Active Cancer Surveillance: Proactive Monitoring for Long-Term Health and Early Detection
A monitoring strategy may be offered to you when the tumor is localized and does not cause symptoms. This is mostly active monitoring. Active cancer surveillance is a systematic and proactive approach employed in the management of cancer, focusing on close monitoring and follow-up care for individuals who have undergone cancer treatment and achieved remission. This vigilant surveillance strategy aims to detect any signs of cancer recurrence, new malignancies, or treatment-related side effects at their earliest stages, facilitating timely intervention and improving long-term health outcomes for cancer survivors.
Its purpose is to delay treatment, and the side effects that accompany it, until it is necessary. Indeed, some prostate cancers evolve slowly and sometimes for a long time.
The principle of active surveillance is based on regular examinations. If a progression of the disease is detected, a treatment aimed at treating the disease can be programmed.
When monitoring is the choice made in a multidisciplinary consultation meeting (RCP), your doctor will discuss the advantages and disadvantages of this option with you. It informs you of the risk of disease progression, assessed according to your personal medical situation. After this discussion, the decision to implement monitoring or treatment is yours.
Monitoring methods should not be confused with follow-up after treatment, which concerns all cancers. This follow-up is programmed at times and according to different methods from those of active surveillance.
In which cases?
What process?
When cancer progresses
Abstention clinical monitoring (watchful waiting)
IN WHICH CASES?
Active surveillance is intended for certain patients with a localized tumor at low risk of progression, whose cancer does not necessarily require immediate treatment but who could benefit from curative treatment in the event of cancer progression. It is therefore a question of delaying the establishment of a treatment.
WHAT PROCESS?
Active monitoring is based on check-ups set at regular intervals by the team monitoring you at the hospital or clinic, in conjunction with your attending physician. They are mainly based on:
- clinical exam, where your doctor examines you and performs a physical exam to detect signs of clinical change;
- retesting tumor marker tests to follow their evolution over time and especially doubling time;
- in certain situations, a CT scan and/or MRI may be offered to you.
The results of all these tests allow your doctor to monitor the disease and detect any progression. The doctor also tells you the symptoms that should lead you to consult outside of scheduled appointments.
Surveillance is generally continued throughout life or until disease progression.
WHEN CANCER PROGRESS
If an evolution of the cancer is observed through the results of the various examinations carried out, the advisability of starting treatment will be discussed in the MCM. A treatment proposal is then made to you.
WITHHOLD CLINICAL MONITORING (WATCHFUL WAITING)
Withholding clinical surveillance is different from active surveillance. It can be proposed when the age or the state of health of the patient does not allow or does not justify setting up a treatment to treat the disease. This monitoring modality makes it possible to initiate treatment only when the cancer causes symptoms, in order to treat them. This is called palliative treatment. The initiation of treatment is discussed in a multidisciplinary consultation meeting (MCM).
The treatment offered is generally based on hormone therapy, associated according to the needs and the symptoms experienced, with other so-called symptomatic treatments (for example, radiotherapy in the event of bone pain).
WHAT ARE THE OBJECTIVES OF FOLLOW-UP AFTER THE TREATMENTS?
The main objectives of monitoring are:
- detect a possible recurrence of the disease, that is to say the reappearance of cancerous cells, in the same place or in another region of the body;
- monitor the possible appearance of a cancer different from that which was treated, especially if you have one or more risk factors;
- implement the supportive care necessary to restore and/or best preserve your quality of life. This concerns the detection and management of adverse effects of treatments and complications of the disease, but also the management of the psychological consequences of cancer on your personal, social and professional life.
Key Points for Active Cancer Surveillance
Purpose:
The purpose of active cancer surveillance is to proactively monitor cancer survivors after treatment to detect any signs of cancer recurrence, new malignancies, or treatment-related side effects at their earliest stages. The goal is to ensure early detection and timely intervention, leading to improved treatment outcomes and enhanced quality of life for cancer survivors. For example, a breast cancer survivor undergoes regular follow-up tests and examinations to identify any potential recurrence of breast cancer or any new tumors that may require immediate attention.
Regular Follow-Up Visits:
Active cancer surveillance involves scheduling regular follow-up visits with the healthcare team. These visits are essential as they provide an opportunity for healthcare providers to assess the survivor’s overall health, review treatment outcomes, and address any concerns or symptoms that may arise. During these visits, the medical team conducts thorough assessments, including reviewing the survivor’s medical history, performing physical examinations, and ordering relevant tests and screenings. For instance, a colorectal cancer survivor visits the oncologist every six months for physical examination, blood tests to monitor CEA levels, and a colonoscopy to check for any polyps or signs of cancer recurrence.
Tailored Monitoring for Each Cancer Type:
Active surveillance is customized to each individual’s specific cancer type, stage, and treatment history. Different cancers have distinct patterns of recurrence, and the monitoring approach is adapted to align with the unique characteristics of each cancer. For example, a prostate cancer survivor’s active surveillance plan may include regular PSA tests and digital rectal exams to monitor prostate-specific markers and detect any changes or signs of disease progression.
Imaging Tests:
Imaging tests play a crucial role in active cancer surveillance. Computed tomography (CT) scans, magnetic resonance imaging (MRI), positron emission tomography (PET) scans, and ultrasounds are used to visualize internal structures and evaluate specific areas that may be susceptible to cancer recurrence or metastasis. An example would be a lung cancer survivor undergoing periodic CT scans to monitor the lungs for any new tumors or metastatic growth.
