American Cancer Society Colorectal Cancer Survivorship Care Guidelines

Abstract

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.

Keywords: care coordination; clinical care; colorectal cancer; follow-up; guidelines; late effects; long-term effects; primary care; quality of life; survivorship; survivorship care plan.

Figure 1. Colorectal Cancer Incidence and Mortality Rates* by Race/Ethnicity and Sex, United States, 2006–2010

Description: Colorectal cancer incidence and mortality rates by race/ethnicity and sex during 2006 through 2010. Credits:

1. Siegel R, Desantis C, Jemal A. Colorectal cancer statistics, 2014. CA Cancer J Clin. 2014;64(2):104–117.

2. Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Mortality-All COD, Aggregated With State, Total US (1969–2010) <Katrina/Rita Population Adjustment>. Bethesda, MD: National Cancer Institute, Division of Cancer Control and Population Sciences, Surveillance Research Program, Cancer Statistics Branch; 2013. Released April 2013; underlying mortality data provided by National Center for Health Statistics, 2013.

Figure 2. NCCN Distress Thermometer and Problem List, Figure (DIS-A), from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Distress Management V.2.2014

Description: NCCN Distress Thermometer and Problem List, Figure (DIS-A), from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) for Distress Management. The NCCN Distress Management Panel developed the Distress Thermometer, a now well-known tool for initial screening, which is similar to the successful rating scaled used to measure pain: 0 (no distress) to 10 (extreme distress). The DT serves as a rough initial single-item question screen, which identifies distress coming from any source, even if unrelated to cancer. The receptionist can give it to the patient in the waiting room. The screening tool developed by the NCCN Distress Management Panel includes a 39-item Problem List, which is on the same page with the DT. The Problem List asks patients to identify their problems in five different categories: practical, family, emotional, spiritual/religious, and physical. The panel notes that the Problem List may be modified to fit the needs of the local population. Credits:

1. Reproduced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Distress Management (V.2.2014). © 2014 National Comprehensive Cancer Network, Inc. Available at: NCCN.org. Accessed (April 27, 2015). To view the most recent and complete version of the NCCN Guidelines®, go on-line to NCCN. org.

Figure 3. Functional Assessment of Cancer Therapy – General – (7 item version; be used with patients of any tumor type) ((FACT G-7 (Version 4))

Description: General measure for functional assessment of cancer therapy to be used with patients of any tumor type. Credits:

1. Cella DF, Tulsky DS, Gray G, Sarafian B, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3), 570–579. http://www.facit.org/FACITOrg/Questionnaires.

Figure 4. FACT-C

Description: Cancer specific measure for functional assessment of cancer therapy to be used with patients with colorectal cancer. Credits:

1. Cella DF, Tulsky DS, Gray G, Sarafian B, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3), 570–579. http://www.facit.org/FACITOrg/Questionnaires.

Figure 4. FACT-C

Description: Cancer specific measure for functional assessment of cancer therapy to be used with patients with colorectal cancer. Credits:

1. Cella DF, Tulsky DS, Gray G, Sarafian B, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3), 570–579. http://www.facit.org/FACITOrg/Questionnaires.

Figure 4. FACT-C

Description: Cancer specific measure for functional assessment of cancer therapy to be used with patients with colorectal cancer. Credits:

1. Cella DF, Tulsky DS, Gray G, Sarafian B, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3), 570–579. http://www.facit.org/FACITOrg/Questionnaires.

Figure 5. Total Neuropathy Score

Description: The total neuropathy score is a validated measure of peripheral nerve function. Credits:

1. DR Cornblath, Chaudhry V, Carter K, et al. Total neuropathy score: validation and reliability study. Neurology. 1999;53(8):1660.