Abstract
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment. This portion of the guidelines describes recommendations regarding screening for the effects of cancer and its treatment. The panel created a sample screening tool, specifically for use in combination with the NCCN Guidelines for Survivorship, to guide providers to topics that require more in-depth assessment. Effective screening and assessment can help providers deliver necessary and comprehensive survivorship care.
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:
Current disease status
Functional/performance status
Current medications
Comorbidities, including weight and tobacco use
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 dysfunction. In general, those who underwent more intensive therapy are at higher risk for multiple late and/or long-term effects. Survivors undergoing certain treatments, such as mantle radiation or certain systemic therapy agents, may be at increased risk for secondary malignancies. Survivors who continue to smoke are at increased risk for smoking-related comorbidities and second primary cancers.
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.
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) are a statement of consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult the NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The National Comprehensive Cancer Network® (NCCN®) makes no representation or warranties of any kind regarding their content, use, or application and disclaims any responsibility for their applications or use in any way. The full NCCN Guidelines for Survivorship are not printed in this issue of JNCCN but can be accessed online at NCCN.org.
© National Comprehensive Cancer Network, Inc. 2014, All rights reserved. The NCCN Guidelines and the illustrations herein may not be reproduced in any form without the express written permission of NCCN.
NCCN Survivorship Panel Members
*,a,cCrystal S. Denlinger, MD/Chair†, Fox Chase Cancer Center
*,c,dJennifer A. Ligibel, MD/Vice Chair†, Dana-Farber/Brigham and Women’s Cancer Center
fMadhuri Are, MD£, Fred & Pamela Buffett Cancer Center at, The Nebraska Medical Center
b,eK. Scott Baker, MD, MS€ξ, Fred Hutchinson Cancer Research Center/, Seattle Cancer Care Alliance
*,cWendy Demark-Wahnefried, PhD, RD≅, University of Alabama at Birmingham, Comprehensive Cancer Center
*,b,d,gDon Dizon, MD†, Massachusetts General Hospital Cancer Center
b,dDebra L. Friedman, MD, MS€‡, Vanderbilt-Ingram Cancer Center
*,gMindy Goldman, MDΩ, UCSF Helen Diller Family Comprehensive Cancer Center
*,c,dLee Jones, PhDΠ, Memorial Sloan Kettering Cancer Center
bAllison King, MD€Ψ‡, Siteman Cancer Center at Barnes-Jewish Hospital and, Washington University School of Medicine
eGrace H. Ku, MDξ‡, UC San Diego Moores Cancer Center
*,b,hElizabeth Kvale, MD£, University of Alabama at Birmingham, Comprehensive Cancer Center
aTerry S. Langbaum, MAS¥, The Sidney Kimmel Comprehensive Cancer Center at, Johns Hopkins
gKristin Leonardi-Warren, RN, ND#, University of Colorado Cancer Center
bMary S. McCabe, RN, BS, MS#, Memorial Sloan Kettering Cancer Center
b,c,d,gMichelle Melisko, MD†, UCSF Helen Diller Family Comprehensive Cancer Center
*,eJose G. Montoya, MDΦ, Stanford Cancer Institute
a,dKathi Mooney, RN, PhD#, Huntsman Cancer Institute at the University of Utah
c,eMary Ann Morgan, PhD, FNP-BC#, Moffitt Cancer Center
Javid J. Moslehi, MDλÞ, Vanderbilt-Ingram Cancer Center
d,hTracey O’Connor, MD†, Roswell Park Cancer Institute
cLinda Overholser, MD, MPHÞ, University of Colorado Cancer Center
cElectra D. Paskett, PhDε, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
Jeffrey Peppercorn, MD, MPH†, Duke Cancer Institute
f,hMuhammad Raza, MD‡, St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
M. Alma Rodriguez, MD‡, The University of Texas MD Anderson Cancer Center
*,fKaren L. Syrjala, PhDθ, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
*,fSusan G. Urba, MD†£, University of Michigan Comprehensive Cancer Center
gMark T. Wakabayashi, MD, MPHΩ, City of Hope Comprehensive Cancer Center
*,hPhyllis Zee, MDΨΠ, Robert H. Lurie Comprehensive Cancer Center of, Northwestern University
NCCN Staff: Nicole R. McMillian, MS, and Deborah A. Freedman-Cass, PhD
KEY:
*Writing Committee Member
Subcommittees: aAnxiety and Depression; bCognitive Function; cExercise; dFatigue; eImmunizations and Infections; fPain; gSexual Function; hSleep Disorders
Specialties: ξBone Marrow Transplantation; λCardiology; εEpidemiology; ΠExercise/Physiology; ΩGynecology/ Gynecologic Oncology; ‡Hematology/Hematology Oncology; ΦInfectious Diseases; ÞInternal Medicine; †Medical Oncology; ΨNeurology/Neuro-Oncology; #Nursing; ; ≅Nutrition Science/ Dietician; ¥Patient Advocacy; €Pediatric Oncology; θPsychiatry, Psychology, Including Health Behavior; £Supportive Care Including Palliative, Pain Management, Pastoral Care, and Oncology Social Work; ¶Surgery/Surgical Oncology; ωUrology
Footnotes
Disclosures for the NCCN Survivorship Panel
At the beginning of each NCCN Guidelines panel meeting, panel members review all potential conflicts of interest. NCCN, in keeping with its commitment to public transparency, publishes these disclosures for panel members, staff, and NCCN itself.
