RESUMEN
The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.
Asunto(s)
Supervivientes de Cáncer , Neoplasias , American Cancer Society , Dieta , Ejercicio Físico , Humanos , Neoplasias/terapia , Sobrevivientes , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The number of cancer survivors in the US is dramatically increasing and survivors are living longer, making the ongoing care and quality of life in this growing population an important public health issue. Although there has been significant progress in cancer survivorship research, gaps in translating this research to real-world settings to benefit survivors remain. METHODS: The number and type of cancer survivorship research activities in past and current projects were gathered in reports and work plans from the Cancer Prevention and Control Research Network (CPCRN). Additionally, current cross-center projects were aligned with common constructs in dissemination and implementation science to provide a narrative review of progress on translational research. RESULTS: A review of historical activities in the CPCRN indicates that there has been consistent engagement in survivorship from multiple institutions over the last decade, generating 84 grants, 168 papers and 162 presentations. The current membership of the Survivorship Workgroup includes multiple disciplines and all 8 participating institutions. Together these Workgroup members have developed 6 projects, all of which address multiple domains in translational research such as feasibility, practicality, and organizational and cultural factors that affect implementation. CONCLUSIONS: This review of past and ongoing activities in the CPCRN suggests that survivorship has been a consistent priority including the translation of evidence-based approaches into practice. Specific gaps in the translational research agenda that could be the focus of future investigations by Workgroup members and others include the practical and logistic aspects of interventions such as cost and policy.
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Supervivientes de Cáncer , Neoplasias , Humanos , Calidad de Vida , Neoplasias/prevención & control , Atención a la Salud , Investigación Biomédica TraslacionalRESUMEN
PURPOSE: Despite lack of survival benefit, demand for contralateral prophylactic mastectomy (CPM) to treat unilateral breast cancer remains high. High uptake of CPM has been demonstrated in Midwestern rural women. Greater travel distance for surgical treatment is associated with CPM. Our objective was to examine the relationship between rurality and travel distance to surgery with CPM. METHODS: Women diagnosed with stages I-III unilateral breast cancer between 2007 and 2017 were identified using the National Cancer Database. Logistic regression was used to model likelihood of CPM based on rurality, proximity to metropolitan centers, and travel distance. A multinomial logistic regression model compared factors associated with CPM with reconstruction versus other surgical options. RESULTS: Both rurality (OR 1.10, 95% CI 1.06-1.15 for non-metro/rural vs. metro) and travel distance (OR 1.37, 95% CI 1.33-1.41 for those who traveled 50 + miles vs. < 30 miles) were independently associated with CPM. For women who traveled 30 + miles, odds of receiving CPM were highest for non-metro/rural women (OR 1.33 for 30-49 miles, OR 1.57 for 50 + miles; reference: metro women traveling < 30 miles). Non-metro/rural women who received reconstruction were more likely to undergo CPM regardless of travel distance (ORs 1.11-1.21). Both metro and metro-adjacent women who received reconstruction were more likely to undergo CPM only if they traveled 30 + miles (ORs 1.24-1.30). CONCLUSION: The impact of travel distance on likelihood of CPM varies by patient rurality and receipt of reconstruction. Further research is needed to understand how patient residence, travel burden, and geographic access to comprehensive cancer care services, including reconstruction, influence patient decisions regarding surgery.
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Neoplasias de la Mama , Mastectomía Profiláctica , Neoplasias de Mama Unilaterales , Femenino , Humanos , Mastectomía , Neoplasias de la Mama/prevención & control , Neoplasias de la Mama/cirugía , Neoplasias de Mama Unilaterales/cirugía , ProbabilidadRESUMEN
The NCCN Guidelines for Survivorship are intended to help healthcare professionals address the complex and varied needs of cancer survivors. The NCCN Guidelines provide screening, evaluation, and treatment recommendations for psychosocial and physical problems resulting from adult-onset cancer and its treatment; recommendations to help promote healthy behaviors and immunizations in survivors; and a framework for care coordination. These NCCN Guidelines Insights summarize recent guideline updates and panel discussions pertaining to sleep disorders, fatigue, and cognitive function in cancer survivors.
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Supervivientes de Cáncer , Neoplasias , Adulto , Humanos , Supervivencia , Neoplasias/diagnóstico , Neoplasias/terapia , Neoplasias/psicología , Sobrevivientes , Supervivientes de Cáncer/psicología , InmunizaciónRESUMEN
The NCCN Guidelines for Survivorship are intended to help healthcare professionals who work with survivors to ensure that the survivors' complex and varied needs are addressed. The NCCN Guidelines provide screening, evaluation, and treatment recommendations for the consequences of adult-onset cancer and its treatment; recommendations to help promote physical activity, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes updates to the NCCN Guidelines pertaining to preventive health for cancer survivors, including recommendations about alcohol consumption and vaccinations.
