Late toxicity printout — Brain

Cited monitoring paradigm

Acute: ACS names headaches, nausea, fatigue, hair and scalp change, hearing loss, dizziness, seizures, and short-term memory or speech trouble. Late: memory loss, stroke-like symptoms, poor brain function, radiation necrosis, cognitive change, hearing or vision change, lasting fatigue, cavities after head RT or chemo, and low thyroid hormones after head radiation. Monitor: same-day report of headache during RT; later effects from 6 months to years; yearly thyroid exam after head, neck, or throat radiation; lasting fatigue or sleep problems; cavity risk after head RT or chemo. Those names are not encoded. The cited adult after-treatment page still has no official later-cancer sentence. Not an MRI screening engine.

The cited adult brain after-treatment page still has no official later-cancer sentence.

Not a fourth printout section. Cadences stay placeholders. Named tests are not encoded.

Questions to ask

ACS long-term page lists questions to ask the care team: possible long-term and late effects, whether fertility or second-cancer risk is higher, which cancer screening tests belong later, which specialists should follow those effects, whether cancer rehabilitation could help, and when to call primary care versus cancer care. Those questions are not encoded. Not a screening, fertility, rehab, or specialist-interval engine.

ACS long-term page says not everyone who has cancer treatment gets long-term or late effects. Who does can depend on the cancer type, the type and dose of treatment, side effects during treatment, age at diagnosis, health before treatment, genetics, eating and exercise during and after treatment, care-team expertise, and support from others. Those reasons are not encoded. Not a late-effect risk-score engine.

ACS follow-up-care page lists questions to ask: how to get a treatment summary and follow-up care plan, who is in charge of follow-up, how often visits and which tests or screens belong later, signs of recurrence or a second cancer, and which survivor support services are available. Follow-up may stay with the cancer care team, move to a survivorship clinic, or return to primary care, depending on the cancer type and stage, the treatment, remaining side effects, insurance, and wishes. Those questions and choices are not encoded. Not a visit-interval, screening, or clinic-routing engine.

ACS long-term and follow-up-care lists, named not encoded. Not a fourth printout section.

Treatment summary and care plan

ACS follow-up-care page names what a cancer treatment summary most often includes: diagnosis date; cancer type, including where it started, stage, and grade if known; treatments and dates, including type, dose, and number of cycles; side effects and how they were managed; test results; and names and contacts for the treating doctors. A survivorship care plan most often names remaining treatment, how often follow-up should happen, which tests including screens for other cancers, possible long-term or late effects, and ways to improve overall health. Those named contents are not encoded. Not a records, visit-interval, or screening engine.

ACS follow-up-care named contents. Not a fourth printout section.

How late effects are managed

ACS follow-up-care page says long-term side effects begin during treatment and continue after, and late side effects can start months or years later. Follow-up care may include a review of symptoms, a physical exam, blood tests to check blood counts and how the liver, kidneys, and other organs are working, and other tests as needed. Special tests after some treatments stay named on this printout. Those named steps are not encoded. Not a lab-panel, visit-interval, or screening engine.

ACS follow-up-care named steps. Not a fourth printout section.

Acute toxicities

During or shortly after RT. ACS early side effects.

• Headaches — ACS names headaches as a short-term brain-RT effect, including from swelling.ACS-radiation-body
• Nausea and vomiting — ACS names nausea and vomiting during brain RT.ACS-radiation-body
• Fatigue — ACS names extreme tiredness during brain RT.ACS-radiation-body
• Hair loss and scalp change — ACS names hair loss and skin or scalp changes in the field.ACS-radiation-body
• Hearing loss, dizziness, seizures — ACS names hearing loss, dizziness, and seizures as short-term effects to report.ACS-radiation-body
• Memory and speech trouble — ACS names short-term trouble with memory and speech.ACS-radiation-body

Late toxicities

Months to years after RT. ACS delayed effects.

