NCCN Guidelines Insights: Survivorship, Version 2.2020

Featured Updates to the NCCN Guidelines

Authors:
Crystal S. DenlingerFox Chase Cancer Center;

Search for other papers by Crystal S. Denlinger in
Current site
Google Scholar
PubMed
Close
 MD
,
Tara SanftYale Cancer Center/Smilow Cancer Hospital;

Search for other papers by Tara Sanft in
Current site
Google Scholar
PubMed
Close
 MD
,
Javid J. MoslehiVanderbilt-Ingram Cancer Center;

Search for other papers by Javid J. Moslehi in
Current site
Google Scholar
PubMed
Close
 MD
,
Linda OverholserUniversity of Colorado Cancer Center;

Search for other papers by Linda Overholser in
Current site
Google Scholar
PubMed
Close
 MD, MPH
,
Saro ArmenianCity of Hope National Medical Center;

Search for other papers by Saro Armenian in
Current site
Google Scholar
PubMed
Close
 DO, MPH
,
K. Scott BakerFred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

Search for other papers by K. Scott Baker in
Current site
Google Scholar
PubMed
Close
 MD, MS
,
Gregory BroderickMayo Clinic Cancer Center;

Search for other papers by Gregory Broderick in
Current site
Google Scholar
PubMed
Close
 MD
,
Wendy Demark-WahnefriedO’Neal Comprehensive Cancer Center at UAB;

Search for other papers by Wendy Demark-Wahnefried in
Current site
Google Scholar
PubMed
Close
 PhD, RD
,
Debra L. FriedmanVanderbilt-Ingram Cancer Center;

Search for other papers by Debra L. Friedman in
Current site
Google Scholar
PubMed
Close
 MD, MS
,
Mindy GoldmanUCSF Helen Diller Family Comprehensive Cancer Center;

Search for other papers by Mindy Goldman in
Current site
Google Scholar
PubMed
Close
 MD
,
Norah Lynn HenryUniversity of Michigan Rogel Cancer Center;

Search for other papers by Norah Lynn Henry in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Christine Hill-KayserAbramson Cancer Center at the University of Pennsylvania;

Search for other papers by Christine Hill-Kayser in
Current site
Google Scholar
PubMed
Close
 MD
,
Melissa HudsonSt. Jude Children's Research Hospital/The University of Tennessee Health Science Center;

Search for other papers by Melissa Hudson in
Current site
Google Scholar
PubMed
Close
 MD
,
Nazanin KhakpourMoffitt Cancer Center;

Search for other papers by Nazanin Khakpour in
Current site
Google Scholar
PubMed
Close
 MD
,
Divya KouraUC San Diego Moores Cancer Center;

Search for other papers by Divya Koura in
Current site
Google Scholar
PubMed
Close
 MD
,
Allison L. McDonoughMassachusetts General Hospital Cancer Center;

Search for other papers by Allison L. McDonough in
Current site
Google Scholar
PubMed
Close
 MD
,
Michelle MeliskoUCSF Helen Diller Family Comprehensive Cancer Center;

Search for other papers by Michelle Melisko in
Current site
Google Scholar
PubMed
Close
 MD
,
Kathi MooneyHuntsman Cancer Institute at the University of Utah;

Search for other papers by Kathi Mooney in
Current site
Google Scholar
PubMed
Close
 RN, PhD
,
Halle C. F. MooreCase Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

Search for other papers by Halle C. F. Moore in
Current site
Google Scholar
PubMed
Close
 MD
,
Natalie MorylMemorial Sloan Kettering Cancer Center;

Search for other papers by Natalie Moryl in
Current site
Google Scholar
PubMed
Close
 MD
,
Tracey O’ConnorRoswell Park Comprehensive Cancer Center;

Search for other papers by Tracey O’Connor in
Current site
Google Scholar
PubMed
Close
 MD
,
Electra D. PaskettThe Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

Search for other papers by Electra D. Paskett in
Current site
Google Scholar
PubMed
Close
 PhD
,
Chirayu PatelMassachusetts General Hospital Cancer Center;

Search for other papers by Chirayu Patel in
Current site
Google Scholar
PubMed
Close
 MD, MPH
,
Lindsay PetersonSiteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;

Search for other papers by Lindsay Peterson in
Current site
Google Scholar
PubMed
Close
 MD
,
William PirlDana-Farber/Brigham and Women's Cancer Center;

Search for other papers by William Pirl in
Current site
Google Scholar
PubMed
Close
 MD
,
M. Alma RodriguezThe University of Texas MD Anderson Cancer Center;

