Late toxicity printout — Breast

Cited monitoring paradigm

Acute: ACS names fatigue, field skin change, soreness, and swelling during breast RT. Late: skin and size change, heart and lung problems, uncommon rib fracture, lasting fatigue, bone loss after hormone-affecting treatment, low estrogen or testosterone, lymphedema, jaw osteonecrosis after bisphosphonates, neuropathy after chemo, cognitive change after chemo, and vision change after hormone therapy. Monitor: new breast change after about a year; echoes after cardiotoxic chemo; yearly mammograms plus breast MRIs after chest radiation before age 30; lasting fatigue or sleep problems; dental check before bisphosphonates; numbness or tingling after chemo; memory, thinking, or focus change after chemo; vision change after hormone therapy. Those names are not encoded. Not a DXA-interval, Lung-RADS, or second-primary screening engine.

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.

• Fatigue — ACS names fatigue as a common early side effect during or shortly after RT.ACS-radiation-body
• Radiation dermatitis — ACS names redness, irritation, swelling, blisters, itching, or peeling in the treated field.ACS-radiation-body
• Breast soreness — ACS names breast soreness during breast RT.ACS-radiation-body
• Breast swelling / lymphedema — ACS names fluid buildup during or early after breast RT.ACS-radiation-body
• Skin color change — ACS names dryness and color changes in the treated breast skin.ACS-radiation-body

Late toxicities

Months to years after RT. ACS delayed effects.

ACS long-term late names: Osteoporosis after hormone-affecting treatment · Low estrogen or testosterone after hormone-affecting treatment · Osteonecrosis of the jaw after bisphosphonates · Vision change after hormone therapy · Cavities and tooth loss after chemo · Peripheral neuropathy after chemo · Cognitive impairment after brain RT or chemo · Heart problems after some cardiotoxic treatments · Lymphedema after lymph-node surgery or radiation · Lymphedema after node surgery or RT

• Skin look and feel — ACS names darker skin, larger pores, thicker or firmer tissue, and changed sensation.ACS-radiation-body
• Breast size change — ACS names later enlargement from fluid or smaller size from scar tissue.ACS-radiation-body
• Heart complications — ACS names valve damage, irregular heartbeats, or hardening of the arteries after chest-wall / breast RT. No dose reconstruction.ACS-radiation-body
• Radiation pneumonitis / fibrosis — ACS names lung inflammation after breast or chest RT that can lead to pulmonary fibrosis. Not a Lung-RADS engine.ACS-radiation-body
• Rib fracture — ACS names rib weakening after breast RT as uncommon. No invented trial percent.ACS-radiation-body
• 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
• Osteoporosis after hormone-affecting treatment — ACS long-term page names osteopenia and osteoporosis after treatments that affect hormones. Named only on fields that already name hormone-affecting treatment. Not a DXA-interval engine.ACS-long-term-effects
• Low estrogen or testosterone after hormone-affecting treatment — ACS long-term page names low estrogen or testosterone after ovary or testis surgery, pelvic or prostate radiation, hormone-blocking medicines, chemo, or steroids. Highest named risks are breast, ovarian, testicular, and prostate cancer. Named only on fields that already name hormone-affecting treatment. Not a testosterone or hormone-lab engine.ACS-long-term-effects
• Osteonecrosis of the jaw after bisphosphonates — ACS long-term page names osteonecrosis of the jaw after radiation to the jawbone or medicines used to prevent bone loss, called bisphosphonates. Named only on fields that already name osteoporosis after hormone-affecting treatment. Not a dental-calendar engine.ACS-long-term-effects
• Vision change after hormone therapy — ACS long-term page names vision change, cataracts, or glaucoma after some hormone therapies, as well as some chemo, targeted therapies, or immunotherapies. Named only on fields that already name hormone-affecting treatment and do not already carry a head-or-eye RT vision row. Not an eye-screening engine.ACS-long-term-effects
• Cavities and tooth loss after chemo — ACS long-term page names tooth-enamel damage after chemo, which raises cavity and tooth-loss risk. Named only on fields that already name chemo. Not a dental-calendar engine.ACS-long-term-effects
• Peripheral neuropathy after chemo — ACS long-term page names numbness, tingling, or pain in the feet and hands after chemo, immunotherapy, targeted therapy, surgery, or radiation. Named only on fields that already name chemo and do not already carry a CRC-specific neuropathy row. Not a neuropathy-score engine.ACS-long-term-effects
• 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
• Heart problems after some cardiotoxic treatments — ACS long-term page names heart problems after anthracyclines, cisplatin, checkpoint inhibitors, VEGF inhibitors, HER2-directed therapy, hormone therapy or ADT, or radiation to the lung, chest, or breast. Problems may show up years later. Named only on fields that already cite a cardiotoxic treatment. Not a heart-dose or echo-interval engine.ACS-long-term-effects
• Lymphedema after lymph-node surgery or radiation — ACS long-term page names lymphedema after lymph-node surgery or radiation, most often after breast or head and neck cancer. It can start years later and raises cellulitis risk. Named only on the breast and head-neck fields. Not a stage engine.ACS-long-term-effects
• Lymphedema after node surgery or RT — ACS long-term page names lymphedema after lymph-node surgery or radiation for breast cancer. It can start years later. Not a stage 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 dedicated breast second-cancers page. Not a second-primary 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. Complementary to the dedicated breast second-cancers page. Not a DXA-interval or second-primary 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: Echoes after cardiotoxic chemo · Yearly mammograms plus breast MRIs after chest radiation before age 30

