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.
Screening for Effects of Cancer and Its Treatment
All survivors should be periodically screened for symptoms related to cancer and previous cancer treatment, with appropriate follow-up care as clinically indicated. The panel does not assume that all survivorship issues will be addressed at every visit. Some tools that screen for long-term and late physical and psychosocial effects of cancer and its treatment in survivors have been validated.1–6 In addition, the NCCN Survivorship Panel created a sample screening instrument that is guideline-specific and can be self-administered or administered by an interviewer. This assessment tool was developed specifically for use in combination with the NCCN Clinical Practice Guidelines in Oncology for Survivorship to help providers deliver necessary and comprehensive survivorship care (to view the most recent and complete version of these guidelines, visit NCCN.org). Although this instrument has not yet been piloted or validated, the answers can be used to guide providers to topics within the guidelines that require more in-depth assessment via validated tools and/or clinical evaluation.
In addition to screening by history and physical examination, care providers should assess the following to determine whether reversible or contributing causes for symptoms exist:
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Current disease status
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Functional/performance status
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Current medications
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Comorbidities, including weight and tobacco use
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Prior cancer treatment history and modalities used
This information can also inform about the patient’s risk for specific late or long-term effects, including risks for second primary cancers and comorbidities. For example, patients who received pelvic irradiation or surgery are at risk for sexual dysfunction; patients with a history of brain metastasis or cranial irradiation have an elevated risk for cognitive
NCCN Clinical Practice Guidelines in Oncology: Survivorship: Screening for Cancer and Treatment Effects, Version 2.2014
Version 2.2014, 07-22-14 ©2014 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN®.
Citation: Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw 12, 11; 10.6004/jnccn.2014.0152
Individual Disclosures for the NCCN Survivorship Panel
References
- 1.↑
Avis NE, Smith KW, McGraw S et al.. Assessing quality of life in adult cancer survivors (QLACS). Qual Life Res 2005;14:1007–1023.
- 2.
Campbell HS, Hall AE, Sanson-Fisher RW et al.. Development and validation of the Short-Form Survivor Unmet Needs Survey (SF-SUNS). Support Care Cancer 2014;22:1071–1079.
- 3.
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.
- 4.
Ferrell BR, Dow KH, Grant M. Measurement of the quality of life in cancer survivors. Qual Life Res 1995;4:523–531.
- 5.
Ganz PA. Cancer Rehabilitation Evaluation System (CARES) and CARES-SF now publicly available. J Clin Oncol 2012;30:4046–4047.
- 6.↑
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.
