After­care in gyne­co­log­i­cal oncol­o­gy — Why you should pre­vent side effects in cancer

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.

Fol­low-up examinations

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.

Side effects

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

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.

Bone health

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:

• osteo­poro­sis
• 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.

Men­tal health

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

Con­clu­sion

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.