Follow up

• Patients in clinical trials will be followed up according to trial protocol requirements. 
  
  
• Counsel patients on the common late toxicity and disease recurrent signs and symptoms to look out for following radical treatment.
  
  
• Provide patients with the contact details of their specialist and/or clinical nurse specialist and they should be advised to contact if any concerns between scheduled appointments.  
  
  
• Offer individualised follow up intensity, method and schedule taking into account: patient fitness and comorbidities, prognosis, stage of disease, treatment received and intent, and likely further treatment options. 

An example of common post-radical treatment clinical follow up schedule is: 

• During the initial period to first follow up review offer patients information on accessing services including contact number for assistance in management of acute morbidity and general support.
  
  
• At each follow up review, offer assessment and management of acute morbidity and support by heath care professional and multi-disciplinary team.
  
  
• During follow-up offer patient centred holistic multidisciplinary care considering appointments with AHPs (e.g. CNS, Dietetics, Speech and Language Therapy, and Dental teams) in addition to routine follow-up review. During these follow-up appointments consider a holistic needs assessment (HNA) and/or capture Patient Reported Outcome Measures (PROMS). 
  
  
• Consider referral to specialist palliative care in radical patients with complex symptom or cancer related needs or if being managed with palliative intent.
  
  
• For rarer head and neck cancers e.g. adenoid cystic of salivary gland, consider following up longer than 5 years, at the discretion of treating team. 

Offer individualised radiological follow up with an intensity, method and schedule should be individualised taken into account: patient fitness and comorbidities, prognosis, stage of disease, treatment received and intent, likely further treatment options, and pre treatment imaging. 

Timing of Post Radiotherapy CT/PET-CT in node-positive disease

• At 12 weeks for HPV negative oropharyngeal SCC/unknown primary and all HPV unrelated subsites.

• At 12 weeks for all if CT being used as a screening tool for the need for post-treatment FDG PET-CT.  

• At 16 weeks for HPV positive disease (oropharyngeal SCC and head and neck SCC unknown primary). 

Follow up of patients with cancer of the unknown primary

• Consider regular follow-up, surveillance should include chromoendoscopy (narrow band imaging). 

• Consider adding CT/MRI to the regular surveillance in patients who have undergone treatment for SCCUP. Consider FDG PET to aid in distinguishing recurrent disease from post treatment change.