NCCN Guidelines® Insights: Survivorship, Version 1.2022

Featured Updates to the NCCN Guidelines

Authors:
Tara Sanft Yale Cancer Center/Smilow Cancer Hospital;

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Andrew Day UT Southwestern Simmons Comprehensive Cancer Center;

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Lindsay Peterson Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine;

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M. Alma Rodriguez The University of Texas MD Anderson Cancer Center;

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Shannon Ansbaugh Patient advocate;

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Saro Armenian City of Hope National Medical Center;

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K. Scott Baker Fred Hutchinson Cancer Center;

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Tarah Ballinger Indiana University Melvin and Bren Simon Comprehensive Cancer Center;

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Gregory Broderick Mayo Clinic Cancer Center;

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Wendy Demark-Wahnefried O’Neal Comprehensive Cancer Center at UAB;

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Kristin Dickinson Fred & Pamela Buffett Cancer Center;

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Nathan Paul Fairman UC Davis Comprehensive Cancer Center;

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Debra L. Friedman Vanderbilt-Ingram Cancer Center;

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Mindy Goldman UCSF Helen Diller Family Comprehensive Cancer Center;

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Norah Lynn Henry University of Michigan Rogel Cancer Center;

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Christine Hill-Kayser Abramson Cancer Center at the University of Pennsylvania;

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Melissa Hudson St. Jude Children's Research Hospital/The University of Tennessee Health Science Center;

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Nazanin Khakpour Moffitt Cancer Center;

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Divya Koura UC San Diego Moores Cancer Center;

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Allison L. McDonough Massachusetts General Hospital Cancer Center;

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Michelle Melisko UCSF Helen Diller Family Comprehensive Cancer Center;

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Kathi Mooney Huntsman Cancer Institute at the University of Utah;

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Halle C.F. Moore Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute;

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Natalie Moryl Memorial Sloan Kettering Cancer Center;

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Heather Neuman University of Wisconsin Carbone Cancer Center;

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Tracey O’Connor Roswell Park Comprehensive Cancer Center;

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Linda Overholser University of Colorado Cancer Center;

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Electra D. Paskett The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute;

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Chirayu Patel Massachusetts General Hospital Cancer Center;

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William Pirl Dana-Farber/Brigham and Women's Cancer Center;

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Andrea Porpiglia Fox Chase Cancer Center;

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Kathryn J. Ruddy Mayo Clinic Cancer Center;

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Lidia Schapira Stanford Cancer Institute;

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Lillie Shockney The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins;

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Sophia Smith Duke Cancer Institute;

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Karen L. Syrjala Fred Hutchinson Cancer Center;

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Amye Tevaarwerk University of Wisconsin Carbone Cancer Center;

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Eric H. Yang UCLA Jonsson Comprehensive Cancer Center;

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Phyllis Zee Robert H. Lurie Comprehensive Cancer Center of Northwestern University; and

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Nicole R. McMillian National Comprehensive Cancer Network.

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Deborah A. Freedman-Cass National Comprehensive Cancer Network.

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Restricted access

The NCCN Guidelines for Survivorship are intended to help healthcare professionals who work with survivors to ensure that the survivors’ complex and varied needs are addressed. The NCCN Guidelines provide screening, evaluation, and treatment recommendations for the consequences of adult-onset cancer and its treatment; recommendations to help promote physical activity, weight management, and immunizations in survivors; and a framework for care coordination. This article summarizes updates to the NCCN Guidelines pertaining to preventive health for cancer survivors, including recommendations about alcohol consumption and vaccinations.

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  • 1.

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

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    Ha DM, Prochazka AV, Bekelman DB, et al. Association of leisure-time physical activity with health-related quality of life among US lung cancer survivors. JNCI Cancer Spectr 2021;5:pkaa118.

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    Schwedhelm C, Boeing H, Hoffmann G, et al. Effect of diet on mortality and cancer recurrence among cancer survivors: a systematic review and meta-analysis of cohort studies. Nutr Rev 2016;74:737748.

