Survivorship, Version 1.2021

Featured Updates to the NCCN Guidelines

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  • 1 University of Wisconsin Carbone Cancer Center;
  • | 2 Fox Chase Cancer Center;
  • | 3 Yale Cancer Center/Smilow Cancer Hospital;
  • | 4 Patient Advocate;
  • | 5 City of Hope National Medical Center;
  • | 6 Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance;
  • | 7 Mayo Clinic Cancer Center;
  • | 8 UT Southwestern Simmons Comprehensive Cancer Center;
  • | 9 O’Neal Comprehensive Cancer Center at UAB;
  • | 10 Fred & Pamela Buffett Cancer Center;
  • | 11 Vanderbilt-Ingram Cancer Center;
  • | 12 UCLA Jonsson Comprehensive Cancer Center;
  • | 13 UCSF Helen Diller Family Comprehensive Cancer Center;
  • | 14 University of Michigan Rogel Cancer Center;
  • | 15 Abramson Cancer Center at the University of Pennsylvania;
  • | 16 St. Jude Children's Research Hospital/The University of Tennessee Health Science Center;
  • | 17 Moffitt Cancer Center;
  • | 18 UC San Diego Moores Cancer Center;
  • | 19 Massachusetts General Hospital Cancer Center;
  • | 20 Huntsman Cancer Institute at the University of Utah;
  • | 21 Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;
  • | 22 Memorial Sloan Kettering Cancer Center;
  • | 23 Roswell Park Comprehensive Cancer Center;
  • | 24 University of Colorado Cancer Center;
  • | 25 The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;
  • | 26 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;
  • | 27 Dana-Farber/Brigham and Women's Cancer Center;
  • | 28 The University of Texas MD Anderson Cancer Center;
  • | 29 Stanford Cancer Institute;
  • | 30 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;
  • | 31 Duke Cancer Institute;
  • | 32 Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and
  • | 33 National Comprehensive Cancer Network.

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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    Nekhlyudov L, Madden J, Graves AJ, et al. Cost-related medication nonadherence and cost-saving strategies used by elderly Medicare cancer survivors. J Cancer Surviv 2011;5:395404.

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    Keegan TH, Tao L, DeRouen MC, et al. Medical care in adolescents and young adult cancer survivors: what are the biggest access-related barriers? J Cancer Surviv 2014;8:282292.

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  • 11.

    de Souza JA, Yap BJ, Wroblewski K, et al. Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST). Cancer 2017;123:476484.

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    Moran JR, Short PF. Does cancer reduce labor market entry? Evidence for prime-age females. Med Care Res Rev 2014;71:224242.

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    Zajacova A, Dowd JB, Schoeni RF, et al. Employment and income losses among cancer survivors: estimates from a national longitudinal survey of American families. Cancer 2015;121:44254432.

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  • 14.

    Kim YA, Yun YH, Chang YJ, et al. Employment status and work-related difficulties in lung cancer survivors compared with the general population. Ann Surg 2014;259:569575.

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    de Boer AG, Taskila T, Ojajärvi A, et al. Cancer survivors and unemployment: a meta-analysis and meta-regression. JAMA 2009;301:753762.

  • 16.

    de Boer AG, Torp S, Popa A, et al. Long-term work retention after treatment for cancer: a systematic review and meta-analysis. J Cancer Surviv 2020;14:135150.

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  • 17.

    Dumas A, Vaz Luis I, Bovagnet T, et al. . Impact of breast cancer treatment on employment: results of a multicenter prospective cohort study (CANTO). J Clin Oncol 2020;38:734743.

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  • 18.

    Duijts SF, van Egmond MP, Spelten E, et al. Physical and psychosocial problems in cancer survivors beyond return to work: a systematic review. Psychooncology 2014;23:481492.

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  • 19.

    Moskowitz MC, Todd BL, Chen R, et al. Function and friction at work: a multidimensional analysis of work outcomes in cancer survivors. J Cancer Surviv 2014;8:173182.

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  • 20.

    Tevaarwerk AJ, Kwekkeboom K, Buhr KA, et al. Results from a prospective longitudinal survey of employment and work outcomes in newly diagnosed cancer patients during and after curative-intent chemotherapy: a Wisconsin Oncology Network study. Cancer 2021;127:801808.

