NCCN Guidelines Insights: Survivorship, Version 2.2019

Featured Updates to the NCCN Guidelines

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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.

  • 1.

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  • 2.

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    Nekhlyudov L, Aziz NM, Lerro C, . Oncologists’ and primary care physicians’ awareness of late and long-term effects of chemotherapy: implications for care of the growing population of survivors. J Oncol Pract 2014;10:e29–36.

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  • 5.

    McCabe MS, Bhatia S, Oeffinger KC, . American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care. J Clin Oncol 2013;31:631–640.

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    El-Shami K, Oeffinger KC, Erb NL, . American Cancer Society colorectal cancer survivorship care guidelines. CA Cancer J Clin 2015;65:428–455.

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    Resnick MJ, Lacchetti C, Penson DF. Prostate cancer survivorship care guidelines: American Society of Clinical Oncology practice guideline endorsement. J Oncol Pract 2015;11:e445–449.

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    Runowicz CD, Leach CR, Henry NL, . American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. J Clin Oncol 2016;34:611–635.

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  • 11.

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    Luctkar-Flude M, Aiken A, McColl MA, . Are primary care providers implementing evidence-based care for breast cancer survivors? Can Fam Physician 2015;61:978–984.

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    Potosky AL, Han PK, Rowland J, . Differences between primary care physicians’ and oncologists’ knowledge, attitudes and practices regarding the care of cancer survivors. J Gen Intern Med 2011;26:1403–1410.

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  • 18.

    Virgo KS, Lerro CC, Klabunde CN, . Barriers to breast and colorectal cancer survivorship care: perceptions of primary care physicians and medical oncologists in the United States. J Clin Oncol 2013;31:2322–2336.

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  • 19.

    Walter FM, Usher-Smith JA, Yadlapalli S, . Caring for people living with, and beyond, cancer: an online survey of GPs in England. Br J Gen Pract 2015;65:e761–768.

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  • 20.

    Rubinstein EB, Miller WL, Hudson SV, . Cancer survivorship care in advanced primary care practices: a qualitative study of challenges and opportunities. JAMA Intern Med 2017;177:1726–1732.

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  • 21.

    Hudson SV, Miller SM, Hemler J, . Adult cancer survivors discuss follow-up in primary care: ‘not what I want, but maybe what I need’. Ann Fam Med 2012;10:418–427.

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  • 22.

    Mayer EL, Gropper AB, Neville BA, . Breast cancer survivors’ perceptions of survivorship care options. J Clin Oncol 2012;30:158–163.

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    Khan NF, Evans J, Rose PW. A qualitative study of unmet needs and interactions with primary care among cancer survivors. Br J Cancer 2011;105(Suppl 1)S46–51.

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  • 26.

    Rechis R, Beckjord EB, Nutt S. Potential benefits of treatment summaries for survivors’ health and information needs: results from a LIVESTRONG survey. J Oncol Pract 2014;10:75–78.

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  • 27.

    Majhail NS, Murphy E, Laud P, . Randomized controlled trial of individualized treatment summary and survivorship care plans for hematopoietic cell transplantation survivors. Haematologica 2019;104:1084–1092.

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  • 28.

    Grunfeld E, Julian JA, Pond G, . Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol 2011;29:4755–4762.

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  • 29.

    Boekhout AH, Maunsell E, Pond GR, . A survivorship care plan for breast cancer survivors: extended results of a randomized clinical trial. J Cancer Surviv 2015;9:683–691.

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  • 30.

    Jefford M, Schofield P, Emery J. Improving survivorship care. J Clin Oncol 2012;30:1391–1392.

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    Smith TJ, Snyder C. Is it time for (survivorship care) plan B? J Clin Oncol 2011;29:4740–4742.

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    Stricker CT, Jacobs LA, Palmer SC. Survivorship care plans: an argument for evidence over common sense. J Clin Oncol 2012;30:1392–1393.

