Definition and Overview
A radiation oncology follow-up is a visit to a radiologist, oncologist, or other members of the cancer patient's health care team after radiation therapy has been completed.
Cancer is a disease characterized by the uncontrolled growth and development of abnormal cells. This occurs when the genes mutate, the person is exposed to certain chemicals and environment that cause gene mutation, or when the patient has a genetic predisposition to a particular disease. Due to the presence of abnormal cells, the old cells, which are already damaged or old, no longer undergo programmable death (apoptosis), while the body produces new cells even if they are not necessary.
When this happens, the cells stop functioning properly, form tumors that can prevent an organ from doing its job well, and travel to other parts of the body in a condition known as metastasis.
Over the last few decades, different kinds of treatment options have become available to cure cancer. These include radiation therapy, a method that utilizes high-energy radiation, such as gamma and X-rays, to kill cancer cells. These particles are delivered to the body internally in a procedure known as brachytherapy or externally, wherein the machine that gives off the radiation is used.
Radiation therapy promotes cellular death by damaging the DNA, the particle that contains the body’s genetic information and instruction on how cells should behave. Once the cells die, they are eliminated from the body.
According to statistics, radiation therapy is used to cure cancer more than 70% of the time. But cancers such as those that affect the brain and lung have lower numbers at 50% and 59%, respectively. In all other instances, radiation therapy is performed to relieve the symptoms or delay the progression of the disease.
Who Should Undergo and Expected Results
More than 60% of the cancer patients will receive at least one radiation therapy session. The follow-up care is then conducted to:
Monitor the potential side effects of radiation therapy – Although radiation therapy can kill abnormal cells, it can also harm the healthy ones. Also, the level and frequency of exposure can introduce different side effects including but not limited to skin soreness, fatigue, anemia, and increased risk of infections. Aside from being uncomfortable and painful, these side effects can also significantly reduce a patient’s quality of life, particularly after a few weeks following the radiation therapy. Increased risk of infection, on the other hand, can become life threatening for the patient.
Keep track of recurrence – Recurrence, or the risk of suffering from the same cancer, is always possible even if the patient has gone through a complete round of radiotherapy. In fact, some studies suggest that radiation therapy itself can trigger recurrence as the DNA in cells can also mutate due to their exposure to radioactive materials. During follow-up, multiple tests are conducted to see any changes in cancer cells or if there’s a new batch of cancer cells that has developed in the body.
Help the patient cope with life after treatment – A follow-up is a good time to counsel the patient and his family as well as his carers on the steps that can be undertaken to make the recovery from the treatment and cancer itself as easy, comfortable, and quick as possible.
Assess the success of the radiation therapy - Depending on the outcome of radiation therapy, the oncologist may decide to repeat the entire procedure, use a different kind of method, suggest an entirely different protocol, or stop radiation.
How Does the Procedure Work?
A radiation oncologist is responsible for informing the patient about the follow-up care as part of the post-operative procedure. It should be discussed during the pre-operative assessment to ensure the patient knows what he can expect after the treatment has been completed.
During the follow-up, the radiation oncologist will create a schedule that should be followed by the patient. The first visit is conducted immediately after the treatment. By then, the patient may be staying either in or out of the hospital, although the former is more common. The oncologist will assess the patient’s level of discomfort and pain, the success of the treatment in terms of its objective (which can be curative or palliative), and determine if side effects are present. Different types of tests, including imaging and blood tests, are carried out for a more conclusive and comprehensive assessment.
The oncologist shall also determine whether the patient can already resume to normal activities or if there are certain activities that he needs to avoid during recovery or for the rest of his life. The doctor may also outline the necessary therapy after-care especially if the patient is experiencing side effects.
In the succeeding follow-up visits, the oncologist is expected to share the assessment and test results to the patient and provide the best course of action. The patient may also see other health care providers, such as the surgeon and primary care physician, for other types of follow-up care.
Because cancer can affect the patient’s mental state, the radiation oncologist may also provide counseling or refer the patient to a support group to help him effectively cope with the disease.
Possible Risks and Complications
For some patients, following the aftercare schedule can be difficult for a number of reasons. One, some side effects, such as fatigue, may discourage them from moving about, including visiting their radiation oncologist, more so if they have to see several health care providers multiple times. Patients may also feel frustrated with the treatment especially if they experience symptoms of side effects, as well as recurrence. There are also other times when patients may avoid follow-up altogether as a way of putting the disease in the past or avoiding being reminded that they have cancer.
It is the role of the radiation oncologist to explain fully and properly the full benefits of follow-up care and why it’s necessary for the patients’ survival, so they are motivated to stick to it.
Zemen EM, Schreiber EC, Tepper JE. Basics of radiation therapy. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 27.
National Cancer Institute. Radiation therapy and you: support for people who have cancer. Available at: http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you. Accessed May 29, 2014.