New NCCN Guidelines For Cancer Survivors
The National Comprehensive Cancer Network (NCCN) issued new guidelines regarding cancer survivors. Survivorship means the post-treatment period. Eight areas are covered including anxiety/depression, fatigue, pain, sleep disorders (which were previously addressed) and the newly added cognitive function, exercise, sexual function and immunization/infections.
Cognitive function was added since patients complained of loss of memory and ability to concentrate after chemotherapy, which led to several randomized studies. To date there is limited evidence to guide management of cognitive dysfunction from chemotherapy.
It is recommended that all patients with cancer receive vaccination for influenza and pneumonia.
Exercise was also added to the new guidelines since numerous studies have linked regular exercise to not only better psychological status but also lower recurrence rates in multiple cancers. It is recommended exercising at least 150 minutes a week.
Sexual dysfunction is a frequent side effect of rectal, prostate and breast cancer. Sexual health is often not addressed by physicians and it is now recommended referring the patient to a sex counselor or urologist or gynecologist.
It is important to screen for anxiety and depression and then treat the patient pharmacologically, if necessary, or refer the patient to a psychiatrist or psychologist.
For the complaint of fatigue evaluate the patient to assess for medical versus emotional or nutritional reasons for the symptom and treat accordingly.
When evaluating the patient for pain it needs to be determined if the pain is post-surgical, neuropathic, musculoskeletal, gastrointestinal, etc. And therapy is therefore selected based on patients needs. Approximately one-third of cancer survivors experience some kind of chronic pain.
Evaluation of sleep disorder is recommended as well. Once the patient does not respond to general sleep hygiene measures and cognitive behavioral treatments, several FDA approved hypnotic agents are available.
As survival of cancer patients continues to improve additional supportive measures need to be taken for patients well being.