The First Survivorship Visit in Primary Care: A Practical Cardiac Checklist
What to gather, ask, examine, and order when a cancer survivor transfers into your list, structured so a single appointment produces a surveillance schedule rather than a referral queue.
A survivor transferring into your list arrives with exposures that are not in the record and a surveillance schedule nobody owns. One structured appointment can produce that schedule. This is what to cover.
Before or at the start: gather the exposures
Request the treatment summary from the treating centre if one has not travelled with the patient. You need diagnosis and dates, chemotherapy agents with cumulative anthracycline dose, radiation site and dose, surgery, and any cardiac studies performed during treatment. Where the dose is unavailable, agent names and treatment duration still allow risk banding.
Code the exposures onto the problem list. An exposure sitting only in a scanned letter will not trigger anything later.
History and examination
Ask specifically about exertional breathlessness and how it compares with a year ago, orthopnoea, palpitations, chest discomfort, presyncope, and swelling. Ask about fatigue in functional terms rather than as a score. Examine blood pressure in both arms, pulse for rate and regularity, jugular venous pressure, heart sounds for a murmur, lung bases, and peripheral oedema.
Jugular venous elevation with a normal ejection fraction after chest radiation should raise constriction rather than reassurance.
Baseline investigations
Electrocardiogram, full blood count, renal function with electrolytes and magnesium after platinum agents, HbA1c, lipids, thyroid function after neck or total body irradiation, and ferritin with transferrin saturation where fatigue is prominent. Echocardiography with strain where exposure warrants it, stating the exposure history on the request.
Close the visit with a schedule
Set the imaging interval by exposure, the blood pressure and metabolic review interval, and the vaccination and second-cancer screening items that apply to the radiation field. Write who reviews each result. Refer to cardio-oncology for significant exposure with symptoms, a strain or ejection fraction decline, or suspected radiation valve or pericardial disease.
Give the patient a copy. In practice the patient is the most reliable carrier of their own surveillance plan.
Frequently asked questions
- What should primary care check at a first cancer survivorship visit?
- Obtain the treatment summary, code the exposures, take a targeted cardiac history and examination, order an electrocardiogram with bloods and exposure-appropriate echocardiography, and set a written surveillance schedule with named result owners.
- When should a survivor be referred to cardio-oncology?
- For significant cardiotoxic exposure with new symptoms, a decline in strain or ejection fraction, suspected radiation-related valve or pericardial disease, or when a surveillance plan is needed and no specialist owner exists.