Survivorship Center: Survivorship FAQs

1. When Am I Considered a Cancer Survivor?

The term “cancer survivor” means different things to different people. For some, the term refers to anyone who has been diagnosed with cancer; others consider a cancer survivor to be anyone who has completed active treatment and is free of any signs of disease.

For the purpose of Memorial Sloan-Kettering Cancer Center survivorship services, the transition from cancer patient to cancer survivor occurs after completion of your active treatment at a time designated by your physician. During the survivorship phase, you will still require careful monitoring of your health status and management of ongoing and late effects of cancer treatment.

Resources

• Survivorship Clinics
• Resources for Life After Cancer

2. What Should My Medical Follow-up Be Once My Cancer Treatment Is Finished?

At the completion of your cancer treatment, ask your oncologist to develop a survivorship care plan with you. This plan should provide the medical guidance for your care as you transition to living beyond cancer.

At Memorial Sloan-Kettering Cancer Center, your plan will likely include follow-up visits with your doctor during the first years after cancer treatment. At some point, you may be referred to a survivorship nurse practitioner for your follow-up care. The nurse practitioner specializes in treating cancer survivors and will work closely with your oncologist to monitor your health status and to manage ongoing and late effects of cancer treatment. Communication between your other doctors is a priority so that information about post-treatment issues can be incorporated into your overall medical plan.

You and your local doctor will always have access to your Memorial Sloan-Kettering Cancer Center care providers should you need us at any time.

Resources

• Survivorship Clinics
• Follow-up Care After Cancer Treatment: Questions and Answers
  From the National Cancer Institute

3. What Is a Survivorship Care Plan?

A survivorship care plan is the record of a patient's cancer history and recommendations for follow-up care. The plan should define responsibilities of cancer-related, non-cancer-related, and psychosocial providers. Clear designation of who is responsible for the various aspects of care can optimize care coordination, avoid unnecessary use of resources, and ensure that care does not “fall through the cracks.” Patients should be encouraged to provide a copy of the care plan to their primary care providers and other healthcare providers throughout life.

Elements of a Survivorship Care Plan

Treatment Summary

• Details of the cancer diagnosis
  • Diagnosis date
  • Type of cancer
  • Location
  • Stage
  • Histology
• Names and contact information of the providers and treatment facilities
• Treatments administered
  • Chemotherapy/biotherapy — regimen, drug, dose, cycles; clinical trial information
  • Radiation — type, dose, site
  • Surgery — procedure

Follow-up Plan

• Specific recommendations for ongoing care
  • Schedule of visits with oncology specialist
  • Surveillance testing for recurrence
  • Identify and manage long-term and late effects
• Health promotional strategies
  • Smoking cessation
  • Alcohol and dietary modifications
  • Regular weight-bearing exercise

Memorial Sloan-Kettering Cancer Center

Oncology nurses and physicians from the Memorial Sloan-Kettering Survivorship Initiative have developed a cancer treatment summary and follow-up plan template cancer treatment summary and follow-up plan template which can be modified by other institutions. This document was designed to be completed by oncology professionals and shared with survivors and survivors' primary care physicians. The template allows customization of the following information:

• Treatment Summary
  • surgery
  • chemotherapy/biotherapy
  • radiation therapy
• Follow-up Plan
  • visit schedule
  • testing schedule
  • cancer screening
  • health behavior recommendations

The LIVESTRONG^TM Care Plan

The LIVESTRONG^TM Care Plan has been developed by a team of oncology nurses and physicians and details the medical challenges a survivor may face. This document will be individualized based on the answers you provide in a brief questionnaire. In order to develop the most accurate plan of care, you may need to talk to your oncology team to have some details of your cancer therapy available. This care plan is meant for you to review and discuss with your healthcare team (both oncology and primary care).

American Society of Clinical Oncology (ASCO)

ASCO has developed disease specific cancer treatment summaries and follow-up plans. These resources should be given to patients, nurses, and doctors as a record of care planned and received and to promote communication about future health needs. The link below describes and provides access to the templates.

Please Note: These resources are not intended to replace communication with a physician about your cancer care.

For Healthcare Professionals

See our information for healthcare professionals on developing a survivorship care plan.

4. What Types of Follow-up Tests Might I Need?

Your doctor or nurse practitioner will have you undergo specific tests to check for any signs of cancer depending on your individual diagnosis and treatment plan. These tests may be performed at every doctor visit or less frequently. Be sure to ask your doctor for the specifics of your follow-up care plan.

Follow-up Assessments

Physical Exam

An examination of various parts of the body to identify any abnormalities or general signs of disease.

Laboratory Tests

Laboratory tests involve testing a sample of blood, urine, or other body fluids to learn or confirm what is happening in the body. The most common lab tests include tumor markers, blood chemistries, and a complete blood count.