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    Lee IM, Wolin KY, Freeman SE, et al. Physical activity and survival after cancer diagnosis in men. J Phys Act Health 2014;11:8590.

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    Van Blarigan EL, Fuchs CS, Niedzwiecki D, et al. Association of survival with adherence to the American Cancer Society nutrition and physical activity guidelines for cancer survivors after colon cancer diagnosis: the CALGB 89803/Alliance trial. JAMA Oncol 2018;4:783790.

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    Karavasiloglou N, Pestoni G, Wanner M, et al. Healthy lifestyle is inversely associated with mortality in cancer survivors: results from the Third National Health and Nutrition Examination Survey (NHANES III). PLoS One 2019;14:e0218048.

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    Kehm RD, MacInnis RJ, John EM, et al. Recreational physical activity and outcomes after breast cancer in women at high familial risk. JNCI Cancer Spectr 2021;5:pkab090.

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    De Cicco P, Catani MV, Gasperi V, et al. Nutrition and breast cancer: a literature review on prevention, treatment and recurrence. Nutrients 2019;11:1514.

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    Ligibel JA, Pierce LJ, Bender CM, et al. Attention to diet, exercise, and weight in oncology care: results of an American Society of Clinical Oncology national patient survey. Cancer 2022;128:28172825.

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    Hyland KA, Jacobs JM, Lennes IT, et al. Are cancer survivors following the National Comprehensive Cancer Network health behavior guidelines? An assessment of patients attending a cancer survivorship clinic. J Psychosoc Oncol 2018;36:6481.

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    Arem H, Mama SK, Duan X, et al. Prevalence of healthy behaviors among cancer survivors in the United States: how far have we come? Cancer Epidemiol Biomarkers Prev 2020;29:11791187.

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  • 20.

    Asare M, McIntosh S, Culakova E, et al. Assessing physical activity behavior of cancer survivors by race and social determinants of health. Int Q Community Health Educ 2019;40:716.

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  • 21.

    Byrd DA, Agurs-Collins T, Berrigan D, et al. Racial and ethnic differences in dietary intake, physical activity, and body mass index (BMI) among cancer survivors: 2005 and 2010 National Health Interview Surveys (NHIS). J Racial Ethn Health Disparities 2017;4:11381146.

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    Cancino RS, Su Z, Mesa R, et al. The impact of COVID-19 on cancer screening: challenges and opportunities. JMIR Cancer 2020;6:e21697.

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    Vanderbruggen N, Matthys F, Van Laere S, et al. Self-reported alcohol, tobacco, and cannabis use during COVID-19 lockdown measures: results from a web-based survey. Eur Addict Res 2020;26:309315.

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    Knell G, Robertson MC, Dooley EE, et al. Health behavior changes during COVID-19 pandemic and subsequent “stay-at-home” orders. Int J Environ Res Public Health 2020;17:6268.

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  • 25.

    Irwin ML, Cartmel B, Harrigan M, et al. Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer 2017;123:12491258.

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  • 26.

    Brown JC, Giobbie-Hurder A, Yung RL, et al. The effects of a clinic-based weight loss program on health-related quality of life and weight maintenance in cancer survivors: a randomized controlled trial. Psychooncology 2022;31:326333.

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  • 27.

    Shaikh H, Bradhurst P, Ma LX, et al. Body weight management in overweight and obese breast cancer survivors. Cochrane Database Syst Rev 2020;12:CD012110.

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    Stump TK, Robinson JK, Yanez B, et al. Physicians’ perspectives on medication adherence and health promotion among cancer survivors. Cancer 2019;125:43194328.

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    Hwang NK, Jung YJ, Park JS. Information and communications technology-based telehealth approach for occupational therapy interventions for cancer survivors: a systematic review. Healthcare (Basel) 2020;8:355.

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    Demark-Wahnefried W, Morey MC, Sloane R, et al. Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol 2012;30:23542361.

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    Goode AD, Lawler SP, Brakenridge CL, et al. Telephone, print, and web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv 2015;9:660682.