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  • 21.

    Hiltrop K, Heidkamp P, Halbach S, et al. Occupational rehabilitation of male breast cancer patients: return patterns, motives, experiences, and implications—a qualitative study [published online January 23, 2021] Eur J Cancer Care (Engl), doi: 10.1111/ecc.13402

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  • 22.

    Employment Outcomes among Cancer Survivors. National Cancer Institute, Division of Cancer Control & Population Sciences. Accessed March 3, 2021. Available at: https://healthcaredelivery.cancer.gov/employment/

  • 23.

    de Moor JS, Kent EE, McNeel TS, et al. Employment outcomes among cancer survivors in the United States: implications for cancer care delivery. J Natl Cancer Inst 2020;djaa084djaa084.

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  • 24.

    Siu AM, Hung A, Lam AY, et al. Work limitations, workplace concerns, and job satisfaction of persons with chronic disease. Work 2013;45:107115.

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  • 25.

    Duijts SF, Kieffer JM, van Muijen P, et al. Sustained employability and health-related quality of life in cancer survivors up to four years after diagnosis. Acta Oncol 2017;56:174182.

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  • 26.

    de Boer AG, Verbeek JH, Spelten ER, et al. Work ability and return-to-work in cancer patients. Br J Cancer 2008;98:13421347.

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    Kamal KM, Covvey JR, Dashputre A, et al. A systematic review of the effect of cancer treatment on work productivity of patients and caregivers. J Manag Care Spec Pharm 2017;23:136162.

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  • 28.

    Lerner D, Amick BC III, Lee JC, et al. Relationship of employee-reported work limitations to work productivity. Med Care 2003;41:649659.

  • 29.

    Mehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol 2011;77:109130.

  • 30.

    Pearce A, Timmons A, O’Sullivan E, et al. Long-term workforce participation patterns following head and neck cancer. J Cancer Surviv 2015;9:3039.

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  • 31.

    Jagsi R, Hawley ST, Abrahamse P, et al. Impact of adjuvant chemotherapy on long-term employment of survivors of early-stage breast cancer. Cancer 2014;120:18541862.

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  • 32.

    Verrill M, Wardley AM, Retzler J, et al. Health-related quality of life and work productivity in UK patients with HER2-positive breast cancer: a cross-sectional study evaluating the relationships between disease and treatment stage. Health Qual Life Outcomes 2020;18:353364.

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  • 33.

    de Moor JS, Dowling EC, Ekwueme DU, et al. Employment implications of informal cancer caregiving. J Cancer Surviv 2017;11:4857.

  • 34.

    Longacre ML, Weber-Raley L, Kent EE. Cancer caregiving while employed: caregiving roles, employment adjustments, employer assistance, and preferences for support [published online December 20, 2019]. J Cancer Educ, doi: 10.1007/s13187-019-01674-4

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  • 35.

    Mols F, Tomalin B, Pearce A, et al. Financial toxicity and employment status in cancer survivors. A systematic literature review. Support Care Cancer 2020;28:56935708.

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  • 36.

    PDQ Adult Treatment Editorial Board. Financial Toxicity and Cancer Treatment (PDQ): Health Professional Version. Accessed April 26, 2021. Available at: https://www.ncbi.nlm.nih.gov/books/NBK384502/

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  • 37.

    Lentz R, Benson AB III, Kircher S. Financial toxicity in cancer care: prevalence, causes, consequences, and reduction strategies. J Surg Oncol 2019;120:8592.

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  • 38.

    Tevaarwerk AJ, Hocking WG, Buhr KA, et al. A randomized trial of immediate versus delayed survivorship care plan receipt on patient satisfaction and knowledge of diagnosis and treatment. Cancer 2019;125:10001007.

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  • 39.

    Tamminga SJ, Jansen LP, Frings-Dresen MHW, et al. Long-term employment status and quality of life after cancer: a longitudinal prospective cohort study from diagnosis up to and including 5 years post diagnosis. Work 2020;66:901907.

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  • 40.

    Wright P, Wilding S, Watson E, et al. Key factors associated with social distress after prostate cancer: results from the United Kingdom Life after Prostate Cancer diagnosis study. Cancer Epidemiol 2019;60:201207.

