Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
The provided guidelines do not specifically detail follow-up care for Acute Lymphoblastic Leukemia (ALL) in remission. However, general principles for follow-up and survivorship care for other cancers, such as Non-Hodgkin's Lymphoma and brain tumours, can offer relevant considerations for long-term patient management.
- Follow-up for Remission (General Principles from Non-Hodgkin's Lymphoma):
- For people in complete remission after first-line treatment with curative intent for diffuse large B-cell lymphoma, regular clinical assessment is offered NICE NG52.
- Consider stopping regular clinical assessment aimed at detecting relapse 3 years after completing treatment for people in ongoing complete remission NICE NG52.
- Offer urgent appointments to people who experience a recurrence of lymphoma symptoms or new symptoms that suggest disease relapse NICE NG52.
- Do not offer LDH surveillance or routine surveillance imaging (including chest X-ray, CT, and PET-CT) for detecting relapse in people who are asymptomatic NICE NG52.
- Survivorship Care (General Principles from Non-Hodgkin's Lymphoma):
- Provide end-of-treatment summaries for people (and their GPs), discussing personal and general risk factors, including late effects related to their lymphoma subtype and/or its treatment NICE NG52.
- Provide information on how to recognise possible relapse and late effects of treatment NICE NG52.
- At 3 years after treatment completion, consider switching surveillance of late effects of treatment to nurse-led or GP-led services NICE NG52.
- Discuss exercise and lifestyle from diagnosis onwards NICE NG52.
- Ensure people have a named key worker at diagnosis and during treatment, and contact details for the specialist team after treatment NICE NG52.
- Information and support should cover communication, treatment details (benefits, short-term risks, late effects), financial support, fertility issues, sexual function, support groups, and access to wellbeing services and psychological support NICE NG52.
- Surveillance for Late-Onset Side Effects (General Principles from Brain Tumours):
- Be aware that people who have had cancer treatment can develop side effects months or years later, which may include cataracts, cognitive decline, epilepsy, hearing loss, hypopituitarism, infertility, neuropathy, radionecrosis, secondary tumours, SMART (stroke-like migraine attacks after radiotherapy), and stroke NICE NG99.
- Assess the person's individual risk of developing late effects when they finish treatment, record these in their written treatment summary, and explain them to the person NICE NG99.
- Encourage a healthy lifestyle, including exercise, a healthy diet, and stopping smoking, to decrease the risk of stroke NICE NG99.
- For people at risk of stroke, consider checking their blood pressure, HbA1c level, and cholesterol profile regularly NICE NG99.
- Consider ongoing neuropsychology assessment for people at risk of cognitive decline NICE NG99.
- If a person has had a radiotherapy dose that might affect pituitary function, consider checking their endocrine function regularly after the end of treatment NICE NG99.
- Consider referring people at risk of visual impairment for an ophthalmological assessment NICE NG99.
- Consider referring people at risk of hearing loss to audiology for a hearing test NICE NG99.