HOLLYWOOD, FLA. — For the first time, the National Comprehensive Cancer Network has added cancer survivorship care recommendations to its non-small cell lung cancer and colorectal cancer guidelines.
The recommendations are aimed at smoothing the transition of patients to primary care once acute treatment for their cancer is completed. Oncologists are advised to develop a long-term treatment plan with specific duties for themselves and a primary care physician.
The goal is to give the primary care provider a summary of surgical, radiation, and chemotherapy treatment. Information should be provided about the expected time to resolution of acute toxicities, potential late adverse effects, and possible long-term effects of treatment.
A significant number of people could benefit. According to the American Cancer Society, there are nearly 150,000 new cases of colorectal cancer and 215,000 new cases of lung cancer (small and non-small cell) diagnosed each year.
Regarding surveillance of colorectal cancer survivors, NCCN recommends that they have a history and physical examination every 3-6 months for 2 years, and then every 6 months for 3 years. Carcinoembryonic antigen (CEA) testing also is recommended with the same frequency.
Colonoscopy should be performed at 1 year, and then as clinically indicated. The guideline authors also recommend a CT scan of the abdomen and pelvis annually for 3 years.
Surveillance for non-small cell lung cancer survivors requires a history and physical examination with a contrast-enhanced chest CT scan every 4-6 months for 2 years. Thereafter, an annual history, physical exam, and a non-contrast-enhanced chest CT scan is recommended. Smoking status should be assessed at each visit, with counseling and referral as warranted. In addition, the NCCN recommends annual trivalent inactivated influenza vaccinations and pneumococcal vaccination, with repeat vaccinations as necessary.
Survivors of colorectal cancer or non-small cell lung cancer should be routinely screened for breast cancer, cervical cancer, and prostate cancer. Non-small cell lung cancer survivors should be screened regularly for colorectal cancer.
“The main reason for surveillance is to make certain there is no recurrence, to make certain they don't develop a second neoplasm,” said Dr. Paul F. Engstrom, senior vice president of extramural research programs at Fox Chase Cancer Center in Philadelphia.
General health monitoring such as routine blood pressure, cholesterol, and glucose testing is recommended. “I have patients 15-20 years out now who have coronary artery disease and need to be stented. So other conditions arise as they age,” Dr. David S. Ettinger said during the meeting at an update on non-small cell lung cancer guidelines.
“Just because you have cancer” does not mean one is exempt from all other diseases, said Dr. Ettinger, professor of oncology and medicine, otolaryngology-head and neck surgery, obstetrics and gynecology, and radiation oncology at The Johns Hopkins University School of Medicine in Baltimore.
Guidelines to manage the late sequelae of colorectal cancer and its treatment address chronic diarrhea and incontinence; oxaliplatin-induced neuropathy; and bone health and sexual dysfunction after pelvic radiation. “Chronic diarrhea can be disabling for some patients, and neuropathy is an issue with the use of our main agent, oxaliplatin,” Dr. Engstrom said.
The guidelines recommend physicians counsel survivors to maintain a healthy weight, limit alcohol consumption, and adopt a healthy diet and physically active lifestyle. “By and large medical oncologists are not up on what kind of diet and healthy lifestyle is most appropriate,” Dr. Engstrom said. “We need to learn more.”
The optimal diet is unknown for survivors, Dr. Engstrom said, but the guidelines recommend an emphasis on plant sources of food. Exercise has been associated with increased survival with colorectal cancer. “Tell [patients] exercise matters.