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.
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.
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 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.
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:
- 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.
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
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.