Advances in oncology have significantly improved the prognosis for many types of cancer in recent years. Modern immunotherapies, targeted drugs, optimized surgical procedures, and more precise radiation therapies now enable many patients to live with cancer for years or even indefinitely.

This brings a new challenge into focus: Many patients continue to suffer from the physical, psychological, or social consequences of their disease long after completing cancer treatment.

Professional societies such as the American Society of Clinical Oncology (ASCO) now regard this phase as a distinct stage of cancer care that requires structured, long-term follow-up care.

In outpatient care, primary care physicians play a central role. They are often the first point of contact for symptoms and long-term effects that do not appear until months or even years after the end of cancer treatment. These five tips will help you provide better care for cancer survivors.

Tip 1: Actively Inquire About Long-Term Effects

Many long-term effects of cancer treatment are overlooked in everyday practice. The most common symptoms include fatigue, polyneuropathies, sleep disorders, chronic pain, and cognitive impairments. Studies show that these symptoms often persist for years and can significantly impair quality of life. However, one challenge for doctors is that many affected individuals do not actively bring up their symptoms. Some view fatigue or concentration problems as an inevitable consequence of their illness, while others do not want to be perceived as “patients” again after completing treatment. Symptoms requiring treatment often go unrecognized. Experts therefore recommend specifically addressing typical long-term effects during follow-up appointments. Particularly relevant are questions about physical endurance, sensory disturbances, pain, shortness of breath, heart-related symptoms, as well as concentration and memory problems.

Tip 2: Recognize Psychosocial Stress

Added to this is the psychological stress experienced by many patients. Their fear of a relapse, depressive symptoms, sleep disturbances, or social isolation can impair quality of life in the long term. Of particular significance is the so-called “fear of cancer recurrence.” A systematic review identifies the fear of recurrence as one of the most common and distressing issues.

psychosocial problems among cancer survivors, even years after successful treatment. International survivorship guidelines therefore recommend a regular screening for psychosocial distress. Even simple questions about mood, sleep quality, worries, family stressors, or social support can help identify which individuals require psycho-oncologic or psychotherapeutic interventions.

The period after treatment ends deserves special attention. Many people find the transition from intensive oncologic care back to everyday life stressful and report feeling uncertain or abandoned.

Tip 3: Check Vaccination Status and Optimize Protection Against Infection

After completing cancer treatment, immune function and the body’s ability to fight off infections may remain impaired for an extended period. For adult cancer patients, an ASCO guideline is now available on this topic. It recommends systematically assessing vaccination status and considering vaccinations an integral part of care.

Vaccinations against influenza, COVID, pneumococcal disease, and herpes zoster are particularly important. The ASCO guideline explicitly recommends these vaccinations for adults with cancer. For the influenza vaccine, there is a Cochrane review on immunosuppressed adults with cancer. The authors conclude that the vaccine is safe and that observational data point to lower mortality as well as more favorable infection-related outcomes.

For outpatient care, it therefore makes sense to firmly integrate vaccination monitoring into oncologic follow-up care. In practice, this means: checking the vaccination record, documenting any missing routine and indication-based vaccinations, giving preference to inactivated vaccines, and, in cases of ongoing or recently completed immunosuppressive therapy, consulting with the oncology department.

Tip 4: Prescribe Exercise Specifically Rather Than Just Vaguely Recommending It

Physical activity is now one of the best-studied nonpharmacologic measures in cancer follow-up care. Numerous studies demonstrate positive effects on fatigue, physical performance, mental well-being, and quality of life.

Large-scale studies support the benefits of exercise. A meta-analysis from 2023, involving 28 randomized trials and 1573 participants, found significant improvements in cancer-related fatigue and quality of life through exercise interventions.

The recommendation is for at least 150 minutes of moderate physical activity per week, along with supplemental strength training, tailored to the type of tumor, the effects of treatment, comorbidities, and the individual’s tolerance. Even low-threshold activities such as regular walking, cycling, or oncology exercise groups can bring about significant improvements. For physicians, this means viewing exercise not merely as well-intentioned lifestyle advice, but as an evidence-based therapeutic measure.

Tip 5: Coordinate Follow-Up Care and Develop a Survivorship Plan

Many cancer survivors are cared for simultaneously by primary care physicians, oncologists, and other specialists. As the number of long-term survivors increases, so does the challenge of coordinating follow-up care, prevention, and treatment of therapy-related late effects. Experts point out that high-quality survivorship care requires structured collaboration between oncology and primary care.

ASCO therefore recommends survivorship care plans. Such follow-up plans contain information on the cancer diagnosis, treatments, potential late effects, recommended follow-up examinations, as well as measures for prevention and health promotion. The goal is to improve communication between oncologists, primary care physicians, and patients and to facilitate the transition to long-term follow-up care.

A survivorship care plan not only facilitates interdisciplinary collaboration but also increases patient safety. Studies show that survivorship care plans can, in particular, improve communication among healthcare providers and help patients better understand and engage with their follow-up care. However, the benefits depend largely on how consistently the plans are implemented and integrated into care.

General practitioners often take on a coordinating role in this process. They frequently care for patients over many years, monitor comorbidities, watch for potential long-term effects, and ensure that recommended follow-up examinations are performed.

Conclusion: Survivorship Is Becoming the New Challenge for Outpatient Medicine

Medical advances mean that more people are living for many years after a cancer diagnosis. As a result, the importance of structured outpatient follow-up care is growing. Those who actively inquire about long-term effects, take psychological stress into account, check vaccination status, specifically promote physical activity, and coordinate follow-up care can make a significant contribution to improving the long-term quality of life and health of cancer survivors.

Modern cancer care does not end with the last round of chemotherapy or surgery and the final imaging. For many patients, this marks the beginning of a new phase in which outpatient care plays a central role.

This story was translated from Medscape’s German edition.