The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment. This portion of the guidelines describes recommendations regarding screening for the effects of cancer and its treatment. The panel created a sample screening tool, specifically for use in combination with the NCCN Guidelines for Survivorship, to guide providers to topics that require more in-depth assessment. Effective screening and assessment can help providers deliver necessary and comprehensive survivorship care.

Abstract

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment. This portion of the guidelines describes recommendations regarding screening for the effects of cancer and its treatment. The panel created a sample screening tool, specifically for use in combination with the NCCN Guidelines for Survivorship, to guide providers to topics that require more in-depth assessment. Effective screening and assessment can help providers deliver necessary and comprehensive survivorship care.

NCCN Categories of Evidence and Consensus

Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.

Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate.

Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate.

Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.

All recommendations are category 2A unless otherwise noted.

Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.

Screening for Effects of Cancer and Its Treatment

All survivors should be periodically screened for symptoms related to cancer and previous cancer treatment, with appropriate follow-up care as clinically indicated. The panel does not assume that all survivorship issues will be addressed at every visit. Some tools that screen for long-term and late physical and psychosocial effects of cancer and its treatment in survivors have been validated.16 In addition, the NCCN Survivorship Panel created a sample screening instrument that is guideline-specific and can be self-administered or administered by an interviewer. This assessment tool was developed specifically for use in combination with the NCCN Clinical Practice Guidelines in Oncology for Survivorship to help providers deliver necessary and comprehensive survivorship care (to view the most recent and complete version of these guidelines, visit NCCN.org). Although this instrument has not yet been piloted or validated, the answers can be used to guide providers to topics within the guidelines that require more in-depth assessment via validated tools and/or clinical evaluation.

In addition to screening by history and physical examination, care providers should assess the following to determine whether reversible or contributing causes for symptoms exist:

  • Current disease status

  • Functional/performance status

  • Current medications

  • Comorbidities, including weight and tobacco use

  • Prior cancer treatment history and modalities used

This information can also inform about the patient’s risk for specific late or long-term effects, including risks for second primary cancers and comorbidities. For example, patients who received pelvic irradiation or surgery are at risk for sexual dysfunction; patients with a history of brain metastasis or cranial irradiation have an elevated risk for cognitive

F1NCCN Clinical Practice Guidelines in Oncology: Survivorship: Screening for Cancer and Treatment Effects, Version 2.2014

Version 2.2014, 07-22-14 ©2014 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

Citation: Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw 12, 11; 10.6004/jnccn.2014.0152

dysfunction. In general, those who underwent more intensive therapy are at higher risk for multiple late and/or long-term effects. Survivors undergoing certain treatments, such as mantle radiation or certain systemic therapy agents, may be at increased risk for secondary malignancies. Survivors who continue to smoke are at increased risk for smoking-related comorbidities and second primary cancers.

Individual Disclosures for the NCCN Survivorship Panel

T1

References

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    AvisNESmithKWMcGrawS. Assessing quality of life in adult cancer survivors (QLACS). Qual Life Res2005;14:10071023.

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    CampbellHSHallAESanson-FisherRW. Development and validation of the Short-Form Survivor Unmet Needs Survey (SF-SUNS). Support Care Cancer2014;22:10711079.

    • Search Google Scholar
    • Export Citation
  • 3.

    ChopraIKamalKM. A systematic review of quality of life instruments in long-term breast cancer survivors. Health Qual Life Outcomes2012;10:14.

    • Search Google Scholar
    • Export Citation
  • 4.

    FerrellBRDowKHGrantM. Measurement of the quality of life in cancer survivors. Qual Life Res1995;4:523531.

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    GanzPA. Cancer Rehabilitation Evaluation System (CARES) and CARES-SF now publicly available. J Clin Oncol2012;30:40464047.

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    PearceNJSanson-FisherRCampbellHS. Measuring quality of life in cancer survivors: a methodological review of existing scales. Psychooncology2008;17:629640.

    • Search Google Scholar
    • Export Citation

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    NCCN Clinical Practice Guidelines in Oncology: Survivorship: Screening for Cancer and Treatment Effects, Version 2.2014

    Version 2.2014, 07-22-14 ©2014 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.

References

  • 1.

    AvisNESmithKWMcGrawS. Assessing quality of life in adult cancer survivors (QLACS). Qual Life Res2005;14:10071023.

  • 2.

    CampbellHSHallAESanson-FisherRW. Development and validation of the Short-Form Survivor Unmet Needs Survey (SF-SUNS). Support Care Cancer2014;22:10711079.

    • Search Google Scholar
    • Export Citation
  • 3.

    ChopraIKamalKM. A systematic review of quality of life instruments in long-term breast cancer survivors. Health Qual Life Outcomes2012;10:14.

    • Search Google Scholar
    • Export Citation
  • 4.

    FerrellBRDowKHGrantM. Measurement of the quality of life in cancer survivors. Qual Life Res1995;4:523531.

  • 5.

    GanzPA. Cancer Rehabilitation Evaluation System (CARES) and CARES-SF now publicly available. J Clin Oncol2012;30:40464047.

  • 6.

    PearceNJSanson-FisherRCampbellHS. Measuring quality of life in cancer survivors: a methodological review of existing scales. Psychooncology2008;17:629640.

    • Search Google Scholar
    • Export Citation

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