X-ray

In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body.1

Computerized Tomography (CT)

A procedure that uses special x-ray equipment to obtain cross-sectional pictures of the body, including detailed images of organs, bones, and other tissues. The CT scan can detect or confirm the presence of a tumor.2

Single Photon Emission Computed Tomography (SPECT)

A special type of computed tomography (CT) scan in which a small amount of a radioactive drug is injected into a vein, and a scanner is used to make detailed images of areas inside the body where the radioactive material is taken up by the cells. SPECT can give information about blood flow to tissues and chemical reactions in the body.3

Positron Emission Tomography (PET)

A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body.4

Positron Emission Tomography/Computerized Tomography (PET/CT)

Combination PET/CT shows both the location and the metabolic signal of actively growing cancer cells if a tumor should arise. If the PET/CT study indicates a recurrence, your doctor may order a separate CT study for precise information about the location of the tumor.5

Ultrasound

A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Ultrasound is helpful in diagnosing cancer found in the soft tissue.6

Magnetic Resonance Imaging (MRI)

A procedure in which radio waves and a powerful magnet linked to a computer is used to create detailed pictures of areas inside the body. These pictures can show the difference between healthy and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as CTs or x-rays. MRI is especially useful for imaging the brain, spine, the soft tissue of joints, and the inside of bones.7

¹National Cancer Institute. Dictionary of Cancer Terms. X-ray. Retrieved June 12, 2006, from the World Wide Web: www.cancer.gov.
²National Cancer Institute. Dictionary of Cancer Terms. Computerized tomography. Retrieved June 12, 2006, from the World Wide Web: www.cancer.gov.
³National Cancer Institute. Dictionary of Cancer Terms. Single photon emission computed tomography. Retrieved June 12, 2006, from the World Wide Web: www.cancer.gov.
⁴National Cancer Institute. Dictionary of Cancer Terms. Positron emission tomography. Retrieved June 12, 2006, from the World Wide Web: www.cancer.gov.
⁵Memorial Sloan Kettering Cancer Institute. Cancer Information. (August 13, 2004). Diagnosis. Retrieved June 12, 2006, from the World Wide Web: www.MSKCC.org.
⁶Mayo Clinic. Cancer. (June 14, 2006). Diagnosing cancer: Common tests, biopsies and examinations. Retrieved June 14, 2006, from the World Wide Web: www.mayoclinic.com.
⁷National Cancer Institute. Dictionary of Cancer Terms. Magnetic resonance imaging. Retrieved June 12, 2006, from the World Wide Web: www.cancer.gov.

Resource

• Survivorship Clinics

5. Where Can I Learn More about Cancer Recurrence?

The uncertainty associated with wondering if or when your cancer will ever return can be frustrating. Risk of cancer recurrence differs by type of cancer, stage at diagnosis, treatment method, elapsed time since treatment, and other environmental factors that are still being uncovered. We advise you to discuss your personal risk of cancer recurrence with your doctor or nurse practitioner.

6. What Are the Signs That the Cancer Might Be Returning?

A set of precise indicators that one might feel when cancer is returning does not exist. Symptoms, such as lumps or pain, will vary depending on how the cancer develops. In some cases, patients will not feel or see any signs. Therefore, maintaining follow-up visits with your doctor or nurse is vital for assessing and discussing your health status.

Remember that every symptom you have will not be related to a cancer returning. However, it is important to communicate your symptoms to your care provider so that they can be evaluated.

Resources

• Survivorship Clinics

7. Am I at Risk for a New Cancer?

Cancer survivors can have a higher risk of developing a second primary cancer as a result of their prior cancer treatment, environmental exposures, or genetics. Having all appropriate cancer screening tests done at the recommended intervals is an important step in the early detection of these cancers.

Consult Screening for other Types of Cancer

Learn more about screening for skin, ovarian, cervical, breast, rectal, and prostate cancers.
More »

Cancer Risk: Understanding the Puzzle

The National Cancer Institute offers online guidance on making informed decisions about lowering your risk.
Go to Web Page »

8. What Actions Can I Take to Minimize My Risk for a New Cancer?

Researchers are beginning to understand how people can lower their risk of getting certain cancers. The following preventive actions may reduce your risk for developing another cancer:

Stop Smoking

Quitting smoking is one of the best ways to improve your general health. Quitting will help you breathe easier and feel better overall. Furthermore, becoming smoke free will reduce your risk of developing cancer and help prevent cardiovascular disease as well. To learn more about how Memorial Sloan-Kettering Cancer Center can assist you in your effort to quit smoking, visit Smoking Cessation.

Protect Yourself from the Sun

You can reduce your risk of getting skin cancer by protecting yourself from the sun's ultraviolet rays. Protect your skin from direct sunlight by wearing protective clothing, applying sunscreen, or seeking shade. Also, avoid sunlamps and tanning booths.

Diet and Exercise

Eating a diet rich in fruits and vegetables and exercising 30 minutes daily does not guarantee that cancer will not return. However, improving the way you eat, exercise, and live your life can help you feel better and may also lower your chances of developing other health problems.

Chemoprevention

Chemoprevention is the use of specific natural or man-made drugs, vitamins, or other agents to reverse, suppress, or prevent cancer growth. Many agents are being evaluated for their usefulness. Please discuss the specific product you wish to use in advance with your doctor or nurse.

9. Where Can I Find Information about Health Insurance Issues for Cancer Survivors?

Health insurance questions are important and often complex. Memorial Sloan-Kettering Cancer Center has an Insurance Information line at 646-497-9176 where we can help answer your health insurance questions pertaining to treatment within Memorial Sloan-Kettering. To learn more about Memorial Sloan-Kettering insurance information, visit How We Help. Information resources on health insurance issues can be found by visiting Practical Matters for cancer survivors.

10. Where Can I Find Information about Workplace Issues for Cancer Survivors?

Your cancer, cancer treatment, or late side effects of treatment may entitle you to protection under the Americans with Disabilities Act. If so, your employer cannot discriminate against you as long as you are qualified to do your job. Furthermore, if your cancer or late side effects of cancer interfere with your ability to perform the responsibilities of job, your employer may need to provide reasonable accommodations to allow you to perform the essential functions of your job. Information resources on health insurance and workplace issues can be found by visiting Practical Matters for cancer survivors.