Healthcare Provider Resources
This section is designed to support physician assistants, primary care providers, and other frontline clinicians in delivering comprehensive, evidence based survivorship care. As more patients live longer after cancer treatment, it is vital that providers are equipped with the tools and knowledge to address late effects, monitor for recurrence, and promote overall health and wellness. Within this page you will find evidence based tools, best practices, and concise guidelines to promote high quality survivorship care.Primary Care Physicians (PCP's) are the ones to bridge the gap as patients transition between daily survivorship visits and survivorship care. Below are resources to help you navigate this gap.
Quick Practice Guidelines
Concise, evidence based recommendations for managing common survivorship concerns. These summaries are designed for quick reference during clinical care, covering follow up schedules, surveillance protocols, late effect management, and patient education.
For guidance on the initial diagnosis and management of head and neck squamous cell carcinoma of unknown primary, including recommended workup and treatment options, see the ASCO Clinical Practice Guideline.
As part of developing a survivorship care plan, it’s important to take a concise, survivorship focused medical history. This history should document prior treatments, current concerns, and long term risks, allowing providers to tailor follow up care and monitor for late effects. ASCO recommends including the following elements in this assessment:
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Cancer & Treatment History
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Cancer type, stage and date of diagnosis
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Hormonal and/or targeted therapies received.
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Treatment related side effects
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General Health & Risk Factors
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Psychosocial & Emotional Wellbeing
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Lifestyle & Preventative Care
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Follow Up Needs & Referrals
Structured Follow-Up & Surveillance per ACS guidelines and ASCO Recommendations:
Recommendations for PCPs:
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Follow-up should be guided by the oncology team and based on the patient’s individual care plan.
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Perform a detailed cancer-related history and physical exam:
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Every 1–3 months during year 1
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Every 2–6 months during year 2
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Every 4–8 months during years 3–5
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Annually after 5 years
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Confirm the patient continues seeing an otolaryngologist or head and neck specialist as part of their plan.
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Ensure patient has regular dental examinations, especially if the patient received oral or salivary gland radiation.
Care should transition to the PCP with oncology support. PCPs must stay alert to symptoms of recurrence and late effects, and re-engage specialists as needed
Recurrence & Surveillance
PCPs should:
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Be educated by the oncology team about signs/symptoms of recurrence (local or distant).
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Ensure patients receive the same education.
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Refer back to Head and neck cancer specialists if symptoms arise.
Per ASCO, routine imaging is not recommended unless symptoms are present. Surveillance should be collaborative and focused on symptom driven evaluation.
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Follow routine screening protocols based on age/gender (per ACS and USPSTF).
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Lung cancer screening (annual low dose CT) is recommended for high-risk survivors with smoking history.
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Screen for additional head and neck or esophageal cancers in survivors at increased risk.
Use risk-based judgment. Head and neck cancer history alone is not a sufficient reason for lung cancer screening.
Management of Long-Term & Late Effects
Key late effects to monitor include:
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Fatigue, GERD, thyroid dysfunction, osteonecrosis of the jaw, swallowing issues, lymphedema, and psychological distress
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Monitor TSH every 6–12 months in patients who received neck radiation
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Refer patients to specialists as needed based on symptoms
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Monitor for emerging issues such as carotid artery disease, neurocognitive deficits, and vision changes after radiation
Head and Neck Cancer Survivorship Timeline
Cancer surveillance typically involves monitoring for disease recurrence, progression, or the development of second primary cancers, particularly within the first five years after treatment ends. On the other hand, cancer survivorship encompasses a more comprehensive, lifelong approach. It includes managing physical and psychosocial effects of cancer and its treatment, coordinating care between specialists and primary providers, preventing new cancers and late effects, and developing survivorship care plans.
Most current evidence supports a shift in focus beyond five years post treatment, from intensive cancer monitoring to broader survivorship needs. Surveillance and survivorship principles can be integrated during the initial five years after treatment, when oncology teams maintain close follow up through clinical evaluations, imaging, and testing, while also addressing treatment related side effects and survivorship needs.
