Colon Cancer News
Last week the National Comprehensive Cancer Network (NCCN) published their first Survivorship Guidelines. Dr. Laura Porter relays what these new guidelines mean for patients and healthcare professionals.
Although other organizations are currently working on survivorship guidelines, NCCN has been the first to publish this preliminary guide.
These guidelines are a first step for healthcare professionals to assess how you’re doing when you arrive for a follow-up appointment.
In a perfect world, when you’d go in for your follow-up visits according to your survivorship care plan, your PCP or oncologist would use these guidelines to assess your mental, physical and emotional health. They wouldn’t have to review these every time, but they should do an assessment on a regular basis.
What’s great about these new guidelines is that the questions are laid out into easy sections with “yes” or “no” answers. That should make it easy for doctors to start incorporating the guidelines into their routine exams with cancer survivors.
Why We Need Guidelines
“Aren’t you glad to be finished with treatment?”
That’s the question many cancer survivors are asked once they’re finished with treatment. The thing is, the physical fight is only half the battle. After that, there are the follow-ups, future exams and appointments. The nagging worry of whether this round of tests will reveal a recurrence is always in the back of your mind.
Then there’s dealing with the side effects of treatment that are still present, from neuropathy to memory loss. Plus, trying to get back to work and wondering if life is ever going to return to normal.
Listen now: Managing Side Effects of Cancer Treatment
After treatment, many cancer survivors suffer from mild to severe forms of depression and anxiety. And the last thing a patient wants to be told – after everything they’ve been though – is that what they are going through now is all in their head.
These new survivorship guidelines, written for healthcare professionals, are an important part of ensuring that cancer patients don’t fall through the cracks and continue to get the care they need.
What Are the Guidelines?
In 2005, the Institute of Medicine (IOM) released a report entitled “Cancer Patient to Cancer Survivor: Lost in Transition.” The study defined the essential components of a survivorship care plan, which included:
- Prevention of new and recurrent cancers and other late effects
- Surveillance for cancer spread, recurrence or second cancers
- Assessment of late psychosocial and medical effects
- Intervention for consequences of cancer and treatment (e.g. Medical problems, symptoms, psychology distress, financial and social concerns)
- Coordination of care between PCPs and specialists to ensure that all health needs are met
As a result, several organizations have been working on survivorship guidelines. The NCCN guidelines are intended for healthcare professionals who work with survivors of adult-onset cancer in the primary care and oncology setting. The topics, assessments and interventions may also be applicable to those living with metastatic disease and are to be used in conjunction with the NCCN disease-specific guidelines.
The guidelines are used to examine patients in the following areas:
- Anxiety and depression - very common in cancer survivors due to multiple stressors, including fear of recurrence
- Cognitive function - growing evidence supports the validity of patient-reported “chemo-brain” and its symptoms
- Exercise - all patients should be physically active, and activities should be tailored to each person’s ability and preferences
- Fatigue – cancer-related fatigue is fatigue that is not proportional to recent activity and interferes with usual functioning
- Immunizations and infections - infections can be avoided with proper education, the guidelines list vaccines that are safe for cancer survivors and their close contacts
- Pain – includes cancer-pain or treatment-related pain, this should be screened for at every visit
- Sexual function - present and past levels of sexual activity should be discussed and reviewed and if/how cancer treatment has affected intimacy
- Sleep disorders - include insomnia, excessive sleepiness, obstructive sleep apnea, restless leg syndrome and parasomnias (sleep walking, night terrors, violent movements)
In order to discuss each area with the patient, the guidelines were developed with questions in each category for use as a baseline assessment. A flow chart is included to help the physician interpret the results and diagnosis and then there are suggestions for treatment.
In addition to the categories above, a doctor will also look at the following criteria to see how the following areas are affecting the survivor’s health and/or any symptoms a cancer survivor may be experiencing:
- Current disease status
- Functional/performance status
- Prior cancer treatment history and modalities used
What Can You Do As a Survivor?
Talk to your doctor. Ask them if they are aware of the guidelines print out a copy and take it with you to your next appointment. Be sure that you have a survivorship care plan which includes all the treatments and interventions you have had.
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