The follow-up care phase of treatment is the time after completion of the initial course of therapy. Life-long follow-up is necessary to identify problems following cancer treatment, such as new cancers or recurrence of the same cancer.

Cancer may recur in the same part of the body in which it was found originally (a local recurrence), or it may reappear in a more distant part of the body (a metastasis). The type of treatment that is selected for a recurring cancer depends on the specific type of cancer, how large it is, how it behaves biologically, and what previous therapy was given. Recurrent cancers can be cured, but the chance of cure is usually far lower than it is for the initial treatment of cancer. Advanced and incurable cancer may exist at the time of diagnosis, or it may occur after many years of treatment and follow-up care. In either case, the usual goal of care for the patient with advanced cancer resistant to anticancer therapy is symptom relief. Some patients may also want to participate in clinical trials of new experimental treatments.

Much can be done to relieve symptoms, ease distress, provide comfort, and in other ways improve the quality of life of someone with cancer. This care may be referred to as palliative care, supportive care, or comfort care. Palliative care is important at any stage of cancer care management. For a person with cancer, maintenance of quality of life requires, at a minimum, relief from pain and other distressing symptoms; relief from anxiety and depression, including the fear of pain; and a sense of security that assistance will be readily available if needed. Hospice care is an approach to care during the final stages of life.

One-half of cancer patients die of the disease, making death and end-of-life care important issues that must be addressed (American Society of Clinical Oncology, 1998). Poor symptom control, fear, and a lack of acceptance of death before dying, can be minimized by ensuring that appropriate medical and social support services are available (Foley, 1998). End-of-life care is in itself a diverse set of services and may involve the following (Lynn, 1997):

• management of physical or emotional symptoms and limitations of function;
• provision of pain relief and palliation to improve or maintain the quality of remaining life;
• counseling on the potential harm or benefit of aggressive life-extending treatments;
• respite, social support, and other services to relieve caregiver burden;
• advance care planning (e.g., living wills); and
• bereavement support.