By: Nina N. Grenon, DNP
Fortunately, more and more patients are surviving colorectal cancer (CRC), and the numbers are expected to increase. After treatment, cancer surveillance is recommended for CRC survivors who have undergone therapy with curative intent. The rationale for intense surveillance in CRC is early identification of recurrent disease, which is potentially treatable and curable with further surgery, and also screening for polyps and secondary cancers. The American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN), provide recommendations with guidelines, although each expert group varies.
In addition to close surveillance, CRC survivors are faced with a number of health care needs. The purpose of survivorship care is to ensure all the needs of the survivors are met. The key component of survivorship care includes:
Identification and management of long-term and late effects of cancer and treatment.
Promoting and or improving health behaviors and coordination of care.
Psychosocial care and communication with primary care clinicians and other specialists.
Genetic counseling and testing should always be addressed and considered to address the risks of future disease.
Post treatment needs of cancer survivors addressed in the Institute of Medicine (IOM) report “From Cancer patient to Cancer Survivor: Lost in Transition,” published in 2006, found that these needs are often not met (IOM, 2006).
Survivorship care should occur at the end of treatment. A treatment summary and a comprehensive survivorship care plan (SCP), need to be developed and shared with the patient and the primary care provider. One model of care delivering SCP that prioritizes the elements of survivorship care planning includes delivering comprehensive survivorship care alongside the surveillance follow up.
The optimal timing of providing a survivorship visit is not clear and often debated among clinicians. The NCCN recommends a survivorship sometime in the post treatment period. At our institution a referral for survivorship visit occurs soon after the completion of treatment. The SCP, including a treatment summary, is prepared and reviewed with the patient and a copy is also made available to the patient’s primary care provider. The visit is comprehensive includes reviewing the surveillance schedule, addressing late effects from treatment and disease. Late effects can be physical, psychological and a number of interventions can be incorporated to improve care, and appropriate referrals are made and care is coordinated. The patients have the option for a follow up survivorship visit every year and more often if needed.
Nina N. Grenon, DNP, practices at the Dana-Farber Cancer Institute, Boston Center for Gastrointestinal Oncology, Adult Survivorship Program. She spoke at AllyCon 2019, the Colorectal Cancer Alliance’s national conference.