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    Goodwin PJ, Segal RJ, Vallis M, et al. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol 2014;32:22312239.

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    Hawkes AL, Chambers SK, Pakenham KI, et al. Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol 2013;31:23132321.

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    Lynch BM, Courneya KS, Sethi P, et al. A randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors: effects on sedentary behavior. Cancer 2014;120:26652672.

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    Stacey FG, James EL, Chapman K, et al. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv 2015;9:305338.

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    Short CE, James EL, Girgis A, et al. Main outcomes of the Move More for Life trial: a randomised controlled trial examining the effects of tailored-print and targeted-print materials for promoting physical activity among post-treatment breast cancer survivors. Psychooncology 2015;24:771778.

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    Sarich P, Canfell K, Egger S, et al. Alcohol consumption, drinking patterns and cancer incidence in an Australian cohort of 226,162 participants aged 45 years and over. Br J Cancer 2021;124:513523.

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    Islami F, Tramacere I, Rota M, et al. Alcohol drinking and laryngeal cancer: overall and dose-risk relation--a systematic review and meta-analysis. Oral Oncol 2010;46:802810.

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    Di Credico G, Polesel J, Dal Maso L, et al. Alcohol drinking and head and neck cancer risk: the joint effect of intensity and duration. Br J Cancer 2020;123:14561463.

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    GBD 2020 Alcohol Collaborators. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. Lancet 2022;400:185235.

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    Rumgay H, Shield K, Charvat H, et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncol 2021;22:10711080.

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    Gapstur SM, Bandera EV, Jernigan DH, et al. Alcohol and cancer: existing knowledge and evidence gaps across the cancer continuum. Cancer Epidemiol Biomarkers Prev 2022;31:510.

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    Goding Sauer A, Fedewa SA, Bandi P, et al. Proportion of cancer cases and deaths attributable to alcohol consumption by US state, 2013-2016. Cancer Epidemiol 2021;71(Pt A):101893.

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    Naimi TS, Brown DW, Brewer RD, et al. Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. Am J Prev Med 2005;28:369373.

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    van de Luitgaarden IAT, van Oort S, Bouman EJ, et al. Alcohol consumption in relation to cardiovascular diseases and mortality: a systematic review of Mendelian randomization studies. Eur J Epidemiol 2022;37:655669.

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    Oppenheimer GM, Bayer R. Is moderate drinking protective against heart disease? The science, politics and history of a public health conundrum. Milbank Q 2020;98:3956.

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    Biddinger KJ, Emdin CA, Haas ME, et al. Association of habitual alcohol intake with risk of cardiovascular disease. JAMA Netw Open 2022;5:e223849.

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    Sanford NN, Sher DJ, Xu X, et al. Alcohol use among patients with cancer and survivors in the United States, 2000-2017. J Natl Compr Canc Netw 2020;18:6979.

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    Lyu J, Kaur M, Dibble KE, et al. A national study of alcohol consumption patterns among population-based U.S. cancer survivors compared with cancer-free individuals. Cancer Epidemiol 2022;77:102101.

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    Delker E, Brown Q, Hasin DS. Alcohol consumption in demographic subpopulations: an epidemiologic overview. Alcohol Res 2016;38:715.

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    Lehavot K, Browne KC, Simpson TL. Examining sexual orientation disparities in alcohol misuse among women veterans. Am J Prev Med 2014;47:554562.

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    Hatzenbuehler ML, Corbin WR, Fromme K. Trajectories and determinants of alcohol use among LGB young adults and their heterosexual peers: results from a prospective study. Dev Psychol 2008;44:8190.

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    Hatzenbuehler ML, McLaughlin KA, Xuan Z. Social networks and sexual orientation disparities in tobacco and alcohol use. J Stud Alcohol Drugs 2015;76:117126.

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    Huang Q, Luo K, Yang H, et al. Impact of alcohol consumption on survival in patients with esophageal carcinoma: a large cohort with long-term follow-up. Cancer Sci 2014;105:16381646.

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