New NCCN Guidelines Focus on Key Aspects of Survivorship

Two new guidelines from the National Comprehensive Cancer Network (NCCN) offer jargon-free information that clinicians can use to help counsel and educate patients about what comes after an initial cancer diagnosis and therapy for the disease.

Part of NCCN’s “Survivorship” series, the publications address late and long-term effects of cancer and cancer treatment, and factors that are key to healthy living. Designed for patients with adult-onset cancer, they are applicable whether an individual’s cancer treatment is ongoing or has been paused, stopped, or completed. 

“Primary care physicians can’t be experts in all of the areas covered in the NCCN physician guidelines, and these guidelines can help them understand what sort of issues survivors they see may be facing and provide appropriate resources or referrals,” says Halle C.F. Moore, MD, Director of the Breast Cancer Program at Cleveland Clinic Cancer Center. “The patient guidelines are ideal for use at the time of a comprehensive survivorship assessment, during which treatment, symptoms or delayed effects may be discussed.”

Broad and multidisciplinary consensus

Endorsed by Good Days, the American Lung Association, Be the Match, the Cancer Hope Network, the Save Your Skin Foundation, and The Leukemia & Lymphoma Society, the guidelines were developed by a panel of experts. Among them are oncologists and specialists in bone marrow transplantation, urology, cardiology and psychology, as well as a primary care physician, nutrition scientist, nurse, epidemiologist and a sociologist.

“The group is a pretty broad and multidisciplinary group, and it includes at least one cancer survivor,” says Dr. Moore, who represents the Case Comprehensive Cancer Center, University Hospitals Seidman Cancer Center and Cleveland Clinic on the panel. “We come together to update the guidelines every year, based on a thorough review of the current literature and expert opinion. That process informs development of recommendations based on consensus grading.”

Screening and cardiovascular risk updates

The new publication on cancer-related late and long-term effects covers topics such as lymphedema, cognitive dysfunction, sexual dysfunction, fatigue, sleep, pain and distress and mental health. The two most noteworthy additions to it in 2020, according to Dr. Moore, are an expanded section on cardiovascular disease risk and a significant update related to screening for subsequent primary malignancies.

“We know that cancer survivors are at higher risk for cardiovascular disease for a variety of reasons, which may be related to their treatment or to shared risk factors for cancer and cardiovascular disease — smoking, age and obesity, among others,” she says. “The guidelines provide tools that clinicians can use to assess traditional and cancer treatment-related risk factors when guiding patients and recommendations for counseling to help mitigate those risks.”

The healthy living guideline reviews physical activity, food and supplements, weight and metabolism, and prevention of infections. Both publications include an appendix with resources and a glossary of key terms, as well as listings of NCCN cancer centers. “Survivorship Care for Healthy Living” and “Survivorship Care for Cancer-Related Late and Long-Term Effects” are available for free to view and print at NNCN.org/patients or via the NCCN Patient Guides for Cancer App.

“Good care for cancer survivors begins at diagnosis and can improve a patient’s health, wellness and quality of life,” says Dr. Moore. “These NCCN publications can further that goal by facilitating coordination of care between primary care physicians, oncologists and other clinicians, and providing evidence-based guidance on health maintenance, screening for and evaluation of consequences of cancer and cancer treatment.”