Search for other papers by M. Alma Rodriguez in
Current site
Google Scholar
PubMed
Close
 MD
,
Kathryn J. RuddyMayo Clinic Cancer Center;

Search for other papers by Kathryn J. Ruddy in
Current site
Google Scholar
PubMed
Close
 MD, MPH
,
Lillie ShockneyThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

Search for other papers by Lillie Shockney in
Current site
Google Scholar
PubMed
Close
 RN, MAS
,
Sophia SmithDuke Cancer Institute;

Search for other papers by Sophia Smith in
Current site
Google Scholar
PubMed
Close
 PhD, MSW
,
Karen L. SyrjalaFred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;

Search for other papers by Karen L. Syrjala in
Current site
Google Scholar
PubMed
Close
 PhD
,
Amye TevaarwerkUniversity of Wisconsin Carbone Cancer Center;

Search for other papers by Amye Tevaarwerk in
Current site
Google Scholar
PubMed
Close
 MD
,
Phyllis ZeeRobert H. Lurie Comprehensive Cancer Center of Northwestern University; and

Search for other papers by Phyllis Zee in
Current site
Google Scholar
PubMed
Close
 MD, PhD
,
Nicole R. McMillianNational Comprehensive Cancer Network.

Search for other papers by Nicole R. McMillian in
Current site
Google Scholar
PubMed
Close
 MS, CHES
, and
Deborah A. Freedman-CassNational Comprehensive Cancer Network.

Search for other papers by Deborah A. Freedman-Cass in
Current site
Google Scholar
PubMed
Close
 PhD
Restricted access

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.

  • Collapse
  • Expand
  • 1.

    Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev 2016;25:10291036.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Centers for Disease Control and Prevention (CDC). Cancer survivors—United States, 2007. MMWR Morb Mortal Wkly Rep 2011;60:269272.

  • 3.

    Miller KD, Nogueira L, Mariotto AB, et al.. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 2019;69:363385.

  • 4.

    DeSantis CE, Lin CC, Mariotto AB, et al.. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014;64:252271.

  • 5.

    Mariotto AB, Rowland JH, Yabroff KR, et al.. Long-term survivors of childhood cancers in the United States. Cancer Epidemiol Biomarkers Prev 2009;18:10331040.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Heron M. Deaths: leading causes for 2017. Natl Vital Stat Rep 2019;68:177.

  • 7.

    Zaorsky NG, Churilla TM, Egleston BL, et al.. Causes of death among cancer patients. Ann Oncol 2017;28:400407.

  • 8.

    Armenian SH, Xu L, Ky B, et al.. Cardiovascular disease among survivors of adult-onset cancer: a community-based retrospective cohort study. J Clin Oncol 2016;34:11221130.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Strongman H, Gadd S, Matthews A, et al.. Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases. Lancet 2019;394:10411054.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Schoormans D, Vissers PAJ, van Herk-Sukel MPP, et al.. Incidence of cardiovascular disease up to 13 year after cancer diagnosis: a matched cohort study among 32 757 cancer survivors. Cancer Med 2018;7:49524963.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Darby SC, Ewertz M, McGale P, et al.. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 2013;368:987998.

  • 12.

    Ky B, Vejpongsa P, Yeh ET, et al.. Emerging paradigms in cardiomyopathies associated with cancer therapies. Circ Res 2013;113:754764.

  • 13.

    Li W, Croce K, Steensma DP, et al.. Vascular and metabolic implications of novel targeted cancer therapies: focus on kinase inhibitors. J Am Coll Cardiol 2015;66:11601178.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Moslehi JJ. Cardiovascular toxic effects of targeted cancer therapies. N Engl J Med 2016;375:14571467.

  • 15.

    O’Farrell S, Garmo H, Holmberg L, et al.. Risk and timing of cardiovascular disease after androgen-deprivation therapy in men with prostate cancer. J Clin Oncol 2015;33:12431251.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Schmid M, Sammon JD, Reznor G, et al.. Dose-dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events. BJU Int 2016;118:221229.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Dess RT, Sun Y, Matuszak MM, et al.. Cardiac events after radiation therapy: combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer. J Clin Oncol 2017;35:13951402.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Jaiswal S, Fontanillas P, Flannick J, et al.. Age-related clonal hematopoiesis associated with adverse outcomes. N Engl J Med 2014;371:24882498.

  • 19.

