEXA scan is indicated to evaluate your bone health and risk of fracture.
Lymphedema
Lymphedema is swelling that occurs in the areas where cancer treatment has taken place. Symptoms include aching pain or heaviness, swelling numbness, tightness and stiffness. You are at risk for this symptoms if you have had lymph nodes removed surgical or if you received radiation to your lymph nodes. These risks are increased if you are overweight. Please speak with your cancer provider regarding preventive strategies available through the lymphedema clinic.
Ototoxicity – Cisplatin Therapy
Treatment with platinum-based chemotherapy such as cisplatin can cause damage to the inner ear called ototoxicity. You may have symptoms of hearing loss, dizziness or tinnitus (ringing or abnormal sounds like roaring, hissing, humming) sound in the ear or head is called tinnitus. All these symptoms can interfere with a person’s daily activities. Report symptoms to your cancer provider.
Vision
Cancer treatments such as chemotherapy and steroids that may have been used to prevent treatment side effects can cause eye related symptoms such as irritated dry eyes, increased tearing, redness, pain, and blurred vision. Loss of eyelashes from chemotherapy can also increase irritation. Cataracts can worsen and clogged tear ducts develop due to radiation near the eye and use of certain chemotherapy agents. Surgery near the optic nerve can cause long term vision changes. If you are experiencing any eye irritation or vision changes, please inform your cancer care provider.
Dermatology
Some cancer treatments, especially radiation therapy, can cause changes in the skin. You should check your skin and lymph nodes using the ABCDE method. Not all cases of melanoma fit into ABCDE guidelines so report any skin lesions that do not heal, spread color from one area to the surrounding area, develop new redness beyond the border of the lesion, become itchy or tender or develop surface changes.
- A – Asymmetry
- B – Border irregularity
- C – Color Variegation
- D – 1/4”
- E – Evolving/Changing
Video on How to Do Skin Exams:
www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/detect