Survivorship, Psychosocial, and Coordinated Care
Surveillance after treatment
Follow-up consists of history and physical examination every few months for several years and then annually, with annual mammography. Routine tumor markers, blood tests, and imaging in asymptomatic patients are not recommended and are a classic distractor. Survivors need attention to bone health, cardiovascular risk, lymphedema surveillance, and late effects of radiation or chemotherapy.
Fertility and family building
Fertility counseling should occur before treatment begins, with referral for embryo or oocyte cryopreservation when appropriate. Pregnancy after breast cancer is generally discussed after risk assessment, particularly in hormone receptor-positive disease.
Psychosocial care
Screen for distress with a validated tool such as the distress thermometer. Address depression, anxiety, fear of recurrence, body image, sexual function, financial toxicity, return to work, and caregiver burden. Cultural background, health literacy, and social determinants shape how needs are expressed and met.
Coordination and palliative care
Multidisciplinary teams, shared decision-making, and clear transitions to primary care are core. Palliative care is symptom-focused and can begin at diagnosis alongside curative treatment; it is not synonymous with hospice. Advance care planning and goals-of-care conversations belong in routine oncology care.
Traps
Equating palliative care with end-of-life care, ordering surveillance tumor markers, and omitting fertility discussions in younger patients.
Worked example. A survivor two years out asks whether she needs a PET scan and CA 15-3. The answer is no: she needs a history and physical, annual mammography, and symptom-driven testing. Her distress score of 7 triggers referral and a discussion of fear of recurrence.