NCCN Issues First Survivorship Guidelines
At their 18th annual conference, “Advancing the Standard of Cancer Care,” The National Comprehensive Cancer Network (NCCN) presented Clinical Practice Guidelines in Oncology (NCCN Guidelines): Survivorship, new guidelines to help doctors focus on the post-treatment needs of individuals diagnosed with and treated for cancer.
Background and Reason for the Survivorship Guidelines
According to data from the National Cancer Institute and U.S. Centers for Disease Control and Prevention, there were nearly 14 million survivors of cancer in 2012. More than 1.6 million men and women will be diagnosed this year.
Throughout survivorship — the process of living long-term with, through and beyond cancer — millions of people have distinct mental, emotional and physical health needs that must be met. Problems that emerge during treatment may linger beyond it, or even develop as late effects several years after treatment is completed.
Developed by a panel of NCCN medical experts, Survivorship is the first set of guidelines issued to healthcare providers that gives them a framework for addressing the needs of a cancer survivor, which the NCCN defines as “an individual. . . from the time of diagnosis, through the balance of his or her life.”
The Survivorship Guidelines
The guidelines provide medical advice for screening, diagnosing, evaluating and treating common side effects of cancer and cancer treatment as they pertain to the following eight health and wellness topics.
Anxiety and Depression
People finished with cancer treatment have a greater risk of developing anxiety and depression, and of experiencing issues like fear of recurrence, or of the cancer returning. In addition to offering screening questions and tools, the authors of the guidelines recommend that doctors closely monitor the mental health of the individual, since conditions such as anxiety and depression are treatable.
Many people who finish cancer treatment report experiencing treatment-associated cognitive dysfunction, such as difficulty remembering things and paying attention. The guidelines suggest that healthcare providers recognize the types of drugs used for cancer treatment that may contribute to this potential long term side effect. They also recommend that providers obtain a complete family history of cognitive function and mental health in addition to examining factors such as the individual’s side effects from treatment, hormone status, emotional distress and use of substances like alcohol.
The authors suggest incorporating coping strategies that help an individual relieve stress, feel more organized, and be better able to manage his or her time.
The guidelines provide tools to evaluate a person’s level of fitness as well as factors that inhibit physical activity (pain and emotional stress, for example). The authors suggest that individuals be physically active, with at least 150 minutes of moderate–intense or 75 minutes of vigorous–intense exercise per week, including 2–3 weekly sessions devoted to strength training the major muscle groups.
Healthcare providers are advised to screen an individual and have them score their fatigue on a scale from 0–10 (“0” meaning no fatigue and “10” meaning severe fatigue). Factors that may contribute to fatigue, such as medicine side effects, lack of exercise, pain and sleep disturbances, should be treated.
Immunizations and Infections
To prevent infection from serious diseases, providers are advised to use inactivated vaccines, meaning vaccines made of virus particles that are killed but still offer the possibility of triggering a protective response from the immune system. Live vaccines should not be given to men and women with weakened immune systems due to risk of disease from the live organism.
Doctors are advised to assess an individual’s pain and to determine if it is a side effect of treatment such as neuropathy. If no pain is present, healthcare providers should re-screen at the following visit.
It is recommended that doctors ask individuals about their sexual function and review past and present levels of sexual activity. Long-term side effects from treatment and their impact on sexual health and wellness should be addressed.
Screening assessments are available in the guidelines to help healthcare providers determine if the person affected by cancer is dealing with any sleep disorder or disturbance, such as insomnia, excessive sleepiness and restless legs syndrome, a strong urge to move the legs brought on during rest.
What This Means for You
The clinical care survivorship guidelines provided by the NCCN are not meant to offer your healthcare provider specific rules for the follow-up care of your primary breast cancer. Instead, the guidelines are geared toward management of possible long-term side effects and late effects of cancer and its treatment that you might experience in living beyond a cancer diagnosis.
In the guidelines, experts recommend that you routinely undergo screening assessments and schedule follow-up visits with your healthcare provider as needed, since not every concern will be addressed in one visit.
Overall, these guidelines are an important tool for both you and your healthcare providers as you create your survivorship care plan. The content in each section provides important assessment tools to guide your doctor in helping you meet your needs as you transition into life after cancer treatment. Nevertheless, the guidelines may not be able to help your doctor address every follow-up health concern you may have, so be sure to ask your healthcare providers questions that will help you get the information and care that you need.
Talk with your doctor about the guidelines, and about creating a survivorship care plan that meets your needs and is best suited for you.
Learn more about the NCCN Clinical Practice Guidelines in Oncology: Survivorship on the NCCN's website.