Late toxicity printout — Lymphoma / myeloma fields

Cited monitoring paradigm

Acute: ACS names fatigue, field skin change, sore throat, nausea, and low blood counts. Late: heart and lung problems after chest-field RT or named cardiotoxic or lung-toxic drugs, thyroid problems after neck-field RT, breast-imaging after chest RT, lasting fatigue, bowel or bladder problems after abdomen or pelvis treatment, hearing loss after high-dose platinum chemo, fertility effects, sexuality changes, neuropathy after chemo, and cognitive change after chemo. Monitor: COG / ASCO echo flags; yearly thyroid exam; lung function tests after some chemo or transplant; yearly mammograms plus breast MRIs after chest radiation before age 30; lasting fatigue or sleep problems; bowel or bladder change after abdomen or pelvis treatment; hearing change after high-dose platinum chemo; fertility after pelvis, belly, or spine treatment; sexuality or body-image change; numbness or tingling after chemo; memory, thinking, or focus change after chemo. Those names are not encoded. Hodgkin stays Ann Arbor. Official Stage I percent-of-cases cells are not restated. Anthracycline and bleomycin stay unnamed as myeloma-specific. Not an AML or PET/CT engine.

Anthracycline and bleomycin stay unnamed as myeloma-specific.

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
• Radiation dermatitis — ACS names skin changes in the treated field.ACS-radiation-body
• Sore throat and swallowing trouble — ACS names these after neck or chest-field RT.ACS-radiation-body
• Nausea — ACS names nausea after abdomen or chest-field RT.ACS-radiation-body
• Low blood counts — ACS names low blood counts as uncommon with RT alone and more likely with chemo.ACS-radiation-body

Late toxicities

Months to years after RT. ACS delayed effects.

ACS long-term late names: Heart problems after anthracyclines or chest RT · Lung problems after bleomycin or chest RT · Second cancers after chemo or chest RT · Bowel or bladder problems after abdomen or pelvis treatment · Hearing loss after high-dose platinum chemo · Cavities and tooth loss after chemo · Peripheral neuropathy after chemo · Cognitive impairment after brain RT or chemo · Heart problems after some cardiotoxic treatments · Low thyroid hormones after head or neck radiation · Lung problems after bleomycin, busulfan, or chest RT · Fertility after pelvis, belly, or spine RT · Sexuality after cancer treatment

• Heart complications after chest-field RT — ACS names later heart-disease awareness. COG / ASCO echo flags stay complementary. No dose reconstruction.ACS-radiation-body
• Radiation pneumonitis / fibrosis — ACS names lung inflammation after chest-field RT.ACS-radiation-body
• Thyroid problems after neck-field RT — ACS names thyroid problems after neck RT.ACS-radiation-body
• Breast-imaging after chest RT — ACS NHL page names yearly breast MRI plus mammogram and clinical exam beginning at age 30 after chest radiation. Those months are not encoded.ACS-nhl-follow
• Second-cancer awareness — ACS Hodgkin and NHL pages say most experts do not recommend extra second-cancer tests unless there are symptoms.ACS-hodgkin-follow
• Heart problems after anthracyclines or chest RT — ACS long-term page names anthracyclines, cisplatin, checkpoint inhibitors, and radiation to the lung, chest, or breast as cardiotoxic. Problems may show up years later. No dose reconstruction.ACS-long-term-effects
• Lung problems after bleomycin or chest RT — ACS long-term page names lung problems after bleomycin or chest radiation, with higher risk when those treatments are given together. Not a Lung-RADS engine.ACS-long-term-effects
• Second cancers after chemo or chest RT — ACS long-term page names acute myelogenous leukemia after chemo and breast cancer after chest radiation as examples. Those names are not encoded. Not an AML 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
• Bowel or bladder problems after abdomen or pelvis treatment — ACS long-term page names bowel blockage from adhesions, urinary retention, urinary or bowel incontinence, and UTIs after surgery or radiation to the abdomen or pelvis. Those names apply only when the field or surgery includes the abdomen or pelvis. Not an endoscopy or cystoscopy-interval engine.ACS-long-term-effects
• Hearing loss after high-dose platinum chemo — ACS long-term page names hearing loss after high-dose platinum chemo, often permanent, and may name an ENT or audiology referral. Named only on fields that already name platinum or cisplatin. Not an audiogram-interval 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
• 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
• Lung problems after bleomycin, busulfan, or chest RT — ACS long-term page names cough, shortness of breath, or wheezing after bleomycin, busulfan, or chest radiation, with higher risk when those treatments are given together. Named only on fields that already cite a lung-toxic treatment. Anthracycline and bleomycin stay unnamed as myeloma-specific. Not a Lung-RADS engine.ACS-long-term-effects
• Fertility after pelvis, belly, or spine RT — ACS long-term page names fertility effects after chemo or radiation to the pelvis, belly, or spine. Named only on abdomen or pelvis fields that do not already carry their own fertility row. Not a fertility-preservation engine.ACS-long-term-effects
• Sexuality after cancer treatment — ACS long-term page names changes to sex organs, sexual drive, sexual function and well-being, and body image after cancer treatment. Named only on abdomen or pelvis fields that do not already carry their own sexual-function names. Not a sexual-function 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 Hodgkin / NHL living-as pages and the ACS long-term second-cancer names. Official Stage I percent-of-cases cells are not restated. Not an AML or PET/CT 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. Yearly thyroid exam after neck-field RT, lung function tests after some chemo or transplant, echoes after cardiotoxic chemo, and yearly mammograms plus breast MRIs after chest radiation before age 30 are named. Official Stage I percent-of-cases cells are not restated. Not an AML or PET/CT 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 · Lung function tests after some chemo or a stem-cell or bone-marrow transplant · Echoes after cardiotoxic chemo · Yearly mammograms plus breast MRIs after chest radiation before age 30