Asunto(s)
Supervivientes de Cáncer , Neoplasias , Adulto , Humanos , Inmunización , Neoplasias/diagnóstico , Neoplasias/terapia , Sobrevivientes , SupervivenciaRESUMEN
With the increasing numbers of individuals surviving a diagnosis of cancer, an aging population, and more individuals experiencing multi-morbidity, primary care providers (PCPs) are seeing more patients with a history of cancer. Effective strategies are needed to adequately prepare the primary care workforce for the phase of cancer care now widely recognized as survivorship. A survivorship education program for rural primary care practices was developed using a community engagement process and delivered at the practice level by community health liaisons. A mixed method approach was used to evaluate the program impact which included a questionnaire and interviews. Descriptive analyses and generalized linear regression were used to evaluate quantitative outcomes from the questionnaires. Immersion crystallization was used to define themes from the qualitative components. Thirty-two (32) practices participated, averaging 10.3 team members/practice. The percent of correct responses to the knowledge questionnaire increased significantly, almost doubling between baseline and post-test (25% vs 46%, p < .001). Four major themes emerged from the interviews which included positive impact of the training, putting the training into practice, intention to change care delivery, contextual influences in survivorship care. Evidence from the cancer survivorship education program evaluation supports its value to key stakeholders and the potential wider dissemination of the iSurvive Program. These data also suggest the need for additional investigation into other ways beyond education that primary care practices can be supported to ensure the needs of the growing cancer survivor population in the US are met.
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Supervivientes de Cáncer , Neoplasias , Anciano , Humanos , Neoplasias/terapia , Atención Primaria de Salud , Encuestas y Cuestionarios , SupervivenciaRESUMEN
The NCCN Guidelines for Survivorship are intended to help healthcare professionals working with cancer survivors to ensure that each survivor's complex and varied needs are addressed. The Guidelines provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment; recommendations to help promote healthful lifestyle behaviors, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes the recommendations regarding employment and return to work for cancer survivors that were added in the 2021 version of the NCCN Guidelines.
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Supervivientes de Cáncer , Neoplasias , Adulto , Humanos , Tamizaje Masivo , Neoplasias/diagnóstico , Neoplasias/terapia , Sobrevivientes , SupervivenciaRESUMEN
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment, with the goal of helping healthcare professionals who work with survivors, including those in primary care. The guidelines also provide recommendations to help clinicians promote physical activity, weight management, and proper immunizations in survivors and facilitate care coordination to ensure that all of the survivors' needs are addressed. These NCCN Guidelines Insights summarize additions and changes made to the guidelines in 2020 regarding cardiovascular disease risk assessment and screening for subsequent primary malignancies.
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Neoplasias , Supervivencia , Adulto , Mantenimiento del Peso Corporal , Ejercicio Físico , Humanos , Inmunización , Tamizaje Masivo , Neoplasias/diagnóstico , Neoplasias/terapia , Guías de Práctica Clínica como Asunto , SobrevivientesRESUMEN
BACKGROUND: The impact of cancer and its treatment on employment and financial burden in adolescents/young adults (AYAs) is not fully known. METHODS: Eligibility for this cross-sectional study of AYA cancer survivors included the diagnosis of a malignancy between ages 18 and 39 years and survey completion within 1 to 5 years from diagnosis and ≥1 year after therapy completion. Participants were selected randomly from the tumor registries of 7 participating sites and completed an online patient-reported outcomes survey to assess employment and financial concerns. Treatment data were abstracted from medical records. Data were analyzed across diagnoses and by tumor site using logistic regression and Wald-based 95% confidence intervals adjusting for age (categorized), sex, insurance status, education (categorized), and treatment exposures. RESULTS: Participants included 872 survivors (breast cancer, n = 241; thyroid cancer, n = 126; leukemia/lymphoma, n = 163; other malignancies, n = 342). Exposure to chemotherapy in breast cancer survivors was associated with an increase in self-reported mental impairment in work tasks (odds ratio [OR], 2.66) and taking unpaid time off (OR, 2.62); survivors of "other" malignancies reported an increase in mental impairment of work tasks (OR, 3.67) and borrowing >$10,000 (OR, 3.43). Radiation exposure was associated with an increase of mental impairment in work tasks (OR, 2.05) in breast cancer survivors, taking extended paid time off work in thyroid cancer survivors (OR, 5.05), and physical impairment in work tasks in survivors of "other" malignancies (OR, 3.11). Finally, in survivors of "other" malignancies, having undergone surgery was associated with an increase in physical (OR, 3.11) and mental impairment (OR, 2.31) of work tasks. CONCLUSIONS: Cancer treatment has a significant impact on AYA survivors' physical and mental work capacity and time off from work.