ACS long-term late names: Cognitive impairment after brain RT or chemo · Hearing loss after brain RT or platinum chemo · Vision change after head or eye RT · Cavities and tooth loss after head RT or chemo · Low thyroid hormones after head or neck radiation

• Memory loss — ACS names later memory loss after brain RT.ACS-radiation-body
• Stroke-like symptoms — ACS names later stroke-like symptoms.ACS-radiation-body
• Poor brain function — ACS names later poor brain function.ACS-radiation-body
• Radiation necrosis — ACS names tissue death due to radiation.ACS-radiation-body
• Another tumor in the area — ACS names a later tumor in the treated area as uncommon. Official relative-risk figures are not restated.ACS-radiation-body
• Cognitive impairment after brain RT or chemo — ACS long-term page names changes in memory, thinking, or focus after brain radiation or chemo, also called chemo brain or brain fog. New or worsening change should be reported right away. Named only on the brain field and on fields that already name chemo. Not a cognitive-screening engine.ACS-long-term-effects
• Hearing loss after brain RT or platinum chemo — ACS long-term page names hearing loss after high-dose platinum chemo or radiation to the head, ear, or brain. Not an audiogram-interval engine.ACS-long-term-effects
• Vision change after head or eye RT — ACS long-term page names vision change, cataracts, or glaucoma after radiation to the head or eye. Not an eye-screening engine.ACS-long-term-effects
• Cancer-related fatigue that lasts — ACS long-term page names cancer-related fatigue as the most common long-term effect, lasting months or years and not always improving with rest. Sleep problems are also named and may have more than one cause.ACS-long-term-effects
• Joint or muscle pain after some treatments — ACS long-term page names joint or muscle pain after chemo, steroids, or hormone therapy. Symptoms may improve over time. People who are not physically active may have a higher risk. Not a rehab-interval engine.ACS-long-term-effects
• Mental health and distress after treatment — ACS long-term page names anxiety, depression, post-traumatic stress, loneliness, and fear of recurrence among common mental-health effects after cancer treatment. Not a mental-health screening engine.ACS-long-term-effects
• Cavities and tooth loss after head RT or chemo — ACS long-term page names permanent salivary-gland damage after radiation to the head, neck, or brain, plus tooth-enamel damage after chemo. Named only where head RT or chemo is already on this printout. Not a dental-calendar engine.ACS-long-term-effects
• Low thyroid hormones after head or neck radiation — ACS long-term page names hypothyroidism after radiation to the head and neck, thyroidectomy, total body irradiation, high-dose chemo, some immunotherapy or targeted therapy, or radioactive iodine. Highest named risk is after thyroid or head and neck cancer. Named only on fields that already name a thyroid exam or neck-field thyroid problem. Not a thyroid-lab engine.ACS-long-term-effects
• Second cancers after radiation or chemo — ACS adult second-cancers hub says a second cancer is a new unrelated cancer, not a recurrence. Radiation is linked to later AML, CML, ALL, or MDS, and to solid tumors that more often show up 10 years or more later, including breast, lung, thyroid, or bone and soft-tissue sarcomas. Chemo is linked most often to MDS and AML; ALL is also named. Chemo is named as a greater leukemia risk factor than radiation. Those names are not encoded. Complementary to the radiation-body later-tumor name. The cited adult brain after-treatment page still has no official later-cancer sentence. Not an MRI screening engine.ACS-second-cancers-adults
• Follow-up care plan after treatment — ACS follow-up-care page, developed with ASCO review, names a cancer treatment summary and a survivorship care plan, plus watching for recurrence and for a second cancer. Regular cervical, breast, colorectal, or lung screening may be named. Those plans and screens are not encoded. A yearly thyroid exam is named after radiation to the head, neck, or throat. The cited adult brain after-treatment page still has no official later-cancer sentence. Not an MRI screening engine.ACS-follow-up-care

Named conditions to monitor

Red flags and suggested follow-up cadence placeholders. Not a personal calendar.

ACS follow-up tests named here: Yearly thyroid exam after head, neck, or throat radiation

• Headache or new neurologic change during RT

  Headache or new neurologic change during RT — ACS says to tell the care team about headaches or any other symptoms because brain swelling can occur. Same-day report placeholder during RT — not encoded. Not an MRI screening engine.