  • 33.

    Jefford M, Gough K, Drosdowsky A, . A randomized controlled trial of a nurse-led supportive care package (SurvivorCare) for survivors of colorectal cancer. Oncologist 2016;21:1014–1023.

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  • 34.

    Nicolaije KA, Ezendam NP, Vos MC, . Impact of an automatically generated cancer survivorship care plan on patient-reported outcomes in routine clinical practice: longitudinal outcomes of a pragmatic, cluster randomized trial. J Clin Oncol 2015;33:3550–3559.

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  • 35.

    Maly RC, Liang LJ, Liu Y, . Randomized controlled trial of survivorship care plans among low-income, predominantly Latina breast cancer survivors. J Clin Oncol 2017;35:1814–1821.

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  • 36.

    Jacobsen PB, DeRosa AP, Henderson TO, . Systematic review of the impact of cancer survivorship care plans on health outcomes and health care delivery. J Clin Oncol 2018;36:2088–2100.

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  • 37.

    Blanch-Hartigan D, Forsythe LP, Alfano CM, . Provision and discussion of survivorship care plans among cancer survivors: results of a nationally representative survey of oncologists and primary care physicians. J Clin Oncol 2014;32:1578–1585.

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  • 38.

    American College of Surgeons Commission on Cancer. Cancer program standards: ensuring patient-centered care. Available at: https://www.facs.org/quality-programs/cancer/coc/standards. Accessed July 10, 2018.

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    Pachman DR, Barton DL, Swetz KM, . Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol 2012;30:3687–3696.

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    Paice JA, Ferrell B. The management of cancer pain. CA Cancer J Clin 2011;61:157–182.

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  • 42.

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  • 43.

    Meretoja TJ, Leidenius MHK, Tasmuth T, . Pain at 12 months after surgery for breast cancer. JAMA 2014;311:90–92.

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  • 45.

    Improving the quality of pain management through measurement and action. Available at: https://www.npcnow.org/system/files/research/download/Improving-the-Quality-of-Pain-Management-Through-Measurement-and-Action.pdf. Accessed April 26, 2019.

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    Sun V, Borneman T, Piper B, . Barriers to pain assessment and management in cancer survivorship. J Cancer Surviv 2008;2:65–71.

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    Argoff CE. Topical analgesics in the management of acute and chronic pain. Mayo Clin Proc 2013;88:195–205.

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    Gewandter JS, Mohile SG, Heckler CE, . A phase III randomized, placebo-controlled study of topical amitriptyline and ketamine for chemotherapy-induced peripheral neuropathy (CIPN): a University of Rochester CCOP study of 462 cancer survivors. Support Care Cancer 2014;22:1807–1814.

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  • 62.

    Barton DL, Wos EJ, Qin R, . A double-blind, placebo-controlled trial of a topical treatment for chemotherapy-induced peripheral neuropathy: NCCTG trial N06CA. Support Care Cancer 2011;19:833–841.

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  • 68.

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    Smith TJ, Razzak AR, Blackford AL, . A pilot randomized sham-controlled trial of MC5-A scrambler therapy in the treatment of chronic chemotherapy-induced peripheral neuropathy (CIPN). J Palliat Care 2019:825859719827589.

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  • 74.

    Henry NL, Unger JM, Schott AF, . Randomized, multicenter, placebo-controlled clinical trial of duloxetine versus placebo for aromatase inhibitor-associated arthralgias in early-stage breast cancer: SWOG S1202. J Clin Oncol 2018;36:326–332.

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  • 75.

    Hershman DL, Unger JM, Greenlee H, . Effect of acupuncture vs sham acupuncture or waitlist control on joint pain related to aromatase inhibitors among women with early-stage breast cancer: a randomized clinical trial. JAMA 2018;320:167–176.

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  • 76.

    Irwin ML, Cartmel B, Gross CP, . Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. J Clin Oncol 2015;33:1104–1111.

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