Monitoring response to treatment is a key element in the management of breast cancer that involves several different viewpoints from surgery, radiology, and medical oncology. In the adjuvant setting, appropriate surgical and pathological evaluation guides adjuvant treatment and follow up care focuses on detecting recurrent disease with the intention of improving long term survival. In the neoadjuvant setting, assessing response to chemotherapy prior to surgery to include evaluation for pathologic response can provide prognostic information to help guide follow up care. In the metastatic setting, for those undergoing treatment, it is crucial to determine responders versus non-responders in order to help guide treatment decisions. In this review, we present the current guidelines for monitoring treatment response in the adjuvant, neoadjuvant, and metastatic setting. In addition, we also discuss challenges that are faced in each setting.

Early detection of breast cancer recurrence is a key element of follow-up care and surveillance after completion of primary treatment. The goal is to improve survival by detecting and treating recurrent disease while potentially still curable assuming a more effective salvage surgery and treatment. In this review, we present the current guidelines for early detection of recurrent breast cancer in the adjuvant setting. Emphasis is placed on the multidisciplinary approach from surgery, medical oncology, and radiology with a discussion of the challenges faced within each setting.

RCC was diagnosed disproportionately early in patients with pretransplant renal cysts and was associated with a worse prognosis and increased costs.

The main goal of follow-up care after breast cancer treatment is the early detection of disease recurrence. In this review, we emphasize the multidisciplinary approach to this continuity of care from surgery, medical oncology, and radiology. Challenges within each setting are briefly addressed as a means of discussion for the future directions of an effective and efficient surveillance plan of post-treatment breast cancer care.

In the prior review, we outlined the current standard of care for monitoring treatment responses in breast cancer and discussed the many challenges associated with these strategies. We described the challenges faced in common clinical settings such as the adjuvant setting, neoadjuvant setting, and the metastatic setting. In this review, we will expand upon future directions meant to overcome several of these current challenges. We will also explore several new and promising methods under investigation to enhance how we monitor treatment responses in breast cancer. Furthermore, we will highlight several new technologies and techniques for monitoring breast cancer treatment in the adjuvant, neoadjuvant and metastatic setting.

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Refeeding syndrome (RFS) has been recognised as a serious biochemical condition resulting from sudden refeeding of malnourished patients. It is characterised by intracellular loss of electrolytes and profound hypophosphataemia, though there is no concrete definition (1,2) . In addition to hypophosphataemia, hypokalaemia and hypomagnesaemia are also common (3) . Patients with various types of malignancies are at-risk of RFS due to treatment side effects and disease progression; however, very little exists in the oncologic literature about this disorder (3) .The aim of this audit was to identify the proportion of hospitalised oncology and haematology patients who are at risk from this potentially fatal condition.In this audit, RFS was defined as "A collection of electrolyte disturbances, including one or more of the following: hypophosphataemia ( <0.7 mmol/l), hypokalaemia (< 3.5 mmol/l), hypomagnesia (< 0.5 mmol/l) occurring 2-4 days post dietetic intervention i.e. oral nutrition support, enteral or parenteral nutrition". A prospective observational audit was undertaken over 3 months (January-March 2009); approximately 1400 new patients were admitted to the oncology centre during this time. All newly admitted patients were screened for risk of malnutrition by qualified nursing staff, using a Trust validated screening tool (4) . Of the 1400 new inpatients, 154 (11 %) had a nutritional risk score > 10 (high risk) and were referred to the dietetic department, 95 (62 %) were included in the audit. Sixteen (10 %) patients were excluded due to death (unrelated to RFS) or entering the terminal stages of illness. Forty three (28%) patients were omitted from the audit due to time constraints. Registered Dietitians identified patients who were at a high risk of RFS, medical staff were notified and Vitamin B 1 supplementation requested (5) .The mean age of the patients (n = 95) was 65 years (SD 12), mean weight 65 kg(SD 16) and mean BMI 21 (SD 8). Thirty two percent (n = 31) of the patients were identified as being at high risk of developing RFS. Based on the audit definition, 45 % (n = 14) of the patients identified as high-risk by the dietetic team were found to have developed RFS, four patients had haematological malignancies, 3 head and neck cancer, 3 rectal cancer, 3 lung cancer and 1 prostate cancer. Despite NICE guidelines there was a reluctance to prescribe Vitamin B 1 supplementation in 35 % of cases.Forty five percent of oncology and haematology patients developed RFS after being identified as high risk. RFS is an under recognised serious biochemical condition, which can complicate the treatment of poor nutritional status. Early dietetic involvement to aid recognition of at risk patients, combined with medical staff vigilance is imperative in the management of this under-recognised condition.