December 10, 2015

New Guideline on Breast Cancer Survivor Care Issued by ASCO and ACS

A comprehensive set of recommendations for the lifelong follow-up care of female adult breast cancer survivors has been issued by the American Cancer Society (ACS) and the American Society of Clinical Oncology (ASCO). This is the first time the two societies have collaborated on a joint guideline.

The American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline was published online December 7 in the Journal of Clinical Oncology and in the ACS journal CA: A Cancer Journal for Clinicians.

Targeted to breast cancer specialists and primary care providers, the new document covers a broad spectrum of survivorship issues. The multidisciplinary working group that developed it included members with expertise in primary care, gynecology, surgical, medical, and radiation oncology, and nursing. In addition, a breast cancer survivor provided the patient's perspective.

Backed by an evidence base of 237 eligible articles from the literature, the guidelines also rest on expert consensus opinion. "Most of the evidence is not sufficient to warrant a strong evidence-based recommendation," write the authors, led by Carolyn D. Runowicz, MD, a professor of obstetrics and gynecology at the Herbert Wertheim College of Medicine, in Miami, Florida.

The guideline includes positive recommendations in five key areas:
  • regular surveillance for recurrence by cancer history and physical examination;
  • periodic mammographic screening for second primary breast cancers;
  • assessment and management of the physical and psychosocial long-term and late effects of breast cancer and its treatment;
  • promotion of healthy lifestyle;
  • care coordination and practice implications.
Each recommendation is followed by a specific clinical interpretation.

On the basis of the available evidence, the panel did not recommend routine laboratory or imaging tests for assessing recurrence in asymptomatic survivors.

Posttreatment effects that require monitoring include body image concerns, lymphadema, cardiotoxicity, cognitive impairment, depression, anxiety, and fatigue, as well as bone and musculoskeletal health, pain, neuropathy, infertility, and sexual health. Health promotion recommendations cover healthy weight, maintenance, smoking cessation, good nutrition, and regular exercise.

The guideline advises primary care clinicians to maintain communication with the patient's oncology team and to obtain a treatment summary and survivorship care plan for each patient.

Educational efforts aimed at patients and providers will facilitate implementation, according to coauthor Gary H. Lyman, MD, MPH, professor of medicine, public health, and pharmacy at the University of Washington, in Seattle. "We will continue to solicit feedback from all stakeholders and consider guideline updates as more data emerge," Dr Lyman commented to Medscape Medical News. "Over time, we hope to evaluate the efficacy and impact of the guidelines on the quality of patient care, as well as patient acceptance."

Dr Lyman anticipates that, like earlier guidelines, these new joint recommendations will be integrated into ASCO's quality improvement program, which is currently used by many US oncology practices. "As we move forward with additional survivorship guidelines, we hope to learn from this experience to provide even more effective and valuable recommendations," he commented to Medscape Medical News.

In an ASCO statement, Dr Runowicz, who chaired the working group, said, "The recommendations should result in high-quality survivorship care, with a focus on improving their quality of life and health outcomes."

1). J Clin Oncol. Published online December 7, 2015. Full text
2). CA Cancer J Clin. Published online December 7, 2015. Full text

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