Aftercare in gynecological oncology — Why you should prevent side effects in cancer

After­ca­re is also pre­ven­ti­on, espe­ci­al­ly in gyneco­lo­gi­cal onco­lo­gy. On the one hand, can­cer can recur (rel­ap­se), on the other hand, it can cau­se long-term side effects that can have a major impact on the patient’s qua­li­ty of life.

After every can­cer, regu­lar and cor­rect fol­low-up care by the atten­ding phy­si­ci­an is of gre­at importance. This page is inten­ded to give you a brief over­view of the peri­od in which the fol­low-up exami­na­ti­ons are curr­ent­ly recom­men­ded and which long-term side effects they can improve.

The goal of after­ca­re is to pro­vi­de effec­ti­ve reli­ef from can­cer and the con­se­quen­ces of the­ra­py, geared towards indi­vi­du­al per­for­mance and life planning.

Follow-up examinations

The fol­low-up care plans dif­fe­ren­tia­te bet­ween breast and abdo­mi­nal can­cer. In this artic­le we focus on fol­low-up care for abdo­mi­nal can­cer. This results in the fol­lo­wing peri­ods for fol­low-up examinations:

Fol­low-up care for abdo­mi­nal cancer:

1–3 years after dia­gno­sis, pati­ents should be fol­lo­wed up every 3 months. A phy­si­cal exami­na­ti­on as well as com­plaints and side effects are dis­cus­sed. After 4–5 years, the inter­val is exten­ded to every 6 months and from the 6th year fol­low-up care takes place annually.

Side effects

The pro­gno­sis of many can­cers has impro­ved, which means more cures, less risk of recur­rence, and lon­ger sur­vi­val. Howe­ver, this also means that the long-term side effects of tumor the­ra­pies beco­me noti­ceable. This makes them an important topic for pati­ents, rela­ti­ves and doctors.

The following long-term side effects should be noted:

Fatigue

Fati­gue refers to a lack of ener­gy reser­ves, a high need for rest and an often lea­den “tired­ness” that affects both phy­si­cal and men­tal per­for­mance and can­not be explai­ned by lack of sleep or hea­vy stress. This also distin­gu­is­hes fati­gue from “nor­mal” tired­ness (lack of sleep) or exhaus­ti­on (due to hea­vy stress). Fati­gue is one of the most com­mon and stressful can­cer sym­ptoms that pati­ents have to con­t­end with. Most can­cer pati­ents return to their ori­gi­nal ener­gy level within a year of com­ple­ting tumor tre­at­ment. Howe­ver, recent stu­dies show that around 30% of pati­ents con­ti­nue to suf­fer from seve­re fati­gue and the life rest­ric­tions it cau­ses seve­ral years after the tre­at­ment. Unfort­u­na­te­ly, it is still not known exact­ly why about a third of pati­ents deve­lop this chro­nic fati­gue. Howe­ver, the­re are various the­ra­py modu­les that can be used to impro­ve the sym­ptoms of fatigue.

Long-term cardiac side effects

One of the most com­mon and important long-term side effects of onco­lo­gi­cal the­ra­pies is car­dio­to­xi­ci­ty. Che­mi­cal sub­s­tances or drugs that affect or dama­ge the heart in various ways are refer­red to as car­dio­to­xic. Car­dio­to­xi­ci­ty during onco­lo­gi­cal the­ra­py can mani­fest its­elf in dif­fe­rent ways:

• Ear­ly forms: car­diac arrhyth­mi­as, cir­cu­la­to­ry dis­or­ders, arte­ri­al hyper­ten­si­on, etc.
• Late forms: Deve­lo­p­ment of heart fail­ure with the cli­ni­cal signs of impai­red per­for­mance, short­ness of breath, as well as weight gain and edema.

Sin­ce the­se chan­ges in the heart mus­cle deve­lop slow­ly and insi­dious­ly in most cases, inci­pi­ent dama­ge to the heart can initi­al­ly go unno­ti­ced in many pati­ents. The dia­gno­sis is made by loo­king at the fin­dings (by means of ana­mne­sis, phy­si­cal exami­na­ti­on, vital para­me­ters, labo­ra­to­ry dia­gno­stics, EKG) as well as with the gold stan­dard of transtho­ra­cic heart ultra­sound exami­na­ti­on (echo­car­dio­gra­phy). In ever­y­day cli­ni­cal prac­ti­ce, long-term sur­vi­vors after gyneco­lo­gi­cal tumor dise­a­ses, even years and deca­des after onco­lo­gi­cal the­ra­py, have to be careful of poten­ti­al­ly car­dio­to­xic manifestations.