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  • 41.

    Gallups SF, Connolly MC, Bender CM, et al. Predictors of adherence and treatment delays among African American women recommended to receive breast cancer chemotherapy. Womens Health Issues 2018;28:553558.

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  • 42.

    van Muijen P, Weevers NL, Snels IA, et al. Predictors of return to work and employment in cancer survivors: a systematic review. Eur J Cancer Care (Engl) 2013;22:144160.

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  • 43.

    Bradley CJ, Wilk A. Racial differences in quality of life and employment outcomes in insured women with breast cancer. J Cancer Surviv 2014;8:4959.

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  • 44.

    Earle CC, Chretien Y, Morris C, et al. Employment among survivors of lung cancer and colorectal cancer. J Clin Oncol 2010;28:17001705.

  • 45.

    Clarke TC, Christ SL, Soler-Vila H, et al. Working with cancer: health and employment among cancer survivors. Ann Epidemiol 2015;25: 832838.

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  • 46.

    Tevaarwerk AJ, Lee JW, Sesto ME, et al. Employment outcomes among survivors of common cancers: the Symptom Outcomes and Practice Patterns (SOAPP) study. J Cancer Surviv 2013;7:191202.

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  • 47.

    Spencer JC, Rotter JS, Eberth JM, et al. Employment changes following breast cancer diagnosis: the effects of race and place. J Natl Cancer Inst 2020;112:647650.

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  • 48.

    Barnes AJ, Robert N, Bradley CJ. Job attributes, job satisfaction and the return to health after breast cancer diagnosis and treatment. Psychooncology 2014;23:158164.

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  • 49.

    Stergiou-Kita M, Grigorovich A, Tseung V, et al. Qualitative meta-synthesis of survivors’ work experiences and the development of strategies to facilitate return to work. J Cancer Surviv 2014;8:657670.

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  • 50.

    Tevaarwerk AJ, Lee JW, Terhaar A, et al. Working after a metastatic cancer diagnosis: factors affecting employment in the metastatic setting from ECOG-ACRIN’s Symptom Outcomes and Practice Patterns study. Cancer 2016;122:438446.

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    Rotter J, Spencer JC, Wheeler SB. Financial toxicity in advanced and metastatic cancer: overburdened and underprepared. J Oncol Pract 2019;15:e300307.

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    de Boer AG, Taskila TK, Tamminga SJ, et al. Interventions to enhance return-to-work for cancer patients. Cochrane Database Syst Rev 2015:CD007569.

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  • 53.

    de Moor JS, Alfano CM, Kent EE, et al. Recommendations for research and practice to improve work outcomes among cancer survivors. J Natl Cancer Inst 2018;110:10411047.

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    Lamore K, Dubois T, Rothe U, et al. Return to work interventions for cancer survivors: a systematic review and a methodological critique. Int J Environ Res Public Health 2019;16:13431363.

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  • 55.

    Butow P, Laidsaar-Powell R, Konings S, et al. Return to work after a cancer diagnosis: a meta-review of reviews and a meta-synthesis of recent qualitative studies. J Cancer Surviv 2020;14:114134.

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  • 56.

    Hoving JL, Broekhuizen ML, Frings-Dresen MH. Return to work of breast cancer survivors: a systematic review of intervention studies. BMC Cancer 2009;9:117126.

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  • 57.

    Kong YC, Rauf N, Subramaniam S, et al. Working after cancer: in-depth perspectives from a setting with limited employment protection policies [published online October 22, 2020]. J Cancer Surviv Surviv, doi: 10.1007/s11764-020-00962-z

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  • 58.

    Alleaume C, Paraponaris A, Bendiane MK, et al. The positive effect of workplace accommodations on the continued employment of cancer survivors five years after diagnosis. Support Care Cancer 2020;28:44354443.

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    Salit R, Lee S, Syrjala K. Facilitators of successful return to work in 1-5 year post-HCT survivors [abstract]. Transplant Cell Ther 2021;27:S378379. Abstract 464.

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    Rosenzweig M, West M, Matthews J, et al. . Financial toxicity among women with metastatic breast cancer. Oncol Nurs Forum 2019;46: 8391.

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