HOLLYWOOD, Florida (EGMN)–For the first time, the National Comprehensive Cancer Network has added cancer survivorship care recommendations to its non-small cell lung cancer and colorectal cancer guidelines.

The recommendations are aimed at smoothing the transition of patients to primary care once acute treatment for their cancer is completed. Oncologists are advised to develop a long-term treatment plan with specific duties for themselves and a primary care physician.

The goal is to give the primary care provider an overall summary of surgical, radiation, and chemotherapy treatment. In addition, information should be provided about the expected time to resolution of acute toxicities, potential late adverse effects, and possible long-term effects of treatment.

A significant number of people could benefit. According to the American Cancer Society, there are nearly 150,000 new cases of colorectal cancer and 215,000 new cases of lung cancer (small and non-small cell) diagnosed each year.

Regarding surveillance of colorectal cancer survivors, NCCN recommends that they have a history and physical examination every three to six months for two years, and then every six months for three years. Carcinoembryonic antigen (CEA) testing also is recommended with the same frequency.

Colonoscopy should be performed at one year, and then as clinically indicated. The guideline authors also recommend a CT scan of the abdomen and pelvis annually for three years.

Surveillance for non-small cell lung cancer survivors requires a history and physical examination with a contrast-enhanced chest CT scan every 4 to 6 months for two years. Thereafter, an annual history, physical exam, and a non-contrast-enhanced chest CT scan is recommended. Smoking status should be assessed at each visit, with counseling and referral as warranted. In addition, the NCCN recommends annual trivalent inactivated influenza vaccinations and pneumococcal vaccination, with repeat vaccinations as necessary.

Survivors of colorectal cancer or non-small cell lung cancer should be routinely screened for breast cancer, cervical cancer, and prostate cancer. In addition, non-small cell lung cancer survivors should be screened regularly for colorectal cancer.

“The main reason for surveillance is to make certain there is no recurrence, to make certain they don’t develop a second neoplasm,” Dr. Paul F. Engstrom, senior vice president of extramural research programs at Fox Chase Cancer Center in Philadelphia, said at the NCCN’s annual meeting.

Additional and general health monitoring such as routine blood pressure, cholesterol, and glucose testing is recommended. “I have patients 15 to 20 years out now who have coronary artery disease and need to be stented. So other conditions arise as they age,” Dr. David S. Ettinger said during the meeting at an update on non-small cell lung cancer guidelines.

“Just because you have cancer” does not mean one is exempt from all other diseases, said Dr. Ettinger, professor of oncology and medicine, otolaryngology-head and neck surgery, obstetrics and gynecology, and radiation oncology at The Johns Hopkins University School of Medicine in Baltimore.

Guidelines to manage the late sequelae of colorectal cancer and its treatment address chronic diarrhea and incontinence; oxaliplatin-induced neuropathy; and bone health and sexual dysfunction after pelvic radiation. “Chronic diarrhea can be disabling for some patients, and neuropathy is an issue with the use of our main agent, oxaliplatin,” Dr. Engstrom said.

The guidelines recommend physicians counsel survivors to maintain a healthy weight, limit alcohol consumption, and adopt a healthy diet and physically-active lifestyle. “By and large medical oncologists are not up on what kind of diet and healthy lifestyle is most appropriate,” Dr. Engstrom said. “We need to learn more.”

The optimal diet is unknown for survivors, Dr. Engstrom said, but the guidelines recommend an emphasis on plant sources of food. In addition, exercise has been associated with increased survival with colorectal cancer. “Tell [patients] exercise matters. Get out and walk, and preferably have a regular exercise regimen.”

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

佛罗里达州好莱坞(EGMN)——美国国家综合癌症网络(NCCN)首次在非小细胞肺癌和结直肠癌指南中加入了对肿瘤存活患者的保健建议。

该建议旨在使完成癌症治疗的肿瘤存活患者顺利过渡到初级保健体系。肿瘤专家们建议为他们自己和初级保健医师制订一项长期的职责清晰的治疗计划。

这样做的目的是为初级保健医师提供一份关于手术和放化疗的整体概要。此外，还应提供有关急性毒性反应预期发生时间、潜在的晚期不良反应以及治疗可能存在的长期影响等方面的资料。

美国癌症协会(ACS)估计会有相当多的人可从中受益。全美每年新诊断的大肠癌患者近15万例，新诊断的肺癌(包括小细胞肺癌和非小细胞肺癌) 患者则高达21.5万之多。

NCCN建议对结直肠癌存活患者进行监测。在前2年，每3到6个月进行一次病史和身体检查，之后3年则改为每6个月一次。NCCN还推荐以同样的时间间隔检测癌胚抗原(CEA)。

应在1年内完成结肠镜检查，并将其作为一项临床指标。该指南的作者还建议3年内每年对腹部和骨盆进行一次CT检查。

对非小细胞肺癌幸存者的监测包括每2年进行一次病史和身体检查，以及2年内每4到6个月做一次胸部增强CT检查。此后则每年进行一次病史和身体检查及一次非增强胸部CT扫描。每次随访应评估患者的吸烟情况，视需要来提供咨询及指导。此外，NCCN还建议每年接种三价灭活流感疫苗和肺炎球菌疫苗，必要时反复接种。

结直肠癌和非小细胞肺癌存活患者应定期进行乳腺癌、宫颈癌、前列腺癌的相关检查。此外，非小细胞肺癌存活患者应定期进行结直肠癌相关检查。

 “监测主要的原因是确保无肿瘤复发以及未发生其他肿瘤。”费城Fox Chase癌症中心院外研究项目高级副总裁Paul F. Engstrom博士在NCCN的年度会议说道。

该建议还提到对其他一般的健康项目如常规血压、胆固醇和血糖等进行监测。 “我的一些病人存活了15年至20年，现在患有冠状动脉疾病，需要植入支架。随着病人年龄的增长可能会有其他问题出现。”David S. Ettinger博士在此次非小细胞肺癌指南的修订会议上说道。

 “因为你得了癌症”并不意味着不再得其他任何的疾病，巴尔的摩约翰霍普金斯大学医学院耳鼻咽喉头颈外科学、妇产科学、内科及放射肿瘤学教授Ettinger博士说道。

指南中结直肠癌晚期后遗症及其治疗部分关注了慢性腹泻和大便失禁、奥沙利铂诱导的神经病变、盆腔辐射后骨骼健康和性功能障碍的处置措施。“一些患者因慢性腹泻导致失功，主要化疗药物奥沙利铂引发的神经病变也是一个问题。”Engstrom博士说。

该指南建议医生规劝存活患者保持合适的体重、限制饮酒、健康饮食和积极的生活方式。“大多数的临床肿瘤学专家并不擅长向患者解释哪种饮食习惯和生活方式是最合适的，”Engstrom博士说。“我们需要学习的还有很多。”

Engstrom博士指出，尽管肿瘤存活患者的最佳饮食无从得知，但该指南重点推荐了蔬菜类食物。此外，体育锻炼与结直肠癌患者生存时间延长相关。“告诉病人锻炼是有益的。出去散散步，最好制订一个规律性的锻炼计划。” 

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