Cancer personalised stratified follow up (PSFU)

Personalised stratified follow up (PSFU) refers to the ongoing monitoring and follow-up care that you receive after completing your cancer treatment. It helps identify problems early, manage any lasting side effects, and supports your overall health and well-being.

It has been shown to be better for patients in lots of ways. PSFU means that you only have to come to hospital for investigations needed for your follow-up. PSFU means that you can call your team when you have a problem, rather than having to worry waiting until your routine clinic appointment.

The follow up care plan is based upon individual needs and influenced by cancer type, effects of treatment and any other health conditions.

What to expect when you finish treatment

After you finish your treatment, you should meet with your nurse to fill in a holistic needs assessment (HNA). This helps create a care plan tailored to your physical, practical, emotional, or social needs. You will then be monitored for a period of time (usually around five years) after your last treatment. Your surveillance plan may include:

Blood tests: Usually performed every 3-6. For details on booking and attending your appointment, please refer to Blood tests at St Georges hospital

Scans and scope investigations: This may include regular colonoscopies, CT scan, ultrasound scans or mammograms at scheduled intervals.

Supported Self-Management Tips

Instead of routine follow-up clinic appointments, you can contact the clinical nurse specialists directly to arrange an appointment if you feel you need to be seen.

Diet: There is no need for a special diet but try to eat a balanced diet with plenty of fresh fruit, vegetables, and whole-grain foods. Limit foods high in fat and sugar.

Exercise: Try to gradually increase your daily activity, aiming to build up to at least three twenty-minute sessions of moderate activity each week.

Getting back to normal: Reaching the end of treatment can be difficult. It is normal to feel anxious. Talk to your clinical nurse specialist for support if you are struggling with worries or relationships.

Work: If returning to work, meet with your employer or occupational health to discuss reasonable adjustments, such as a phased return.

What happens now?

You will have an end of treatment review with a member of your team. They will discuss with you what will happen next regarding your follow-up. A treatment summary will then be sent to you and your GP and this will provide information regarding:

Your diagnosis

The treatment you have had and the possible side effects

Signs and symptoms to report to your specialist team

Explanation of your personal plan for future investigations

Some patients find that moving away from having lots of contact with their clinical team whilst undergoing treatment to PSFU can be unsettling. Although you may have less appointments to attend you will still be under the care of your consultant. Your test results will still be reviewed by your consultant team and your clinical nurse specialist will contact you with the results by phone or letter. If you have any worries, you can discuss them at the end of treatment appointment or contact your clinical nurse specialist.