Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;28(6):2523-2532.
doi: 10.1007/s00520-020-05301-7. Epub 2020 Feb 5.

Systematic review of clinical practice guidelines for colorectal and anal cancer: the extent of recommendations for managing long-term symptoms and functional impairments

Lisette M Wiltink  1   2   3 , K White  4 , M T King  5 , C Rutherford  5   4
Affiliations

Systematic review of clinical practice guidelines for colorectal and anal cancer: the extent of recommendations for managing long-term symptoms and functional impairments

Lisette M Wiltink et al. Support Care Cancer. 2020 Jun.

Abstract

Purpose: Due to increasing numbers of colorectal and anal cancer survivors, more individuals are living with long-term symptoms after treatment. A systematic review was undertaken to assess the extent to which practice guidelines for colorectal and anal cancer provide recommendations for managing long-term symptoms and functioning impairments.

Methods: Four electronic databases and websites of 30 international cancer societies were searched for clinical practice guidelines, consensus statements, or best practice recommendations for colorectal or anal cancer. Quality of included guidelines was evaluated with the Appraisal of Guidelines for Research & Evaluation II tool. Results were narratively summarized.

Results: We included 51 guidelines or consensus statements. Recommendations for managing long-term symptoms or functioning impairments were reported in 13 guidelines (25.4%). All 13 recommend a healthy lifestyle, diet, body weight, and physical activity. The ASCO Colorectal Cancer Survivorship Care Guideline is the most comprehensive, including interventions targeting sexual and bowel function to pain and cognitive issues, and also highlights limited evidence for informing management strategies. Other guidelines recommend treating incontinence, chronic diarrhea, and distress, and stress the need for greater awareness for sexual dysfunction, survivorship clinics, and referrals to specific supportive care interventions.

Conclusions: Few clinical practice guidelines include recommendations for managing long-term symptoms and functioning impairments. It is unclear if this is due to limited evidence or absence of management strategies and interventions. Clear recommendations for managing long-term symptoms and functioning to help health professionals in supporting colorectal and anal cancer survivors are needed.

Keywords: Anal cancer; Clinical practice guidelines; Colorectal cancer; Long-term functioning; Long-term side effects; Long-term symptoms.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of included guidelines
Fig. 2
Fig. 2
Quality assessment score (%) according to AGREE II for 13 guidelines that included information on interventions to manage or treat long-term symptoms and functioning impairments after treatment. ESMO, European Society for Medical Oncology; NHMRC, National Health and Medical Research Council; NCCN, National Comprehensive Cancer Network; GI, gastrointestinal
Fig. 3
Fig. 3
Proportion of 13 guidelines with information on interventions meeting each AGREE II quality criterion
See this image and copyright information in PMC

References

    1. Ferlay J, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN. Int J Cancer. 2012;136(5):E359–E386. doi: 10.1002/ijc.29210. - DOI - PubMed
    1. Glynne-Jones R, et al. Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25(Supplement.3):iii10–iii20. doi: 10.1093/annonc/mdu159. - DOI - PubMed
    1. Australian Institute of Health and Welfare. Cancer compendium: information and trends by cancer type 2019 September 30, 2019]; Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents...
    1. Glaser AW et al (2013) Patient-reported outcomes of cancer survivors in England 1–5 years after diagnosis: a cross-sectional survey. BMJ Open 3(4) - PMC - PubMed
    1. Wiltink LM, Chen TY, Nout RA, Kranenbarg EM, Fiocco M, Laurberg S, van de Velde C, Marijnen CA. Health-related quality of life 14 years after preoperative short-term radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomised trial. Eur J Cancer. 2014;50(14):2390–2398. doi: 10.1016/j.ejca.2014.06.020. - DOI - PubMed

Publication types