    Weaver KE, Foraker RE, Alfano CM, et al.. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv 2013;7:253261.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Meacham LR, Chow EJ, Ness KK, et al.. Cardiovascular risk factors in adult survivors of pediatric cancer--a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev 2010;19:170181.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Moslehi J. The cardiovascular perils of cancer survivorship. N Engl J Med 2013;368:10551056.

  • 22.

    Gilchrist SC, Barac A, Ades PA, et al.. Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors: a scientific statement from the American Heart Association. Circulation 2019;139:e9971012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Rasmussen-Torvik LJ, Shay CM, Abramson JG, et al.. Ideal cardiovascular health is inversely associated with incident cancer: the Atherosclerosis Risk In Communities study. Circulation 2013;127:12701275.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Sabatino SA, Coates RJ, Uhler RJ, et al.. Provider counseling about health behaviors among cancer survivors in the United States. J Clin Oncol 2007;25:21002106.

  • 25.

    American College of Cardiology. Risk Estimator Plus ASCVD. Accessed March 5, 2020. Available at: http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/

  • 26.

    Montazeri K, Unitt C, Foody JM, et al.. ABCDE steps to prevent heart disease in breast cancer survivors. Circulation 2014;130:e157159.

  • 27.

    Guan J, Khambhati J, Jones LW, et al.. Cardiology patient page. ABCDE steps for heart and vascular wellness following a prostate cancer diagnosis. Circulation 2015;132:e218220.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Chen T, Fallah M, Jansen L, et al.. Distribution and risk of the second discordant primary cancers combined after a specific first primary cancer in German and Swedish cancer registries. Cancer Lett 2015;369:152166.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Gibson TM, Park Y, Robien K, et al.. Body mass index and risk of second obesity-associated cancers after colorectal cancer: a pooled analysis of prospective cohort studies. J Clin Oncol 2014;32:40044011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Lam CJ, Curtis RE, Dores GM, et al.. Risk factors for melanoma among survivors of non-Hodgkin lymphoma. J Clin Oncol 2015;33:30963104.

  • 31.

    Park SM, Yun YH, Kim YA, et al.. Prediagnosis body mass index and risk of secondary primary cancer in male cancer survivors: a large cohort study. J Clin Oncol 2016;34:41164124.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Ricceri F, Fasanelli F, Giraudo MT, et al.. Risk of second primary malignancies in women with breast cancer: results from the European Prospective Investigation into Cancer and Nutrition (EPIC). Int J Cancer 2015;137:940948.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Schaapveld M, Aleman BM, van Eggermond AM, et al.. Second cancer risk up to 40 years after treatment of Hodgkin’s lymphoma. N Engl J Med 2015;373:24992511.

  • 34.

    Shiels MS, Gibson T, Sampson J, et al.. Cigarette smoking prior to first cancer and risk of second smoking-associated cancers among survivors of bladder, kidney, head and neck, and stage I lung cancers. J Clin Oncol 2014;32:39893995.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Travis LB, Rabkin CS, Brown LM, et al.. Cancer survivorship—genetic susceptibility and second primary cancers: research strategies and recommendations. J Natl Cancer Inst 2006;98:1525.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Wallis CJ, Mahar AL, Choo R, et al.. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis. BMJ 2016;352:i851.

  • 37.

    Wood ME, Vogel V, Ng A, et al.. Second malignant neoplasms: assessment and strategies for risk reduction. J Clin Oncol 2012;30:37343745.

  • 38.

    Suk R, Mahale P, Sonawane K, et al.. Trends in risks for second primary cancers associated with index human papillomavirus-associated cancers. JAMA Netw Open 2018;1:e181999.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Murphy CC, Gerber DE, Pruitt SL. Prevalence of prior cancer among persons newly diagnosed with cancer: an initial report from the Surveillance, Epidemiology, and End Results program. JAMA Oncol 2018;4:832836.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Friedman DL, Whitton J, Leisenring W, et al.. Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst 2010;102:10831095.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Henderson TO, Oeffinger KC, Whitton J, et al.. Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study. Ann Intern Med 2012;156:757766, W-260.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Nottage K, McFarlane J, Krasin MJ, et al.. Secondary colorectal carcinoma after childhood cancer. J Clin Oncol 2012;30:25522558.

  • 43.

    Reulen RC, Winter DL, Frobisher C, et al.. Long-term cause-specific mortality among survivors of childhood cancer. JAMA 2010;304:172179.

  • 44.

    Berrington de Gonzalez A, Curtis RE, Kry SF, et al.. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. Lancet Oncol 2011;12:353360.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Davis EJ, Beebe-Dimmer JL, Yee CL, et al.. Risk of second primary tumors in men diagnosed with prostate cancer: a population-based cohort study. Cancer 2014;120:27352741.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Dores GM, Curtis RE, van Leeuwen FE, et al.. Pancreatic cancer risk after treatment of Hodgkin lymphoma. Ann Oncol 2014;25:20732079.