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Supervivientes de Cáncer/psicología , Neoplasias/economía , Neoplasias/terapia , Desempleo/estadística & datos numéricos , Adolescente , Adulto , Costo de Enfermedad , Estudios Transversales , Femenino , Financiación Personal , Humanos , Modelos Logísticos , Masculino , Medición de Resultados Informados por el Paciente , Adulto JovenRESUMEN
Most cancer survivors will follow-up with primary care at some point in the cancer continuum, but coordination between the oncology and primary care teams remains challenging. According to Drs. Linda Overholser and Carlin Callaway, who discussed the importance of care coordination to improve outcomes in cancer survivors at the NCCN 2019 Annual Conference, effective communication is needed between specialists and primary care providers and, when established, has been shown to improve treatment outcomes. Use of survivorship care plans, as well as adherence to the NCCN Guidelines for Survivorship, can further standardize the provision of quality oncology care.
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Supervivientes de Cáncer , Neoplasias/epidemiología , Guías de Práctica Clínica como Asunto , Mejoramiento de la Calidad , Calidad de la Atención de Salud , Humanos , Comunicación Interdisciplinaria , Evaluación de Resultado en la Atención de Salud , Planificación de Atención al Paciente , Atención Primaria de Salud , SupervivenciaRESUMEN
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of cancer and cancer treatment to aid healthcare professionals who work with survivors of adult-onset cancer. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors and to facilitate care coordination to ensure that all needs are addressed. These NCCN Insights summarize some of the topics discussed by the NCCN Survivorship Panel during the 2019 update of the guidelines, including the survivorship population addressed, ways to improve care coordination, and pain management.
Asunto(s)
Guías como Asunto , Neoplasias/terapia , Supervivencia , Mantenimiento del Peso Corporal/fisiología , Ejercicio Físico/fisiología , Humanos , Neoplasias/patologíaRESUMEN
Individuals with a history of cancer, often referred to as cancer survivors, may experience late and long-term effects of their treatment. Because these individuals live longer in the survivorship phase, some of these late effects may also be considered risk factors for other chronic conditions. With cancer and cardiovascular disease now the top 2 leading causes of death in the United States and with common risk factors for both, as well as the morbidity that can occur after cancer treatment, preventive health is becoming an important issue in cancer survivorship care. Multimorbidity is also becoming increasingly commonplace. Along with an ever-expanding number of guidelines available to help guide care and treatment in the noncancer population comes the need to consider where these guidelines overlap or intersect when considering preventive health recommendations specific to cancer survivors. Counseling for health promotion in survivors is lacking. Many currently available guidelines may not apply to this population, and an evidence base is building to help supplement clinical judgement. An interdisciplinary approach will be necessary to help implement preventive care decision-making early in the survivorship trajectory and to ensure that cancer survivors are receiving consistent messages, and patient preferences and priorities should be taken into account when doing so. Incorporating preventive health into collaborative survivorship care can help maintain a high quality of life for individuals living after a cancer diagnosis.
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Supervivientes de Cáncer , Enfermedades Cardiovasculares/prevención & control , Neoplasias/complicaciones , Supervivencia , Enfermedades Cardiovasculares/etiología , Consejo/métodos , Consejo/normas , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Humanos , Oncología Médica/métodos , Oncología Médica/normas , Neoplasias/psicología , Neoplasias/terapia , Guías de Práctica Clínica como Asunto , Prevalencia , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/normas , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Calidad de Vida , Estados Unidos/epidemiologíaRESUMEN
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. This portion of the guidelines describes recommendations regarding the management of anthracycline-induced cardiotoxicity and lymphedema. In addition, recommendations regarding immunizations and the prevention of infections in cancer survivors are included.
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Supervivientes de Cáncer , Oncología Médica/normas , Neoplasias/terapia , Supervivencia , Antraciclinas/efectos adversos , Antibióticos Antineoplásicos/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Infecciones Bacterianas/inmunología , Infecciones Bacterianas/prevención & control , Cardiotoxicidad/diagnóstico , Cardiotoxicidad/etiología , Cardiotoxicidad/terapia , Humanos , Huésped Inmunocomprometido/efectos de los fármacos , Huésped Inmunocomprometido/inmunología , Huésped Inmunocomprometido/efectos de la radiación , Linfedema/inducido químicamente , Linfedema/diagnóstico , Linfedema/terapia , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Oncología Médica/métodos , Neoplasias/complicaciones , Neoplasias/inmunología , Neoplasias/psicología , Medición de Riesgo/métodos , Medición de Riesgo/normas , Sociedades Médicas/normas , Estados Unidos , Vacunación/métodos , Vacunación/normas , Virosis/inmunología , Virosis/prevención & controlRESUMEN
Many cancer survivors experience menopausal symptoms, including female survivors taking aromatase inhibitors or with a history of oophorectomy or chemotherapy, and male survivors who received or are receiving androgen-ablative therapies. Sexual dysfunction is also common in cancer survivors. Sexual dysfunction and menopause-related symptoms can increase distress and have a significant negative impact on quality of life. This portion of the NCCN Guidelines for Survivorship provide recommendations for screening, evaluation, and treatment of sexual dysfunction and menopausal symptoms to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period.