Bone health

The meta­bo­lism in the bones is con­trol­led by hor­mo­nes. Dis­tur­ban­ces in the­se hor­mo­nes lead to dise­a­ses of the bone. An endo­cri­no­lo­gi­cal eva­lua­ti­on should be car­ri­ed out for the fol­lo­wing com­plaints or cli­ni­cal pictures:

• osteo­po­ro­sis
• low or high levels of cal­ci­um in the blood
• Para­thy­ro­id malfunction
• Vit­amin D deficiency

The Cli­nic for Endo­cri­no­lo­gy and Meta­bo­lic Medi­ci­ne offers a com­pre­hen­si­ve and com­pe­tent cla­ri­fi­ca­ti­on of the hor­mo­nes of bone metabolism.

Mental health

Women suf­fe­ring from can­cer can be expo­sed to soma­to-psy­cho­lo­gi­cal stress. So that the­se do not lead to an adjus­t­ment dis­or­der or hin­der the heal­ing pro­cess, it is important to offer a health-pro­mo­ting space for tho­se affec­ted, in which they can expe­ri­ence and expe­ri­ence in a safe setting.

Can­cer pati­ents expe­ri­ence a varie­ty of phy­si­cal, psy­cho­lo­gi­cal and social stres­ses in the cour­se of their ill­ness and tre­at­ment. Various stu­dies have shown that pro­fes­sio­nal psy­cho­so­cial coun­seling is effec­ti­ve in redu­cing psy­cho­lo­gi­cal stress. Long-term sur­vi­vors also have a high need for psycho-onco­lo­gi­cal sup­port. Almost a third of long-term sur­vi­vors with gyneco­lo­gi­cal can­cer are very afraid, e.g. of dying and no lon­ger being the­re for their fami­ly, and over 40% deve­lop depression.

Long-term neurological side effects

Many of the can­cer drugs curr­ent­ly used in sys­te­mic che­mo­the­ra­py can cau­se dama­ge to the peri­phe­ral ner­vous sys­tem. This often cau­ses (pain­ful) abnor­mal sen­sa­ti­ons in the hands and feet (ting­ling, pin­prick-like, like ants’ run, elec­tri­fy­ing) in tho­se affec­ted. The­se so-cal­led “posi­ti­ve sym­ptoms” can increase depen­ding on the tem­pe­ra­tu­re and are often more pro­no­un­ced when it is cold than when it is warm. Howe­ver, many suf­fe­rers also com­plain of redu­ced sen­sa­ti­on or numb­ness (so-cal­led “nega­ti­ve sym­ptoms”) in the affec­ted skin are­as, which can lead to dis­or­ders of fine motor skills or balan­ce and gait. Both posi­ti­ve and nega­ti­ve sym­ptoms are an expres­si­on of the dama­ge to sen­si­ti­ve ner­ve fibers and lead to rest­ric­tions that are rele­vant to ever­y­day life for many of tho­se affec­ted. In very rare cases, motor ner­ve fibers can also be dama­ged by che­mo­the­ra­py, which can lead to sym­ptoms of para­ly­sis. The cau­ses of ner­ve dama­ge cau­sed by che­mo­the­ra­py are still poor­ly unders­tood and, accor­din­gly, the­re are no pre­ven­ti­ve or cura­ti­ve the­ra­pies. Depen­ding on the che­mo­the­ra­peu­tic agent appli­ed, 30–90% of tho­se trea­ted can be affec­ted by CIPN, the ext­ent of which, howe­ver, varies great­ly from per­son to person

Conclusion

In order to be able to coun­ter­act long-term side effects in the cour­se of the fol­low-up care, pati­ents should stay infor­med and keep their atten­ding phy­si­ci­an infor­med about chan­ges. For exam­p­le, about how things went at home after out­pa­ti­ent the­ra­py. Side effects should not be tacit­ly accept­ed accor­ding to the mot­to: “That is part of it.”. It is best to have a kind of dia­ry in which obser­va­tions can be noted and which can impro­ve your fol­low-up care.