  • 47.

    Palumbo A, Bringhen S, Kumar SK, et al.. Second primary malignancies with lenalidomide therapy for newly diagnosed myeloma: a meta-analysis of individual patient data. Lancet Oncol 2014;15:333342.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Rodriguez AM, Kuo YF, Goodwin JS. Risk of colorectal cancer among long-term cervical cancer survivors. Med Oncol 2014;31:943.

  • 49.

    Wolff AC, Blackford AL, Visvanathan K, et al.. Risk of marrow neoplasms after adjuvant breast cancer therapy: the National Comprehensive Cancer Network experience. J Clin Oncol 2015;33:340348.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Wong JR, Morton LM, Tucker MA, et al.. Risk of subsequent malignant neoplasms in long-term hereditary retinoblastoma survivors after chemotherapy and radiotherapy. J Clin Oncol 2014;32:32843290.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51.

    Valdivieso M, Kujawa AM, Jones T, et al.. Cancer survivors in the United States: a review of the literature and a call to action. Int J Med Sci 2012;9:163173.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 52.

    Donin N, Filson C, Drakaki A, et al.. Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008. Cancer 2016;122:30753086.

  • 53.

    Wang Z, Wilson CL, Easton J, et al.. Genetic risk for subsequent neoplasms among long-term survivors of childhood cancer. J Clin Oncol 2018;36:20782087.

  • 54.

    Wiggins J, McLoughlin A, George A, et al.. Germline BRCA1 and BRCA2 testing for breast cancer survivors [published online September 11, 2019]. J Med Genet, doi: 10.1136/jmedgenet-2019-106420

    • Search Google Scholar
    • Export Citation
  • 55.

    Wilson CL, Wang Z, Liu Q, et al.. Estimated number of adult survivors of childhood cancer in United States with cancer-predisposing germline variants. Pediatr Blood Cancer 2020;67:e28047.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 56.

    Slavin TP, Sun CL, Chavarri-Guerra Y, et al.. Older breast cancer survivors may harbor hereditary cancer predisposition pathogenic variants and are at risk for clonal hematopoiesis. J Geriatr Oncol 2020;11:316319.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 57.

    Shah MH, Goldner WS, Benson AB III, et al.. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine and Adrenal Tumors. Version 1.2019. Accessed March 4, 2020. Available at: NCCN.org

  • 58.

    Provenzale D, Gupta S, Ahnen DJ, et al.. NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Colorectal, Version 3.2019. Accessed March 4, 2020. Available at: NCCN.org

  • 59.

    Daly MB, Pilarski R, Berry MP, et al.. NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic, Version 1.2020. Accessed March 4, 2020. Available at: NCCN.org

  • 60.

    Manahan ER, Kuerer HM, Sebastian M, et al.. Consensus guidelines on genetic’ testing for hereditary breast cancer from the American Society of Breast Surgeons. Ann Surg Oncol 2019;26:30253031.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 61.

    Runowicz CD, Leach CR, Henry NL, et al.. American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline. J Clin Oncol 2016;34:611635.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 62.

    Owens DK, Davidson KW, Krist AH, et al.. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer: US Preventive Services Task Force recommendation statement. JAMA 2019;322:652665.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63.

    Schaeffer E, Srinivas S, Antonarakis ES, et al.. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 1.2020. Accessed March 16, 2020. Available at: NCCN.org

  • 64.

    Swetter SM, Thompson JA, Coit DG, et al.. NCCN Clinical Practice Guidelines in Oncology: Cutaneous Melanoma. Version 1.2020. Accessed March 4, 2020. Available at: NCCN.org

  • 65.

    Haddad RI, Bischoff L, Bernet V, et al.. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. Version 2.2019. Accessed March 4, 2020. Available at: NCCN.org.

  • 66.

    Ajani JA, D’Amico TA, Bentrem DJ, et al.. NCCN Clinical Practice Guidelines in Oncology: Gastric Cancer. Version 1.2020. Accessed March 19, 2020. Available at: NCCN.org

  • 67.

    Travis LB, Demark Wahnefried W, Allan JM, et al.. Aetiology, genetics and prevention of secondary neoplasms in adult cancer survivors. Nat Rev Clin Oncol 2013;10:289301.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 8785 2231 104
PDF Downloads 4431 1240 83
EPUB Downloads 0 0 0