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Oncología Médica , Menopausia , Calidad de Vida , Supervivencia , Femenino , Humanos , Persona de Mediana Edad , Oncología Médica/normas , Menopausia/fisiología , Calidad de Vida/psicologíaRESUMEN
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment. They are intended to aid health care professionals who work with survivors of adult-onset cancer in the posttreatment period, including those in general oncology, specialty cancer survivor clinics, and primary care practices. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors. This article summarizes the NCCN Survivorship panel's discussions for the 2016 update of the guidelines regarding the management of anxiety, depression, posttraumatic stress disorder-related symptoms, and emotional distress in survivors.
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Neoplasias/mortalidad , Humanos , Neoplasias/terapia , Tasa de SupervivenciaRESUMEN
Since most patients with Hodgkin lymphoma survive their disease, long-term issues such as development of second primary malignancies arise, especially in patients treated with multimodal therapy including radiation therapy plus chemotherapy. The risk of breast cancer is significantly elevated in women exposed to high-dose ionizing radiation to the chest before age 40. The case of a 48-year-old patient with a lump in her right breast is presented as a clinical scenario in this article. We review available strategies for screening and risk reduction through chemoprevention or risk-reducing surgery, as well as challenges for management of breast cancer in patients with prior exposure to radiation for Hodgkin lymphoma. The Children's Oncology Group clinical practice guidelines for long-term follow-up care of pediatric cancer survivors provide recommendations that have been endorsed by American and European oncologists.
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Neoplasias de la Mama/prevención & control , Enfermedad de Hodgkin/radioterapia , Neoplasias Inducidas por Radiación/prevención & control , Neoplasias Primarias Secundarias/prevención & control , Conducta de Reducción del Riesgo , Neoplasias de la Mama/etiología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Primarias Secundarias/etiologíaRESUMEN
PURPOSE: Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. METHODS: A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. RESULTS: The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. CONCLUSIONS: A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well.
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Instituciones de Atención Ambulatoria/organización & administración , Planificación en Salud/organización & administración , Neoplasias/terapia , Atención Primaria de Salud/organización & administración , Transición a la Atención de Adultos/organización & administración , Adolescente , Adulto , Niño , Preescolar , Enfermedad Crónica/terapia , Colorado , Manejo de la Enfermedad , Femenino , Humanos , Comunicación Interdisciplinaria , Masculino , Neoplasias/diagnóstico , Innovación Organizacional , Evaluación de Resultado en la Atención de Salud , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Sobrevivientes , Adulto JovenRESUMEN
Many cancer survivors report that fatigue is a disruptive symptom even after treatment ends. Persistent cancer-related fatigue affects quality of life, because individuals become too tired to fully participate in the roles and activities that make life meaningful. Identification and management of fatigue remains an unmet need for many cancer survivors. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and management recommendations for fatigue in survivors. Management includes education and counseling, physical activity, psychosocial interventions, and pharmacologic treatments.
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Fatiga/rehabilitación , Actividad Motora , Tasa de Supervivencia , Fatiga/complicaciones , Fatiga/patología , Humanos , Neoplasias/complicaciones , Neoplasias/rehabilitación , Educación del Paciente como AsuntoRESUMEN
Sleep disorders, including insomnia and excessive sleepiness, affect a significant proportion of patients with cancer and survivors, often in combination with fatigue, anxiety, and depression. Improvements in sleep lead to improvements in fatigue, mood, and quality of life. This section of the NCCN Guidelines for Survivorship provides screening, diagnosis, and management recommendations for sleep disorders in survivors. Management includes combinations of sleep hygiene education, physical activity, psychosocial interventions, and pharmacologic treatments.
Asunto(s)
Neoplasias/complicaciones , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/etiología , Trastornos del Sueño-Vigilia/terapia , Sobrevivientes , HumanosRESUMEN
Many posttreatment cancer survivors experience chronic pain, often leading to psychological distress; decreased activity, motivation, and personal interactions; and an overall poor quality of life. This section of the NCCN Guidelines for Survivorship provides screening and management recommendations for pain in survivors. A multidisciplinary approach is recommended, with a combination of pharmacologic treatments, psychosocial and behavioral interventions, physical therapy and exercise, and interventional procedures.