Table 1. Common cancer and treatment-related long-term and late effects with the recommendation.
ENT: Ear, Nose & Throat, BFI: Brief Fatigue Inventory, MDASI: MD Anderson Symptom Inventory, NSAID: nonsteroidal anti-inflammatory drug, DEXA: dual-energy x-ray absorptiometry
| Problem | Common Symptom | Related Malignancy | Recommendation |
| GI Issues | Obstruction | Colon, rectal, and anal malignancies | Discuss bowel habits, rectal bleeding, and sphincter dysfunction |
| Rectal bleeding/ulcers | Evaluate for incisional hernia | ||
| Challenges with ostomy care | Refer to an appropriate specialist | ||
| Dental/Oral | Loss of taste | Head and neck | Adequate oral hygiene |
| Xerostomia hyposalivation | Evaluate for nutritional deficiencies | ||
| Dental caries | Referral to a specialist (ENT, dentists) | ||
| Fatigue (rating in a scale of 0-10) | Tiredness | Common to most | Use of an assessment tool (MDASI, BFI) |
| Optimize nutrition and physical activity | |||
| Assess for causative etiology: anemia, thyroid dysfunction, sleep disorder | |||
| Pain | Somatic | Common to most | Assess using pain scale and comprehensive history and exam |
| Neuropathic | Offer intervention (NSAID, antidepressants, anticonvulsants, opioids, physical activity) | ||
| Refer to a specialist once etiology is determined | |||
| Lymphedema | Breast | Offer compressive garment | |
| Refer symptomatic patients to a specialist | |||
| Bone Health | Breast, prostate, and others | Baseline DEXA scan | |
| Cognitive Dysfunction | Memory changes | Cranial radiation (lung, breast, melanoma) | Assess by asking if the patient is experiencing cognitive dysfunction |
| Difficulty multitasking | Assess for contributing factors (medications, mood disorder, symptoms burden) | ||
| Refer symptomatic patients for neurocognitive testing | |||
| Cardiotoxicity | Chest pain | Breast, gastric, lung | Assess symptoms of heart failure, modifiable and non-modifiable cardiac risk factor |
| Shortness of breath | Consider echocardiogram in a symptomatic patient | ||
| Swelling of legs | Consider referral to a specialist | ||
| Management depends on the stage of heart failure according to ACCF/AHA | |||
| Sexual Health | Erectile dysfunction | Pelvic radiation (prostate, bladder, rectal) | Assess by using the Sexual Health Inventory for Men |
| Vaginal dryness | Hormonal treatment (breast) | Assess using the Brief Sexual Symptom Checklist for woman | |
| Interest changes | Androgen deprivation therapy (ADT) - prostate, breast | Obtain detailed medical, psychosocial, and oncologic histories and physical exam | |
| Obtain appropriate laboratory studies | |||
| Avoid testosterone use in men receiving ADT |