ABSTRACT
OBJECTIVE: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period. METHODS: Consistent with the Program in Evidence-Based Medicine's standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers. RESULTS: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations. CONCLUSIONS: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited evidence to support a shared care model for follow-up, this approach is deemed to be best suited to meet patient needs; however, the roles and responsibilities of care providers need to be clearly defined, and patients need to know when and how to contact them. Although there is insufficient evidence to recommend any individual or combination of signs or symptoms as strong predictor(s) of recurrence, patients should be educated about these and know which care provider to contact if they develop any new or concerning symptoms. Psychosocial support and empathetic, effective, and coordinated communication are most valued by patients for their post-treatment follow-up care. Continuing professional education should emphasize the importance of communication skills and coordination of communication between the patient, family, and healthcare providers.
Subject(s)
Aftercare , Colorectal Neoplasms , Cancer Survivors , Colorectal Neoplasms/therapy , Humans , Practice Guidelines as Topic , Secondary Prevention , Survivorship , Systematic Reviews as TopicABSTRACT
OBJECTIVE: To provide recommendations for a surveillance regimen that leads to the largest overall survival benefit for patients after curative treatment for Stage I-IV colon and rectal cancer. METHODS: Consistent with the Program in Evidence-Based Care's standard approach, guideline databases, i.e., MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO, were systematically searched. Then, we drafted recommendations and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. RESULTS: Four systematic reviews and two randomized controlled trials were identified that provided evidence for recommendations. CONCLUSIONS: For patients with stage I-III colon cancer, a medical history and physical examination should be performed every six months for three years; computed tomography (CT) of the chest-abdomen-pelvis (CT CAP) should be performed at one and three years, or one CT CAP could be performed at 18 months; the use of carcinoembryonic antigen (CEA) is optional if CT imaging is being performed; and surveillance colonoscopy should be performed one year after the initial surgery. The frequency of subsequent surveillance colonoscopy should be dictated by previous findings, but generally, colonoscopies should be performed every five years if the findings are normal. There was insufficient evidence to support these recommendations for patients with rectal cancer, Stage IV colon cancer, and patients over the age of 75 years. Patients should be informed of current recommendations and the treating physician should discuss the specific risks and benefits of each recommendation with their patients.
Subject(s)
Colorectal Neoplasms , Rectal Neoplasms , Aged , Colonoscopy , Humans , Rectal Neoplasms/surgery , Tomography, X-Ray Computed/methodsABSTRACT
OBJECTIVE: To offer primary care providers a comprehensive summary of breast reconstruction options and complications. QUALITY OF EVIDENCE: A literature search was conducted in PubMed with no time restriction using the search terms breast reconstruction, summary, review, complications, and options. Levels of evidence range from I to III. MAIN MESSAGE: As breast cancer survival rates increase, the focus of breast cancer management must shift to include the restoration of a patient's quality of life after cancer. Breast reconstruction plays a crucial role in the restoration of normality for these women. Women who undergo mastectomy often suffer from challenges related to body image, self-esteem, and a decrease in quality of life scores. Cancer Care Ontario's Breast Cancer Treatment Pathway Map mandates that all women diagnosed with breast cancer who might require mastectomy be referred to a plastic surgeon to discuss reconstructive options before surgery. CONCLUSION: The knowledge and guidance of primary care providers is critical to effectively guiding and supporting patients who might undergo breast reconstruction in their decision-making processes. A thorough understanding of patient selection factors, modern options for breast reconstruction, and expected outcomes is essential.
Subject(s)
Breast Neoplasms/surgery , Mammaplasty , Primary Health Care , Clinical Decision-Making , Female , HumansABSTRACT
OBJECTIF: Présenter aux prestataires de soins primaires un résumé complet des options en matière de reconstruction mammaire et de leurs complications. SOURCES DE L'INFORMATION: Une recherche documentaire a été effectuée dans PubMed, sans restrictions relatives à la date de publication, à l'aide des expressions de recherche en anglais breast reconstruction, summary, review, complications et options. Les niveaux des données probantes varient de I à III. MESSAGE PRINCIPAL: Étant donné la hausse des taux de survie au cancer du sein, la prise en charge doit changer de cap pour inclure aussi la restauration de la qualité de vie de la patiente après le cancer. La reconstruction mammaire joue un rôle majeur pour un retour à la normale chez ces femmes. Les femmes qui subissent une mastectomie éprouvent souvent des difficultés quant à leur image corporelle et à leur estime de soi, et elles évaluent leur qualité de vie à la baisse. La carte des voies pathologiques d'Action Cancer Ontario préconise que toutes les femmes ayant reçu un diagnostic de cancer du sein qui pourraient avoir besoin d'une mastectomie soient envoyées en consultation en chirurgie plastique pour discuter des options de reconstruction avant l'opération. CONCLUSION: Les connaissances et les conseils des médecins de soins primaires sont essentiels pour bien orienter et appuyer les patientes dans leur processus décisionnel quant à la reconstruction mammaire. Il est nécessaire de bien comprendre les facteurs de sélection des patientes, les options contemporaines de reconstruction mammaire et les résultats attendus.
