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Getting the Most Out of a Survivor Clinic Visit

3/3/2016

Published in the CURE Childhood Cancer 2016 Newsletter, this article details a survivor visit and gives tips for making the most of your time in clinic. 



Getting the Most Out of a Survivor Clinic Visit

Brooke Cherven, RN MPH CPON, Betsy Record, NP and Lillian Meacham, MD

Most survivors should be seen in a specialty survivor clinic once a year. During these clinic visits patients receive education about survivorship and screening tests for late effects in addition to a physical exam. Often they meet with multiple healthcare providers including a physician, nurse practitioner, endocrinologist, psychologist, social worker and research personnel. As part of the clinic visit, all survivors should receive a Survivorship Healthcare Plan (SHP) which includes:

1)      A medical summary of cancer treatment

2)      Individualized late effects risk profile

3)      Individualized surveillance plan

The SHP is crucial for survivors and each  of their healthcare providers. It includes all of the important information about a survivor’s health history and identifies any potential  health problems that may occur soon after treatment or later in life. But a SHP can be overwhelming – the SHP document is often at least 6 pages long and contains a lot of information. It can be difficult for survivors to pull out the most important information.

In the Aflac Cancer Survivor Clinic our team has created an Executive Summary – a sort of cheat sheet for  the SHP. The executive summary lists 11 health problems that sometimes happen to survivors, with a Yes/No indicating if the individual survivor is at risk. Each late effect will have the recommended screening associated with it. The SHP Executive Summary will also list the results of the most recent testing done at the patient’s last survivor visit.

Example of an Executive Summary


 Potential Late Effect
Are you At Risk?Recommended Monitoring
1. Cardiovascular (Heart) 
Yes 
 Echo every  One Year
2. Pulmonary (Lung) 
 No None
3. Secondary Malignant Neoplasm 
 YesPhysical Exam 
4. Cognitive (Learning) 
 YesPsychological evaluation as needed 
5. Delayed Puberty/Infertility 
 Yes

Tanner Staging

FSH, LH, Testosterone - PRN 

6. Endocrine (growth, bone,thyroid) 
Yes 

Height, Weight

Dexa Scan - Baseline/PRN 

7. Eyes/Ears/Teeth 
 Yes

Eye exam annually

Dentist 

8. Skin
 NoNone 
9. Hematologic (Blood) 
 YesCBCD- PRN 
10. GI/Liver 
 YesFasting Glucose or HgBA1c every 2 years and Liver Function Tests Baseline/and PRN 
11. Renal (Kidney) 
 Yes

UA - Annually/PRN

BMP/MG/PHOS - Baseline/PRN 



Survivors can use this checklist when talking with their survivor doctors and nurses. It is important that every survivor knows their risk for each late effect listed above.

Having access to the full SHP is still crucial. Healthcare providers will need the detailed information included in the SHP. An easy way to store and share the full SHP and executive summary with all providers is by using Cancer SurvivorLink (www.cancersurivivorlink.org ). This secure website allows survivors to store important health documents (like a SHP and its executive summary) and share these with all of their healthcare providers.

If you have feedback on the new executive summary in the Aflac Survivor Clinic, let us know by emailing cancersurvivor@choa.org 


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