• Anthracycline echo and chest-RT flags

  Anthracycline echo and chest-RT flags — COG / ASCO-class cardiomyopathy and chest-RT tracks stay flags only. Guideline-directed echo placeholder. No cumulative doxorubicin-equivalent dose.

  COG-LTFU

• Breast imaging after chest RT before age 30

  Breast imaging after chest RT before age 30 — ACS NHL living-as page names yearly breast MRI plus mammogram and clinical exam beginning at age 30 after chest radiation. ACS-named months are not encoded. Complementary to the COG years-out flag.

  ACS-nhl-follow

• Second-cancer testing

  Second-cancer testing — ACS says most experts do not recommend additional testing to look for second cancers unless there are symptoms. Symptom-directed placeholder. Official Stage I percent-of-cases cells are not restated.

  ACS-hodgkin-follow

• Cardiologist or pulmonologist after named cardiotoxic or lung-toxic treatment

  Cardiologist or pulmonologist after named cardiotoxic or lung-toxic treatment — ACS long-term page names later heart and lung problems and asks which specialists should follow those effects. Referral placeholders — not encoded. No cumulative doxorubicin-equivalent dose.

  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

• Bowel or bladder change after abdomen or pelvis treatment

  Bowel or bladder change after abdomen or pelvis treatment — ACS long-term page names bowel blockage, trouble emptying the bladder, leakage, or UTIs after surgery or radiation to the abdomen or pelvis. Symptom-directed placeholder — not encoded. Not an endoscopy or cystoscopy-interval engine. Named only when the field includes the abdomen or pelvis.

  ACS-long-term-effects

• Hearing change after high-dose platinum chemo

  Hearing change after high-dose platinum chemo — ACS long-term page names hearing loss after high-dose platinum chemo and may name an ENT or audiology referral. Named referral is not encoded. Placeholder only — not an audiogram-interval 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

• 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

• Cough, shortness of breath, or wheezing after lung-toxic treatment

  Cough, shortness of breath, or wheezing after lung-toxic treatment — ACS long-term page says to ask the care team about seeing a lung doctor if breathing changes after cancer treatment. Referral placeholder — not encoded. Not a Lung-RADS engine.

  ACS-long-term-effects

• Fertility after pelvis, belly, or spine treatment

  Fertility after pelvis, belly, or spine treatment — ACS long-term page names fertility effects after chemo or radiation to the pelvis, belly, or spine and may name a specialist referral. Referral placeholder — not encoded. Not a fertility-preservation engine.

  ACS-long-term-effects

• Sexuality or body-image change after treatment

  Sexuality or body-image change after treatment — ACS long-term page says to talk with the cancer care team or primary care provider about sexuality changes. A referral to a sex educator, counselor, therapist, or sexual-health specialist may be named. Referral placeholder — not encoded. Not a sexual-function 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 Hodgkin / NHL living-as pages. Official Stage I percent-of-cases cells are not restated. Not an AML or PET/CT 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. Examples named here are a yearly thyroid exam after head, neck, or throat radiation, lung function tests after some chemo or a stem-cell or bone-marrow transplant, echoes after cardiotoxic chemo, and yearly mammograms plus breast MRIs after chest radiation before age 30. Those named tests are not encoded. Official Stage I percent-of-cases cells are not restated. Not an AML or PET/CT engine. Named yearly and age-30 intervals are not encoded. Placeholder only — not a second-primary screening engine.

  ACS-follow-up-care