Individual disclosures for the NCCN Survivorship Panel members can be found on page1531. (The most recent version of these guidelines and accompanying disclosures are available on the NCCN Web site at NCCN.org.)
These guidelines are also available on the Internet. For the latest update, visit NCCN.org.
| Panel Member | Clinical Research Support/Data Safety Monitoring Board |
Advisory Boards, Speakers Bureau, Expert Witness, or Consultant |
Patent, Equity, or Royalty |
Other | Date Completed |
|---|---|---|---|---|---|
| Madhuri Are, MD | None | None | None | None | 9/6/14 |
| K. Scott Baker, MD, MS | Cincinnati Children’s Medical Center | None | None | None | 10/21/14 |
| Wendy Demark-Wahnefried, PhD, RD | National Cancer Institute; American Cancer Society; Harvest for Health Gardening Project for Breast Cancer Survivors; and Nutrigenomic Link between Alpha- Linolenic Acid and Aggressive Prostate Cancer | American Society of Clinical Oncology | None | American Society of Preventive Oncology | 7/13/14 |
| Crystal S. Denlinger, MD | Bayer HealthCare; Genentech, Inc.; ImClone Systems Incorporated; MedImmune Inc.; OncoMed Pharmaceuticals; Astex Pharmaceuticals; Merrimack Pharmaceuticals; and Pfizer Inc. | Eli Lilly and Company | None | None | 10/16/14 |
| Don Dizon, MD | None | None | None | American Journal of Clinical Oncology; ASCO; UpToDate | 4/4/14 |
| Debra L. Friedman, MD, MS | None | None | None | None | 7/31/14 |
| Mindy Goldman, MD | None | None | None | Lumetra | 8/23/14 |
| Lee W. Jones, PhD | None | None | Exercise by Science, Inc. | None | 8/21/14 |
| Allison King, MD | None | None | None | None | 9/11/13 |
| Grace H. Ku, MD | None | Seattle Genetics, Inc. | None | None | 9/16/14 |
| Elizabeth Kvale, MD | None | None | None | None | 10/23/14 |
| Terry S. Langbaum, MAS | None | None | None | None | 8/22/14 |
| Kristin Leonardi-Warren, RN, ND | None | None | None | None | 1/6/14 |
| Jennifer A. Ligibel, MD | None | None | None | None | 10/3/13 |
| Mary S. McCabe, RN, BS, MS | None | National Cancer Institute | None | None | 5/6/14 |
| Michelle Melisko, MD | Genentech, Inc.; Celldex Therapeutics; and Galena Biopharma | Agendia BV | None | None | 8/19/14 |
| Jose G. Montoya, MD | None | None | None | None | 12/6/13 |
| Kathi Mooney, RN, PhD | University of Utah | None | None | None | 7/15/14 |
| Mary Ann Morgan, PhD, FNP-BC | None | None | None | None | 5/5/14 |
| Javid J. Moslehi, MD | Millennium Pharmaceuticals, Inc.; and Accleron, Inc. | ARIAD Pharmaceuticals, Inc.; Millennium Pharmaceuticals, Inc.; Novartis Pharmaceuticals Corporation; and Pfizer Inc. | None | None | 10/5/14 |
| Tracey O’Connor, MD | None | None | None | None | 9/4/14 |
| Linda Overholser, MD, MPH | None | Colorado Central Cancer Registry Care Plan Project; and George Washington Cancer Institute Survivorship Project | None | Athena Health | 10/13/14 |
| Electra D. Paskett, PhD | Merck & Co., Inc. | None | Pfizer Inc. | None | 9/24/14 |
| Jeffrey Peppercorn, MD, MPH | None | Genentech, Inc. | GlaxoSmithKline | None | 9/2/14 |
| Muhammad Raza, MD | None | None | None | None | 8/23/12 |
| M. Alma Rodriguez, MD | Amgen Inc.; and Ortho Biotech Products, L.P. | None | None | None | 9/16/14 |
| Karen L. Syrjala, PhD | None | None | None | None | 9/2/14 |
| Susan G. Urba, MD | None | Eisai Inc. | None | None | 8/21/14 |
| Mark T. Wakabayashi, MD, MPH | None | None | None | None | 9/5/14 |
| Phyllis Zee, MD | Philips/Respironics | Merck & Co., Inc.; Jazz Pharmaceuticals; Vanda Pharmaceuticals; and Aptalis Pharmaceuticals | None | None | 8/28/14 |
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