Blood Tests and Tumor Markers:
Blood tests, including tumor markers, are used to monitor specific markers associated with certain cancers. Changes in these markers may indicate potential cancer recurrence or progression. For instance, a breast cancer survivor may undergo periodic CA 15-3 blood tests to monitor breast cancer-related markers, providing valuable information about the response to treatment and any signs of recurrence.
Tumor Markers: What They Are and How They’re Used to Diagnose and Monitor Cancer
Physical Examinations:
Regular physical examinations by healthcare professionals help detect any physical changes or abnormalities related to the cancer or its treatment. For example, a melanoma survivor may receive frequent skin examinations by a dermatologist to monitor existing moles and detect any new suspicious lesions.
Duration of Active Surveillance:
The duration of active cancer surveillance varies based on individual factors. For cancers with higher recurrence risks, such as breast or colon cancer, surveillance may extend for several years. In contrast, for cancers with lower recurrence risks, the intensity and frequency of monitoring may reduce over time. For instance, a thyroid cancer survivor may undergo active surveillance for five years, while a low-risk prostate cancer survivor may be monitored for only two years.
Empowering Survivors:
Active cancer surveillance empowers cancer survivors to take an active role in their healthcare journey. By closely monitoring survivors and promptly addressing any changes or concerns, active surveillance encourages survivors to become proactive in their self-care and advocate for their well-being. Empowerment can lead to improved adherence to follow-up appointments and screenings, contributing to better long-term outcomes.
Early Detection and Intervention:
One of the key benefits of active cancer surveillance is early detection. By closely monitoring cancer survivors, healthcare providers can detect cancer recurrence or new malignancies at their earliest stages. Early detection allows for prompt intervention, leading to a higher likelihood of successful treatment outcomes and potentially curative approaches. For example, a testicular cancer survivor may benefit from early detection of a new tumor, leading to effective surgical removal and improved prognosis.
Overall, active cancer surveillance ensures comprehensive post-treatment care, promoting early detection, timely intervention, and better long-term health for cancer survivors. By employing a tailored approach and empowering survivors, active surveillance plays a pivotal role in the ongoing management of cancer survivorship.
How long active monitoring can last?
However, it should be perfectly aware that only 59 to 67% of patients (depending on the studies) will remain under active surveillance after five years. This means that a significant number of patients will have to go for a curative treatment option. This therefore requires a perfect understanding of surveillance and an acceptance of close follow-up so as not to risk a loss of chance in terms of survival.
The analysis of the files of patients released from surveillance and having gone to a curative treatment option does not seem to show any loss of chance. Namely that the tumors were not more advanced, nor that their long-term observations did not demonstrate an increased risk of progressive resumption of the cancerous disease.
Duration
The duration of active cancer surveillance after cancer healing (remission) varies depending on several factors, including the type of cancer, stage of cancer at diagnosis, treatment received, individual risk factors, and the healthcare provider’s recommendation. There is no one-size-fits-all approach, and the duration of active surveillance is typically tailored to each individual’s specific circumstances. However, the following are some general considerations:
Type and Stage of Cancer:
The aggressiveness and behavior of different types of cancer vary. For some cancers with a higher risk of recurrence, such as certain types of breast or colon cancer, active surveillance may be recommended for a more extended period.
Treatment Received and Response
The type of cancer treatment, whether it was surgery, radiation therapy, chemotherapy, immunotherapy, or a combination of these, can influence the duration of active surveillance.
Individual Risk Factors:
Certain risk factors, such as genetic predisposition or family history of cancer, may warrant longer and more frequent surveillance.
Response to Treatment:
The response to initial treatment is an essential factor in determining the need for ongoing surveillance. If the cancer responded well to treatment, the surveillance frequency may be adjusted accordingly.
Risk of Recurrence:
The likelihood of cancer recurrence influences the duration of active monitoring. If there is a higher risk of recurrence, surveillance may be recommended for a more extended period.
Health Status:
The overall health and well-being of the cancer survivor also influence the duration of active surveillance. If the individual remains in good health and has a low risk of recurrence, surveillance may be gradually spaced out.
Other Medical Conditions:
Active monitoring can be applied to various other medical conditions, such as certain neurological disorders, kidney diseases, or respiratory conditions. The duration of active monitoring in these cases will depend on the specific condition and the treatment plan outlined by the healthcare provider.
In many cases, active cancer surveillance is more frequent in the first few years after cancer healing, gradually reducing the frequency of visits and tests as time goes on and there is no evidence of cancer recurrence. For some cancers, surveillance may continue for five years or longer, while for others, it may be less intensive after two or three years of remission.
Conclusion
It is essential for cancer survivors to maintain regular follow-up appointments with their healthcare providers as recommended. Active surveillance plays a crucial role in detecting any signs of cancer recurrence or other health issues early, allowing for timely interventions and improved outcomes. It also provides cancer survivors with ongoing support, education, and resources to address survivorship issues and maintain their overall well-being beyond cancer treatment.
Ultimately, the duration of active cancer surveillance is a decision made collaboratively between the healthcare provider and the cancer survivor, taking into account individual needs, preferences, and the latest evidence-based guidelines.
Sources: PinterPandai, British Association of Urological Surgeons (pdf), National Institutes of Health (.gov), Macmillan Cancer Support
Photo credit: tungnguyen0905 via Pixabay
Information: Cleverly Smart is not a substitute for a doctor. Always consult a doctor to treat your health condition.