Nutrition and Weight Management
Nutrition Guidelines for Cancer Survivors
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Assess: Diet quality, meal timing, portion sizes, snacking, processed food intake, red/processed meats, alcohol, and supplement use.
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Encourage:
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A plant based, nutrient dense diet ensuring that there is sufficient vegetables, fruits, whole grains, and legumes in diet .
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Calorie awareness: may encourage tracking apps if weight control is needed.
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Limit:
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Red meat to less than 18 oz/week (cooked).
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Processed meats, sugary drinks, and highly processed foods.
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Added sugars: <6 tsp/day (2,000 cal), <9 tsp/day (3,000 cal).
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Alcohol: limit or avoid entirely.
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Avoid prolonged fasting that may impair nutritional intake unless patients religion dictates.
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Refer to a registered dietitian for tailored guidance.
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USDA MyPlate as a visual reference and a toolkit:
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50% fruits/vegetables, 30% whole grains, 20% protein.
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Vaccinations and Preventative Health
Due to immunosuppression from treatment, survivors may need re-vaccination. Ensure routine age based preventive screenings are not overlooked. Encourage routine inactivated or recombinant vaccines.
Vaccines that are contraindicated or are to be used with caution in actively immunocompromised survivors or to be used with caution in close contacts of immunocompromised patients:
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Measles, mumps, rubella (MMR)
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Oral typhoid
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Yellow fever
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Rotavirus C
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Nasal Influenza Virus
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Varicella (single or combined with MMR)
Per NCCN Guidelines:
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Inactivated or recombinant vaccines: at least 2 weeks prior or 3 months after chemotherapy.
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Live vaccines: at least 4 weeks before or 3 months after chemotherapy.
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For those on anti–B-cell antibody therapy: delay vaccination at least for 6 months after last dose.
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COVID-19 vaccination is also recommended as appropriate.
Communication Tips for Prognosis & Recovery
Communication in cancer care involves both sharing information and building a supportive connection. Patients rely on clinicians for clear, compassionate guidance to make informed decisions about treatment. Primary Care Providers and Oncologists must deliver serious information in an understandable way, support emotional responses, and assist patients in making sound choices. Follow these tips to help deliver information in a way that is compassionate and informational:
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Recognize both informational and emotional needs, responding to each enhances care quality.
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Use patient centered language and validate experiences to build trust and healing.
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Tailor communication based on patient culture, emotional state, and health literacy. Ensure that there is proper language interpretation at hand, do not use family members to translate.
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Address uncertainty and recovery proactively by discussing next steps clearly and with empathy.
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Encourage shared decision making and provide clear, compassionate follow up information.
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Utilize open ended questions when patients seem reluctant to answer questions or appear closed off.
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Use teach back techniques to make sure the patient has understood everything that has been said during the visit.
Continuing Education
Continuing education resources help providers stay current on survivorship best practices. Options include free CME modules focused on post treatment care, interactive case studies to apply guidelines in clinical practice, and webinars. These tools support ongoing professional growth and improved patient outcomes:
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National Comprehensive Cancer Network Continuing Education
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Survivorship series to access free, high quality educational content for clinicians caring for cancer survivors.
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Cancer Survivorship Professional Education
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A tiered program sponsored by MD Anderson Cancer Center equips community care providers with critical knowledge to effectively manage the long term side effects and overall health of cancer survivors.
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Interactive Case-Based Learning
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The Cancer Survivorship Series for Primary Care Providers sponsored by George Washington University in collaboration with the American Cancer Society and the Centers for Disease Control and Prevention to provide modules that include case based scenarios to learn about follow up care and recovery.
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Webinar: Survivorship Education Series from Siteman Cancer Center
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An archived virtual webinar series covering topics like mental health, barriers to care, and post treatment transitions from providers, social workers and cancer survivors.
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