Objectives
  • To be able to perform outpatient follow-up assessments based on best practice or guideline recommendations for the detection of cancer recurrence, new primary cancers and to evaluate the signs and symptoms of long-term and late side effects of either the cancer or its treatment

  • To be able to educate patients, families, caregivers and primary care providers about:

    • the familial, socioeconomic and lifestyles that may increase the risks of cancer recurrence or new primary cancers

    • the importance of developing and/or maintaining physically active lifestyles, weight management and avoidance of obesity, reducing alcohol consumption, tobacco cessation, making healthy dietary choices, managing depression/anxiety

    • financial/back to work issues, and to successfully reintegrate into a productive social and professional life

Awareness
  • Awareness of the existence of different roles of follow-up:

    • Screening for cancer recurrence and second primary cancers

    • Management of long-term and late side effects: mental/physical/socioeconomic

    • Family and lifestyle risk evaluation, including adverse health behaviours and interventions dedicated to promote healthier lifestyles

    • Empowerment among patients and patients’ advocates

  • Awareness of the existence and risks of treatment-related problems including:

    • Chronic fatigue

    • Pain, disabling neuropathy

    • Skin, mucosal and dental problems

    • Second primary cancers (treatment-related, genetics-related or developing as the population ages)

    • Cardiovascular risk and early symptoms such as hypertension and shortness of breath

    • Cognitive dysfunction

    • Urological problems

    • Gastrointestinal problems

    • Changes due to cancer treatment, including premature menopause, bone loss with the possibility of subsequent osteoporosis, infertility, impotence and sexual dysfunction

    • Anxiety, depression and loss of self-esteem and confidence

    • Relational, social and financial impact (eg, retention to, resume work, inaccessibility to insurance and mortgages)

  • Awareness of the signs or symptoms of cancer recurrence or treatment-related side effects and the use of diagnostic imaging modalities as indicated by best practice or guideline recommendations including:

    • Thorough investigation of new or persistent symptoms as clinically indicated

    • Indications for screening including imaging modalities and blood tests based on the primary cancer

    • The screening, detection and treatment of anxiety, depression, suicidal tendency and socioeconomic problems

    • The recognition that some new cancers and medical problems will occur in the course of normal ageing and that cancer survivors should receive routine standard preventative health maintenance (eg, immunisations, preventive screening for diabetes, hypertension etc); for this reason, a shared-care model between the oncologist and the general practitioner delivers the most comprehensive care to promote wellness among cancer survivors

Knowledge
  • Familiarity with the risks of long-term and late effects of different cancer treatments and the interaction with comorbidities, medications, lifestyle, age and family risk

  • Familiarity with the indications for and the limitations of the different diagnostic imaging modalities for screening for cancer recurrence and second cancers, as well as their psychological and financial impact

  • Understanding of the importance of offering individualised treatment based on age, comorbidities, lifestyle, family history and cancer recurrence risk

  • Understanding of the importance of educating patients, family, caregivers and primary care providers about the risks of cancer recurrence, familial/genetic risks, long-term and late side effects and maintaining healthy lifestyles

Skills
  • Ability to contribute actively to multidisciplinary discussions and patient presentations taking into account age, sex, cancer recurrence risk, lifestyle, comorbidities and consequences of cancer treatments

  • Ability to discuss critically the treatment options/recommendations of screening for cancer recurrences and second cancers, long-term and late effects, promoting empowerment and wellness among survivors and their families/caregivers by teaching or referring them to programmes/primary care providers that emphasise the importance of adopting healthier lifestyles and the importance of obtaining routine preventative healthcare

  • Ability to perform a thorough history, physical examination, laboratory studies and diagnostic imaging as indicated for new or persistent symptoms in cancer survivors

  • Ability to discuss secondary prevention strategies with patients, family and related specialists

  • Ability to discuss potential social challenges patients may face, such as job interruption during treatment