  ACS-radiation-body

• Delayed brain effects

  Delayed brain effects — ACS names later memory loss, stroke-like symptoms, poor brain function, or radiation necrosis. ACS names later effects from 6 months to years after treatment. Placeholder only — not encoded.

  ACS-radiation-body

• Stereotactic single-dose timing

  Stereotactic single-dose timing — ACS names some stereotactic effects that may not show up until 1 to 2 years. ACS names 1 to 2 years after some single-dose brain RT. Placeholder only — not encoded.

  ACS-radiation-body

• New or worsening memory, hearing, or vision change

  New or worsening memory, hearing, or vision change — ACS long-term page says to tell the care team right away about new or worsening memory, thinking, or focus changes, and names ENT, audiology, or eye-doctor referrals after hearing or vision change. Referral placeholders — not encoded. Not an MRI screening engine.

  ACS-long-term-effects

• New or worsening memory, thinking, or focus

  New or worsening memory, thinking, or focus — ACS long-term page says to tell the care team right away about new or worsening memory, thinking, or focus changes after brain radiation or chemo. Named effects are not encoded. Not a cognitive-screening engine.

  ACS-long-term-effects

• Cancer-related fatigue or sleep problems that last

  Cancer-related fatigue or sleep problems that last — ACS long-term page names cancer-related fatigue as the most common long-term effect, plus sleep problems after treatment. Named months-or-years window is not encoded. Placeholder only — not a fatigue-score engine.

  ACS-long-term-effects

• Joint or muscle pain after chemo, steroids, or hormone therapy

  Joint or muscle pain after chemo, steroids, or hormone therapy — ACS long-term page names joint or muscle pain after those treatments and says symptoms may improve over time. Named activity and rehab steps are not encoded. Placeholder only — not a rehab-interval engine.

  ACS-long-term-effects

• Anxiety, depression, or fear of recurrence after treatment

  Anxiety, depression, or fear of recurrence after treatment — ACS long-term page names those as common types of mental distress among cancer survivors and says very worried, depressed, or angry feelings can affect daily life. Named support steps are not encoded. Placeholder only — not a mental-health screening engine.

  ACS-long-term-effects

• Cavity risk after head RT or chemo

  Cavity risk after head RT or chemo — ACS long-term page names a dentist at least once every 6 months after radiation to the head, neck, or brain, or after chemo that raises cavity risk. Named 6-month dental interval is not encoded here. That named interval stays on the head-and-neck printout. Not a dental-calendar engine.

  ACS-long-term-effects

• Fatigue, hair loss, or feeling colder after head or neck radiation

  Fatigue, hair loss, or feeling colder after head or neck radiation — ACS long-term page names fatigue, hair loss, dry skin, muscle cramps, anxiety or depression, and feeling colder than usual after low thyroid hormones. Thyroid levels may be checked every so often after thyroid or head and neck cancer. Named checks are not encoded. Not a thyroid-lab engine.

  ACS-long-term-effects

• Second-cancer awareness after radiation or chemo

  Second-cancer awareness after radiation or chemo — ACS adult second-cancers hub names later MDS or leukemia after some chemo or radiation, and later solid tumors after radiation. Complementary to the radiation-body later-tumor name. The cited adult brain after-treatment page still has no official later-cancer sentence. Not an MRI screening engine. Named several-year and 10-year windows are not encoded. Symptom-directed placeholder — not a second-primary screening engine.

  ACS-second-cancers-adults

• Ask which late-effect tests belong on the follow-up plan

  Ask which late-effect tests belong on the follow-up plan — ACS follow-up-care page names special tests after some treatments. A yearly thyroid exam is named after radiation to the head, neck, or throat. Those named tests are not encoded. The cited adult brain after-treatment page still has no official later-cancer sentence. Not an MRI screening engine. Named yearly and age-30 intervals are not encoded. Placeholder only — not a second-primary screening engine.

  ACS-follow-up-care