Follow-up of long-term cancer survivors in the Nordic countries.

Cancer survivors are at increased risk of developing different co-morbid conditions. With an increasing number of long-term cancer survivors in the Nordic countries, the need for recommendations for long-term follow-up has become necessary. However, at present there are no general guidelines for follow-up in the Nordic countries. Three steps of follow-up should be distinguished and the objectives associated with each: 1) Follow-up research done as clinical studies in cancer survivors and as registry-based epidemiological investigations. Whenever possible these approaches should be combined with translational research relating clinical observations with findings from biological material for increased understanding of pathophysiology and aetiology. Such investigation has to provide evidence-based knowledge of late effects associated with the malignancy itself and its treatment. The Nordic countries have excellent possibilities for conducting such follow-up research; 2) Creation of guidelines, in an attempt to put results from research into clinical practice, should take the local situation and resources into consideration. Provision of an individualized Survivorship Care Plan is a first step; 3) Implementation of guidelines into daily health care. Guidelines have little influence on long-term cancer care if they do not reach the practitioners and convince them to comply. There is a need for well-planned follow-up to manage and reduce possible treatment-related morbidity and mortality in cancer survivors. The Nordic countries provide excellent possibilities for relevant research, but lack, so far evidence-based guidelines. In agreement with the initiatives of ASCO the development of Survivor Care Plans is the first step to improve on this situation.