• New breast change after about a year

  New breast change after about a year — ACS says new changes in size, shape, appearance, or texture after about a year should be reported right away. ACS names about a year as the usual window after which new changes should not start. Placeholder only — not encoded.

  ACS-radiation-body

• Lymphedema that does not settle

  Lymphedema that does not settle — ACS names ongoing fluid buildup after the early weeks as a reason to ask the care team. ACS names soreness, color change, and fluid buildup usually easing in 1 or 2 months. Placeholder only — not encoded.

  ACS-radiation-body

• Chest-RT cardiac and breast-imaging flags

  Chest-RT cardiac and breast-imaging flags — COG / ASCO-class echo and earlier breast imaging stay flags only. Guideline-directed echo and imaging placeholders. No cumulative doxorubicin-equivalent dose.

  COG-LTFU

• Second-cancer testing after breast cancer

  Second-cancer testing after breast cancer — ACS second-cancers page says other than standard early detection screenings, most experts do not recommend additional testing to look for second cancers unless you have symptoms. Symptom-directed placeholder — not a second-primary screening engine. Official second-cancer risk figures are not restated.

  ACS-breast-second

• Bone density after hormone-affecting treatment

  Bone density after hormone-affecting treatment — ACS long-term page names osteopenia and osteoporosis after treatments that affect hormones. Bone-health placeholder — not encoded. Not a DXA-interval or CA-125 engine.

  ACS-long-term-effects

• Hot flashes, bone loss, or sex-hormone change after hormone-affecting treatment

  Hot flashes, bone loss, or sex-hormone change after hormone-affecting treatment — ACS long-term page names hot flashes, cognitive changes, bone loss, changes in sex drive, and weight gain after low estrogen or testosterone. Named effects are not encoded. Not a testosterone, hormone-lab, or CA-125 engine.

  ACS-long-term-effects

• Dental check before bisphosphonates

  Dental check before bisphosphonates — ACS long-term page names a dental check before jaw RT or bisphosphonates so tooth problems can be treated first. Named dental-check-before-start is not encoded. The named 6-month dental interval stays on the head-and-neck printout. Not a dental-calendar engine.

  ACS-long-term-effects

• Vision change after hormone therapy

  Vision change after hormone therapy — ACS long-term page says to ask the care team about seeing an eye doctor after vision change from cancer treatment. Referral placeholder — not encoded. Not an eye-screening engine.

  ACS-long-term-effects

• Cavity risk after chemo

  Cavity risk after chemo — ACS long-term page names a dentist at least once every 6 months after treatments that raise cavity and tooth-loss risk, including chemo. 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

• Numbness or tingling in the feet or hands after chemo

  Numbness or tingling in the feet or hands after chemo — ACS long-term page names peripheral neuropathy after chemo or other cancer treatment and says to tell the care team so symptoms can be managed. Named effects are not encoded. Not a neuropathy-score 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

• New heart symptoms years after cardiotoxic treatment

  New heart symptoms years after cardiotoxic treatment — ACS long-term page names later heart problems after some cardiotoxic treatments and asks which specialist should follow those effects. Referral placeholder — not encoded. Not a heart-dose or echo-interval engine. No cumulative doxorubicin-equivalent dose.

  ACS-long-term-effects

• New swelling after lymph-node surgery or radiation

  New swelling after lymph-node surgery or radiation — ACS long-term page names lymphedema after lymph-node surgery or radiation and says it is usually reversible if managed before it gets severe. Named effects are not encoded. Not a lymphedema stage 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

• 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 dedicated breast second-cancers page. Official second-cancer risk figures are not restated. 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. Examples named here are echoes after cardiotoxic chemo, and yearly mammograms plus breast MRIs after chest radiation before age 30. Those named tests are not encoded. Complementary to the COG / ASCO chest-RT flags. No cumulative doxorubicin-equivalent dose. Named yearly and age-30 intervals are not encoded. Placeholder only — not a second-primary screening engine.

  ACS-follow-up-care