NCCN Issues New Guidelines for Survivorship
The National Comprehensive Cancer Network (NCCN) has issued its first ever NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Survivorship. The new NCCN Guidelines were presented at the NCCN 18th Annual Conference: Advancing the Standard of Cancer Care by Panel Chair, Crystal S. Denlinger, MD, Attending Physician and Assistant Professor of Medical Oncology, Fox Chase Cancer Center; as well as Panel Member, Jennifer A. Ligibel, MD, Attending Physician, Adult Oncology, Dana-Farber/Brigham and Women's Cancer Center, and Assistant Professor, Department of Medicine, Harvard Medical School.
According to the National Cancer Institute (NCI), there are more than 12 million American cancer survivors. Recognizing and managing the health-care needs of these survivors has become a significant responsibility of oncologists and primary care providers.
"An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life," said Dr. Ligibel. "The NCCN Guidelines for Survivorship focus on the vast and persistent impact both the diagnosis and treatment of cancer have on the adult survivor particularly after they have completed their initial cancer treatment."
Assessing Survivors’ Needs
The NCCN Guidelines for Survivorship cover eight distinct areas: anxiety and depression, cognitive function, exercise, fatigue, immunizations and infections, pain, sexual function, and sleep disorders. Key to proper survivorship care, noted Dr. Denlinger, is accurate assessment of survivor's needs and concerns on a routine basis. The NCCN Guidelines include a sample assessment tool with two to three questions on each of the eight key criteria covered in the guidelines.
For accurate assessment of cognitive function, the NCCN Guidelines for Survivorship recommend obtaining a complete, focused history and consideration of contributing factors, such as medication side effects, hormonal interaction, and distress. These evaluations can lead to important interventions for survivor and/or family education, including, but not limited to, supportive self-management, enhanced organizational strategies, and regular exercise (up to 20 minutes per session of light exercise, one to three days per week).
"Sexual health is an important part of an individual's overall physical and emotional well-being," said Dr. Denlinger. The NCCN Guidelines for Survivorship provide physicians with symptom checklists and inventories to assess sexual function in both male and female cancer survivors, and recommend that physicians initiate proactive discussions about sexual function at regular intervals, including topics such as sexual desire, pain, and ability to maintain erection.
Exercise Recommendations
Dr. Ligibel spoke about the NCCN Guidelines for Survivorship recommendations for exercise, stating, "Exercise plays a distinct role in post-cancer health. Physical activity should be discussed at every physician visit and survivors should be encouraged to avoid inactivity. Survivors' exercise recommendations should be tailored to individual ability and preference."
The NCCN Guidelines for Survivorship recommend that physicians determine survivors' ability to exercise by attaining a focused history, and assessing factors that impede physical activity, including, but not limited to, physical limitations, social support, environmental factors, pain, fatigue, emotional distress, and comorbidities. The general recommendations for exercise include an overall weekly volume of 75 to 150 minutes of exercise, depending on intensity, as well as two to three weekly sessions of strength training that include major muscle groups.
The NCCN Guidelines are developed and updated through an evidence-based process in which the expert panels integrate comprehensive clinical and scientific data with the judgment of the multidisciplinary panel members and other experts drawn from NCCN Member Institutions. Access to the complete library of NCCN Guidelines is available free-of-charge to clinicians at NCCN.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
