Survivorship Care for Lung Cancer Patients: What to Expect

After completing treatment for lung cancer, a new chapter unfolds - the road to recovery. It is a time to prioritize your well-being and commit to maintaining your health. This phase can be an opportunity to reflect on what you want to do and how you want to live your life moving forward. Harnessing your inner strength and determination that got you through cancer therapy is essential for your post-treatment care. You may experience entirely new emotions and challenges, but remember to make your health a priority.

“Nearly all patients with NSCLC today...have a choice of therapeutic options. Patients with NSCLC who respond to targeted therapies or immunotherapies now routinely survive 3 to 4 years, with some surviving substantially longer,”

– Dr Nils H. Thoennissen, specialist in lung cancer at Ludwig Maximilian University of Munich, Germany

After undergoing treatment for lung cancer, the type of follow-up care you need depends on your specific situation:

• Early detection of second primary cancer - If you were diagnosed at an early stage and underwent curative treatment, your primary concern should be monitoring for the possibility of a second cancer. Cancer can recur when a small group of cancer cells evade initial treatment. Regular follow-up checks are essential.
• Achieving remission or cancer-free status - If you have achieved cancer remission, are considered cancer-free, or have "No Evidence of Disease" (NED), your focus should be watching for any signs of cancer recurrence. Some patients may be placed under maintenance therapy to prolong this favorable, stable state while delaying cancer progression. Even after successful treatment, cancer can return over time.
• Managing symptoms - In cases where active treatments could not eliminate the cancer, your medical team may focus on managing symptoms. Early and well-planned palliative care can ensure the best quality of life.

Special attention is required for those at risk of second lung cancer, such as individuals with a history of non-small cell lung cancer (NSCLC), inherited cancer genes, or ongoing risk factors like smoking or exposure to high radon levels.

The American Society of Clinical Oncology (ASCO) recommends comprehensive post-treatment care for all successfully treated cancer patients. The follow-up care includes:

• Monitoring for recurrence: Regular checks will be conducted to detect any cancer recurrence or the development of new lung cancer elsewhere in the body. ASCO recommends that surveillance tests be performed every six months during the initial two years following cancer treatment, transitioning to annual testing thereafter. For NED patients, annual low-dose CT scans may continue beyond five years. However, caution must be exercised, especially in younger individuals, to limit radiation exposure and the risk of radiation-induced cancer
• Managing side effects: Long-term or late side effects from cancer treatment will be managed to ensure your overall well-being.
• Overall health monitoring: Your general health and well-being will be closely monitored to address any emerging concerns (including any second cancer).

During follow-up visits, the recommended surveillance tests typically include:

• Review of medical history
• Physical examination
• Low-dose chest computed tomography (CT)

Additional tests, such as blood tests or other imaging studies, may be necessary based on factors like the lung cancer subtype, the stage at initial diagnosis, and the specific treatments you received.

Many lung cancer patients endure side effects during and after therapy. These can be categorized into:

• Long-term side effects - side effects that linger even after the therapy has ended
• Late effects - side effects that develop months or even years after the therapy is complete

Long-term effects often include

• chronic pain
• fatigue
• sleep impairment
• difficulty breathing
• dependence on supplemental oxygen

Unique cancer treatment side effects like neuropathy, hearing loss, depression and skin changes may also persist. While some of these effects gradually improve within 6 to 12 months post-treatment, some may persist for several years. The persisting effects can impair the quality of life.

The side effects can encompass physical and emotional challenges for lung cancer survivors. Some patients may be granted a reprieve, commonly referred to as a “drug holiday” if their condition is considered stable. It is imperative to follow up with the cancer care team and your support group, even if you feel well, to improve your life as a cancer survivor. Every individual responds differently to cancer treatments. Managing these effects is a personalized journey.

Related: Under One Roof With Someone on Chemo: How to Care for Your Loved Ones

The care of lung cancer survivors requires coordination among different care providers. The survivorship care plan should be tailored to your specific needs and health conditions.

The oncologist or other treating clinicians often handle treatment-related symptoms and side effects while monitoring cancer recurrence. Often, lung cancer patients are older and may have other chronic conditions such as high blood pressure or diabetes. These may be more suitably managed by their primary care doctors (i.e. family physician or general practitioner).

Some points to note when preparing a survivorship care plan include:

• Components of care plan –
  • A schedule for follow-up exams and tests
  • Information about potential long-term and late side effects
  • Recommendations for additional tests to monitor health
  • Advice on lifestyle changes to reduce the risk of cancer recurrence
• Keeping medical records - Keeping copies of the comprehensive history of diagnosis and cancer treatment received and sharing them with all future healthcare providers, even if they were not involved in the initial cancer care
• Importance of health insurance - Maintaining health insurance is crucial to cover the costs of tests and doctor visits, as there is a risk of cancer recurrence