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.
Mariotto AB, Rowland JH, Yabroff KR et al. . Long-term survivors of childhood cancers in the United States. Cancer Epidemiol Biomarkers Prev 2009;18:1033–1040.
Nekhlyudov L, Aziz N, Lerro CC, Virgo KS. Oncologists’ and primary care providers’ awareness of late effects of cancer treatment: implications for survivorship care [abstract]. J Clin Oncol 2012;30(Suppl):Abstract 6008.
McCabe MS, Bhatia S, Oeffinger KC et al. . American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care. J Clin Oncol 2013;31:631–640.
About Cancer Survivorship Research: Survivorship Definitions. The National Cancer Institute. Available at: http://dccps.cancer.gov/ocs/definitions.html. Accessed October 11, 2012.
Underwood JM, Townsend JS, Stewart SL et al. . Surveillance of demographic characteristics and health behaviors among adult cancer survivors--Behavioral Risk Factor Surveillance System, United States, 2009. MMWR Surveill Summ 2012;61:1–23.
Rausch SM, Millay S, Scott C et al. . Health behaviors among cancer survivors receiving screening mammography. Am J Clin Oncol 2012;35:22–31.
Grunfeld E, Moineddin R, Gunraj N et al. . Cancer screening practices of cancer survivors: population-based, longitudinal study. Can Fam Physician 2012;58:980–986.
Bloom JR, Petersen DM, Kang SH. Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psychooncology 2007;16:691–706.
Stein KD, Syrjala KL, Andrykowski MA. Physical and psychological long-term and late effects of cancer. Cancer 2008;112:2577–2592.
Harrison SE, Watson EK, Ward AM et al. . Primary health and supportive care needs of long-term cancer survivors: a questionnaire survey. J Clin Oncol 2011;29:2091–2098.
Zucca AC, Boyes AW, Linden W, Girgis A. All’s well that ends well? Quality of life and physical symptom clusters in long-term cancer survivors across cancer types. J Pain Symptom Manage 2012;43:720–731.
Weaver KE, Forsythe LP, Reeve BB et al. . Mental and physical health-related quality of life among u.s. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2012;21:2108–2117.
Valdivieso M, Kujawa AM, Jones T, Baker LH. Cancer survivors in the United States: a review of the literature and a call to action. Int J Med Sci 2012;9:163–173.
Harrington CB, Hansen JA, Moskowitz M et al. . It’s not over when it’s over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med 2010;40:163–181.
Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. Washington, DC: The National Academies Press; 2005.
Park SY, Bae DS, Nam JH et al. . Quality of life and sexual problems in disease-free survivors of cervical cancer compared with the general population. Cancer 2007;110:2716–2725.
Paskett ED, Dean JA, Oliveri JM, Harrop JP. Cancer-related lymphedema risk factors, diagnosis, treatment, and impact: a review. J Clin Oncol 2012;30:3726–3733.
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;98:15–25.
Wood ME, Vogel V, Ng A et al. . Second malignant neoplasms: assessment and strategies for risk reduction. J Clin Oncol 2012;30:3734–3745.
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;102:1083–1095.
Henderson TO, Oeffinger KC, Whitton J et al. . Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study. Ann Intern Med 2012;156:757-766, W-260.
Reulen RC, Winter DL, Frobisher C et al. . Long-term cause-specific mortality among survivors of childhood cancer. JAMA 2010;304:172–179.
Bellizzi KM, Miller MF, Arora NK, Rowland JH. Positive and negative life changes experienced by survivors of non-Hodgkin’s lymphoma. Ann Behav Med 2007;34:188–199.
Bower JE, Meyerowitz BE, Desmond KA et al. . Perceptions of positive meaning and vulnerability following breast cancer: predictors and outcomes among long-term breast cancer survivors. Ann Behav Med 2005;29:236–245.
Crespi CM, Ganz PA, Petersen L et al. . Refinement and psychometric evaluation of the impact of cancer scale. J Natl Cancer Inst 2008;100:1530–1541.
Hodgkinson K, Butow P, Fuchs A et al. . Long-term survival from gynecologic cancer: psychosocial outcomes, supportive care needs and positive outcomes. Gynecol Oncol 2007;104:381–389.
Wakefield CE, McLoone J, Goodenough B et al. . The psychosocial impact of completing childhood cancer treatment: a systematic review of the literature. J Pediatr Psychol 2010;35:262–274.
Zebrack BJ, Stuber ML, Meeske KA et al. . Perceived positive impact of cancer among long-term survivors of childhood cancer: a report from the childhood cancer survivor study. Psychooncology 2012;21:630–639.
Hoffman KE, McCarthy EP, Recklitis CJ, Ng AK. Psychological distress in long-term survivors of adult-onset cancer: results from a national survey. Arch Intern Med 2009;169:1274–1281.
Smith SK, Zimmerman S, Williams CS et al. . Post-traumatic stress outcomes in non-Hodgkin’s lymphoma survivors. J Clin Oncol 2008;26:934–941.
Smith SK, Zimmerman S, Williams CS et al. . Post-traumatic stress symptoms in long-term non-Hodgkin’s lymphoma survivors: does time heal? J Clin Oncol 2011;29:4526–4533.
Wiener L, Battles H, Bernstein D et al. . Persistent psychological distress in long-term survivors of pediatric sarcoma: the experience at a single institution. Psychooncology 2006;15:898–910.
McGrath PD, Hartigan B, Holewa H, Skarparis M. Returning to work after treatment for haematological cancer: findings from Australia. Support Care Cancer 2012;20:1957–1964.
Mols F, Aaronson NK, Vingerhoets AJ et al. . Quality of life among long-term non-Hodgkin lymphoma survivors: a population-based study. Cancer 2007;109:1659–1667.
Carmack CL, Basen-Engquist K, Gritz ER. Survivors at higher risk for adverse late outcomes due to psychosocial and behavioral risk factors. Cancer Epidemiol Biomarkers Prev 2011;20:2068–2077.
Adler NE, Page AE, eds. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: National Academies Press (US); 2008.
Heins M, Schellevis F, Rijken M et al. . Determinants of increased primary health care use in cancer survivors. J Clin Oncol 2012;30:4155–4160.
Snyder CF, Frick KD, Peairs KS et al. . Comparing care for breast cancer survivors to non-cancer controls: a five-year longitudinal study. J Gen Intern Med 2009;24:469–474.
Hudson SV, Miller SM, Hemler J et al. . 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.
Mayer EL, Gropper AB, Neville BA et al. . Breast cancer survivors’ perceptions of survivorship care options. J Clin Oncol 2012;30:158–163.
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.
Grunfeld E, Levine MN, Julian JA et al. . Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol 2006;24:848–855.
Wattchow DA, Weller DP, Esterman A et al. . General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer 2006;94:1116–1121.
Grunfeld E, Julian JA, Pond G et al. . Evaluating survivorship care plans: results of a randomized, clinical trial of patients with breast cancer. J Clin Oncol 2011;29:4755–4762.
Stricker CT, Jacobs LA, Palmer SC. Survivorship care plans: an argument for evidence over common sense. J Clin Oncol 2012;30:1392–1393; author reply 1393-1395.
Chopra I, Kamal KM. A systematic review of quality of life instruments in long-term breast cancer survivors. Health Qual Life Outcomes 2012;10:14.
Pearce NJ, Sanson-Fisher R, Campbell HS. Measuring quality of life in cancer survivors: a methodological review of existing scales. Psychooncology 2008;17:629–640.