The recent publication of the American Cancer Society (ACS)/ASCO breast cancer survivorship care guideline is a tremendous contribution to the literature and should provide a roadmap for providers who care for patients with a history of breast cancer for years to come.1,2 The guideline, reported by Runowicz and colleagues in the Journal of Clinical Oncology1 and CA: A Cancer Journal for Clinicians,2 is summarized in this issue of The ASCO Post.
An Extensive Evidence Base
To develop the guideline, a multidisciplinary expert panel conducted an updated systematic review of the literature and ultimately included over 200 studies to inform the evidence base. The review is comprehensive, and the resulting recommendations cover not only medical follow-up, but are extensive with regard to the potential psychosocial concerns and needs of breast cancer survivors. For example, there is attention to the problems of body image concerns, sexual health, and emotional distress, as well as fatigue and cognitive dysfunction. Recommendations are to screen for these issues in all survivors and to address them with evidence-based solutions when available. Recognizing that most patients with breast cancer will live through and beyond their breast cancer diagnosis and treatment for many years, attention to these concerns is of critical importance to the quality of life for these patients.
The guidelines also consider the non–breast cancer–related risks facing survivors, including the risks of cervical and colorectal cancers as well as heart disease and osteoporosis. The extensive discussion and recommendations regarding energy balance, obesity, physical activity, and nutrition, as well as other health behavioral issues, highlight the growing body of evidence to support the increasing importance of lifestyle modification to optimize outcomes in cancer survivors.
Guidance for Patients and Clinicians
Acknowledging that much under consideration in the care of breast cancer survivors does not have enough of an evidence base, the guideline provides guidance for clinicians and patients alike, taking a commonsense approach to what a prudent oncologist and patient should do in areas of uncertainty. For example, although prospective studies have not yet proved that physical activity improves outcomes in survivors, we know that physical activity is good for many other health and psychosocial outcomes; thus, given the observational data in this regard, it is somewhat of a no-brainer to make a recommendation to increase or maintain adequate physical activity for survivors of breast cancer.
Finally, in addressing the practical implications of implementing evidence- and guideline-based care in our complex health systems, the guideline highlights and addresses the complicated—but not insurmountable—challenges of providing this care. The guideline not only carefully codifies the care considerations and recommendations, it also provides thoughtful solutions with regard to who should be responsible for what in the care of a cancer survivor. ACS, ASCO, and the experts who convened to develop this important guideline should be commended for this prolific work. ■
Disclosure: Dr. Partridge reported no potential conflicts of interest.
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