Late toxicity printout — Head and neck

Cited monitoring paradigm

Acute: ACS names fatigue, mouth or throat sores, dry mouth, swallowing trouble, nausea, earaches, and swelling. Late: lasting dry mouth, tooth decay, jaw stiffness, thyroid problems, jaw osteonecrosis, lymphedema, hearing or vision change, and lasting fatigue. Monitor: dental check before RT; a dentist at least once every 6 months after cavity-risk treatment; yearly thyroid exam after head, neck, or throat radiation; lasting fatigue or sleep problems. Those names are not encoded. Official lifetime figures are not restated. Not a dental-calendar, thyroid-lab, or oral visual-screen 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 RT side effect.ACS-radiation-body
• Mucositis / mouth or throat sores — ACS names soreness or open sores in the mouth or throat.ACS-radiation-body
• Dry mouth — ACS names dry mouth during head-and-neck RT.ACS-radiation-body
• Trouble swallowing — ACS names swallowing trouble and taste change.ACS-radiation-body
• Nausea and earaches — ACS names nausea and earaches in the treated field.ACS-radiation-body
• Swelling — ACS names swelling in the gums, throat, or neck.ACS-radiation-body

Late toxicities

Months to years after RT. ACS delayed effects.

ACS long-term late names: Lymphedema after neck-node surgery or RT · Hearing loss after head RT or platinum chemo · Vision change after head or eye RT · Low thyroid hormones after head or neck radiation · Lymphedema after lymph-node surgery or radiation

• Dry mouth that lasts — ACS names dry mouth that may continue after treatment.ACS-radiation-body
• Tooth decay — ACS names higher cavity risk, especially with dry mouth.ACS-radiation-body
• Jaw stiffness — ACS names jaw stiffness after head-and-neck RT.ACS-radiation-body
• Thyroid problems — ACS names thyroid problems after neck RT. Official lifetime figures are not restated.ACS-radiation-body
• Osteonecrosis of the jaw — ACS names death of bone in the jaw. Not a dental-calendar engine.ACS-radiation-body
• Skin texture and hair change — ACS names hair loss and skin-texture change in the field.ACS-radiation-body
• Second-cancer awareness — ACS oral and larynx after-treatment pages name later cancers after those treatments. Named later-cancer sites are not encoded.ACS-oral-follow
• Lymphedema after neck-node surgery or RT — ACS long-term page names lymphedema after lymph-node surgery or radiation for head or neck cancers. Not a stage engine.ACS-long-term-effects
• Hearing loss after head RT or platinum chemo — ACS long-term page names hearing loss after high-dose platinum chemo or radiation to the head, ear, or brain. Often permanent. 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
• 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
• 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
• 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. Thyroid is named among later solid tumors after radiation. Official lifetime figures are not restated. Complementary to the oral and larynx after-treatment pages. Not a dental-calendar, thyroid-lab, or oral visual-screen 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. Official lifetime figures are not restated. Not a dental-calendar, thyroid-lab, or oral visual-screen 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

• Mouth care and dental check before RT

  Mouth care and dental check before RT — ACS names a complete dental check-up before head-and-neck RT and removal of problem teeth when advised. Dental-check placeholder before start. Not encoded as a visit engine.

  ACS-radiation-body

• Ongoing dry mouth and cavities

  Ongoing dry mouth and cavities — ACS names sugar-free moisture measures and frequent salt-and-soda rinses as care steps, not as an encoded calendar. Visit-directed mouth-care placeholder — not encoded.

  ACS-radiation-body

• Thyroid after neck RT

  Thyroid after neck RT — ACS names thyroid problems after neck-field RT. Thyroid-lab placeholder — not encoded. Official lifetime-risk figures are not restated.

  ACS-thyroid-follow

• Dental visits after head-and-neck treatment

  Dental visits after head-and-neck treatment — ACS long-term page names a dentist at least once every 6 months after treatments that raise cavity and tooth-loss risk, plus a dental check before jaw RT or bisphosphonates. Named 6-month dental interval is not encoded. Not a dental-calendar 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

• 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

• 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

• 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. Thyroid is named among later solid tumors after radiation. Official lifetime figures are not restated. Complementary to the oral and larynx after-treatment pages. 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. Official lifetime figures are not restated. Not a dental-calendar or thyroid-lab engine. Named yearly and age-30 intervals are not encoded. Placeholder only — not a second-primary screening engine.

  ACS-follow-up-care