Survivorship Care Plan

A survivorship care plan is a personalised record and follow-up guide that helps coordinate health care after cancer treatment. It may summarise the cancer diagnosis, treatments received, treatment dates, medicines, possible late effects, recommended monitoring, and the professionals involved. You can share it with your family doctor and other clinicians so they understand your history when new health concerns arise.

Creating the plan is usually a care-planning discussion rather than a new cancer treatment. Your oncology team reviews your treatment summary, asks about current symptoms and daily activities, and sets a follow-up schedule. The plan can include examinations, blood tests or imaging when clinically needed, rehabilitation, emotional support, fertility or sexual-health advice, and healthy-living goals. It should be updated when your needs or care team change.

The plan identifies effects that may continue or appear after treatment, such as tiredness, pain, nerve symptoms, concentration changes, hormonal problems, or emotional distress. It also records who to contact. Seek urgent medical help for severe breathing difficulty, sudden weakness, heavy bleeding, confusion, or a high fever. New or worsening symptoms deserve prompt clinical review even when they are not listed in the plan.

A care plan does not predict an individual outcome or replace clinical judgement. Its value is practical: clear treatment history can reduce gaps between oncology and primary care, while planned monitoring can help identify recurrence concerns, late effects, and rehabilitation needs. Follow-up is tailored to the cancer, treatments, age, other conditions, and personal priorities.

You should receive a copy in a format you can access, understand, and share. Ask which symptoms need same-day advice, which appointments are routine, and how to reach the team outside clinic hours. Keep an updated medicines list and tell clinicians about allergies, implanted devices, and previous therapies.

Anyone completing cancer treatment may benefit, including people moving from active oncology care to long-term follow-up. Children and young adults may need plans that address growth, learning, fertility, heart health, and transition to adult services. People receiving ongoing therapy can also use a plan that is revised as treatment continues.

The team gathers your records, confirms the treatment history, discusses current concerns, agrees on monitoring, and documents referrals. You can correct missing details and add goals that matter to you, such as returning to work or managing fatigue. Bring the plan to appointments and ask for changes when another clinician adds relevant information.

The first plan is often made near the end of active treatment, then reviewed during follow-up. The timing of visits depends on your cancer and treatment history. Some needs settle as recovery progresses; others, including hormonal, nerve, bone, heart, or emotional effects, may need longer-term attention. Keep contact details current if you move or change doctors.

A plan can become inaccurate if records are incomplete or appointments are missed, and it cannot detect every health problem. Do not wait for a scheduled review if you develop a concerning change. Your clinicians may adjust the plan when symptoms, medicines, pregnancy plans, or other medical conditions alter what is appropriate.

Some people use a treatment summary, a primary-care survivorship visit, a rehabilitation programme, or a digital patient record instead of one formal document. These options can work when they contain the same essential information and have a named clinician responsible for follow-up. People treated for [Childhood Cancer](/conditions/childhood-cancer/) may need additional long-term support. [Chemotherapy After Surgery](/treatments/systemic-therapy/adjuvant-chemotherapy/) may appear in a treatment history.

Ask your oncology clinic, family doctor, nurse specialist, or rehabilitation service who can prepare and review your plan. Take your questions, medicines, and treatment records to the visit. If you are unsure whether a new symptom is urgent, contact the service named in your plan and describe when it began, how it is changing, and what makes it better or worse.