Evidence-based guideline for surveillance, late effects monitoring, health promotion, and comprehensive survivorship care planning for cancer survivors.
A comprehensive, evidence-based clinical guideline for the surveillance, long-term follow-up, late effects monitoring, health promotion, and psychosocial support of adult and pediatric cancer survivors. This resource synthesizes recommendations from major international professional societies and expert panels in oncology, cardio-oncology, primary care, and survivorship medicine to provide a single integrated reference for clinicians who manage patients after completion of curative-intent cancer treatment.1 2 3 4 5 6 7
The population of cancer survivors continues to grow, with an estimated 18.1 million survivors in the United States and over 50 million worldwide as of 2025. Advances in early detection, multimodal therapy, and supportive care have driven five-year relative survival rates above 68% for all cancers combined. However, this growing cohort faces a complex and evolving spectrum of medical, psychological, and social challenges that extend years to decades beyond the completion of active treatment. Late and long-term effects of surgery, radiation, chemotherapy, endocrine therapy, targeted therapy, and immunotherapy — including cardiovascular disease, secondary malignancies, endocrine dysfunction, neurocognitive impairment, chronic pain, psychosocial distress, and impaired fertility — demand structured, evidence-based surveillance and management strategies that are distinct from acute cancer treatment protocols.1
Survivorship care encompasses all health services provided from the time of initial cancer diagnosis through the balance of a patient’s life, though the clinical focus of this guideline is the period beginning after completion of primary treatment with curative intent. The fundamental goals of survivorship care include: (1) surveillance for cancer recurrence and new primary malignancies; (2) screening for and management of late and long-term treatment effects; (3) health promotion and disease prevention; (4) coordination of care between oncology and primary care providers; and (5) attention to psychosocial well-being, including financial toxicity and social reintegration.2
This guideline is organized into five parts covering the complete spectrum of survivorship care:
Contents:
| Part | Title | Coverage |
|---|---|---|
| Part 1 | Survivorship Care Plans and Surveillance by Cancer Type | Care plan components and structure; surveillance for recurrence — breast, colorectal, prostate, lung, lymphoma, head and neck; imaging and laboratory monitoring schedules; examination frequency by cancer type |
| Part 2 | Cardiovascular Late Effects and Secondary Malignancies | Anthracycline cardiomyopathy; radiation-associated cardiovascular disease; cardiac monitoring schedules (echocardiography, biomarkers); cardioprotective strategies; dexrazoxane, ACE inhibitors, beta-blockers; secondary malignancy risk by treatment modality; screening for radiation-induced and chemotherapy-induced cancers |
| Part 3 | Endocrine, Neurological, and Musculoskeletal Late Effects | Gonadal dysfunction and fertility preservation; thyroid dysfunction; metabolic syndrome; bone health and osteoporosis; cognitive dysfunction (chemobrain); cancer-related fatigue; chemotherapy-induced peripheral neuropathy; lymphedema prevention and management |
| Part 4 | Psychosocial Health, Sexual Dysfunction, and Health Promotion | Depression, anxiety, PTSD, and fear of recurrence; sexual health and dysfunction; physical activity recommendations; nutrition and weight management; smoking cessation; alcohol moderation; sun protection; immunizations for immunocompromised survivors |
| Part 5 | Care Models, Pediatric/AYA Survivorship, Transition of Care, and Financial Toxicity | Risk-stratified survivorship care models; shared care and primary care integration; transition from oncology to primary care; pediatric and adolescent/young adult survivorship; long-term follow-up guidelines for childhood cancer survivors; financial toxicity; psychosocial support resources |
Scope and Applicability: This guideline applies to all healthcare professionals involved in the follow-up care of cancer survivors, including medical oncologists, surgical oncologists, radiation oncologists, primary care physicians, cardiologists, endocrinologists, neurologists, physiatrists, psychologists, social workers, nurse practitioners, and physician assistants. It is relevant across care settings including outpatient oncology clinics, primary care practices, survivorship clinics, and community health settings. This guideline addresses adult survivors primarily; pediatric and adolescent/young adult (AYA) considerations are addressed in Part 5 with the recognition that dedicated childhood cancer survivorship guidelines should also be consulted.
Limitations: No guideline can anticipate all clinical situations. Individual patients may have comorbidities, treatment histories, and personal preferences that warrant deviation from these recommendations. This document is not intended to replace individualized clinical judgment by qualified professionals. Local institutional protocols, resource availability, and patient-specific factors must always be considered in clinical decision-making.
Runowicz CD, Leach CR, Henry NL, et al. “American Cancer Society / American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.” CA: A Cancer Journal for Clinicians, 66(1): 43–73, 2016. American Cancer Society (ACS) / American Society of Clinical Oncology (ASCO). ↩︎ ↩︎
Nekhlyudov L, Mollica MA, Jacobsen PB, Mayer DK, Shulman LN, Geiger AM. “Developing a Quality of Cancer Survivorship Care Framework: Implications for Clinical Care, Research, and Policy.” Journal of the National Cancer Institute, 111(11): 1120–1130, 2019. ↩︎ ↩︎
Armenian SH, Lacchetti C, Barac A, et al. “Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.” Journal of Clinical Oncology, 35(8): 893–911, 2017. American Society of Clinical Oncology (ASCO). ↩︎
Children’s Oncology Group (COG). “Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers.” Version 6.0, 2023. Children’s Oncology Group (COG). ↩︎
Denlinger CS, Sanft T, Moslehi JJ, et al. “NCCN Clinical Practice Guidelines in Oncology: Survivorship.” Version 1.2024. National Comprehensive Cancer Network (NCCN). ↩︎
Jordan K, Aapro M, Kaasa S, et al. “European Society for Medical Oncology (ESMO) Position Paper on Supportive and Palliative Care.” Annals of Oncology, 29(1): 36–43, 2018. European Society for Medical Oncology (ESMO). ↩︎
Mayer DK, Nasso SF, Earp JA. “Defining Cancer Survivors, Their Needs, and Perspectives on Survivorship Health Care in the USA.” Lancet Oncology, 18(1): e11–e18, 2017. ↩︎
Risk-stratified survivorship care models, shared care integration, transition from oncology to primary care, pediatric and AYA survivorship, childhood cancer late effects, financial toxicity, and psychosocial support resources.
Depression, anxiety, PTSD, fear of recurrence, sexual health, physical activity, nutrition, smoking cessation, alcohol, sun protection, and immunizations for cancer survivors.
Gonadal dysfunction, fertility preservation, thyroid dysfunction, metabolic syndrome, bone health, cognitive dysfunction, cancer-related fatigue, chemotherapy-induced peripheral neuropathy, and lymphedema in cancer survivors.
Anthracycline cardiomyopathy, radiation-associated cardiovascular disease, cardiac monitoring protocols, cardioprotective strategies, and screening for secondary malignancies in cancer survivors.
Survivorship care plan components, structure, and evidence-based surveillance schedules for recurrence monitoring in breast, colorectal, prostate, lung, lymphoma, and head and neck cancer survivors.