Care of the Colorectal Cancer Survivor

 

Am Fam Physician. 2018 Mar 1;97(5):331-336.

  Related letter: Genetic Factors Should Be Considered When Caring for Colorectal Cancer Survivors

Author disclosure: No relevant financial affiliations.

Colorectal cancer is the fourth most common cancer in the United States and has a five-year survival rate of 65%. The American Cancer Society and other experts have released guidelines on surveillance, health promotion, screening for other malignancies, and management of treatment effects. Surveillance for disease recurrence should occur every three to six months for the first two to three years, then every six months for a total of five years. Each visit should include a history and physical examination, routine care for chronic medical conditions, and screening for other primary cancers according to guidelines for the general population. Topics addressed depend on the treatment utilized but generally include gastrointestinal issues, neuropathy, pain, urinary symptoms, fatigue, psychological issues, cognitive problems, sexual symptoms, and stoma care. Carcinoembryonic antigen testing should be performed at each visit in patients who are candidates for further intervention. Chest, abdomen, and pelvic computed tomography should be performed annually for five years after treatment. Colonoscopy should be repeated one year after treatment, then three years later if no advanced adenoma is identified.

Colorectal cancer is the fourth most commonly diagnosed cancer in the United States.1 In 2014, the prevalence was estimated at 0.3%, representing nearly 1.2 million Americans.1 Because successful treatment of colorectal cancer has increased the five-year survival rate to 65%,1 family physicians are likely to encounter survivors in their practice. This article reviews the 2015 American Cancer Society guidelines for the care of the colorectal cancer survivor.2

 Enlarge     Print

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Follow-up visits with colorectal cancer survivors should occur every three to six months for the first two to three years after curative treatment, then every six months for a total of five years.

C

2, 3, 57

CEA testing should be performed every three to six months for five years after curative treatment for colorectal cancer.

C

2, 3, 57

CT and CEA testing are not recommended beyond five years after curative treatment for colorectal cancer.

C

2, 3, 57

Routine positron emission tomography is not recommended in colorectal cancer survivors.

C

2, 3, 57

Patients with stage I or II disease who are at higher risk of recurrence and all patients with stage III disease should be offered annual CT of the chest, abdomen, and pelvis for five years after curative treatment for colorectal cancer.

C

2, 3, 57

Colonoscopy should be performed one year and three years after initial treatment for colorectal cancer, then every five years until there is no longer a benefit to the patient.

C

2, 3, 57

Physicians should screen for other malignancies in colorectal cancer survivors based on guidelines for average-risk patients.

C

2


CEA = carcinoembryonic antigen; CT = computed tomography.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Follow-up visits with colorectal cancer survivors should occur every three to six months for the first two to three years after curative treatment, then every six months for a total of five years.

C

2, 3, 57

CEA testing should be performed every three to six months for five years after curative treatment for colorectal cancer.

C

2, 3, 57

CT and CEA testing are not recommended beyond five years after curative treatment for colorectal cancer.

C

2, 3, 57

Routine positron emission tomography is not recommended in colorectal cancer survivors.

C

2, 3, 57

Patients with stage I or II disease who are at higher risk of recurrence and all patients with stage III disease should be offered annual CT of the chest, abdomen, and pelvis for five years after curative treatment for colorectal cancer.

C

2, 3, 57

Colonoscopy should be performed one year and three years after initial treatment for colorectal cancer, then every five years until there is no longer a benefit to the patient.

C

2, 3, 57

Physicians should screen for other malignancies in colorectal cancer survivors based on guidelines for average-risk patients.

C

2


CEA = carcinoembryonic antigen; CT = computed tomography.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

 Enlarge     Print

The Authors

show all author info

KRISTINA BURGERS, MD, is a faculty family physician at Womack Army Medical Center Family Medicine Residency, Fort Bragg, N.C....

CLINT MOORE, DO, is a flight surgeon for the 82nd General Support Aviation Battalion, Fort Bragg.

LORI BEDNASH, DO, is a family physician at Joel Health Clinic, Fort Bragg.

Address correspondence to Kristina Burgers, MD, Womack Army Medical Center, 2817 Reilly Rd., Fort Bragg, NC 28310 (e-mail: kristina.g.burgers.mil@mail.mil). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. National Institutes of Health; National Cancer Institute; Surveillance, Epidemiology, and End Results Program. SEER cancer statistics review, 1975–2014. June 28, 2017. https://seer.cancer.gov/csr/1975_2014. Accessed October 30, 2017....

2. El-Shami K, Oeffinger KC, Erb NL, et al. American Cancer Society colorectal cancer survivorship care guidelines. CA Cancer J Clin. 2015;65(6):428–455.

3. Earle C, Annis R, Sussman J, Haynes AE, Vafaei A. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: guideline recommendations. March 2016. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/256. Accessed January 29, 2018.

4. Jeffery M, Hickey BE, Hider PN, See AM. Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev. 2016;(11):CD002200.

5. Kahi CJ, Boland CR, Dominitz JA, et al. Colonoscopy surveillance after colorectal cancer resection: recommendations of the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2016;150(3):758–768.e11.

6. Benson AB, Venook AP, Cederquist L, et al. NCCN clinical practice guidelines in oncology (NCCN guidelines): rectal cancer. NCCN evidence blocks, version 3.2017. March 13, 2017. https://www.nccn.org/professionals/physician_gls/pdf/rectal_blocks.pdf [registration required]. Accessed October 30, 2017.

7. Benson AB, Venook AP, Cederquist L, et al. NCCN clinical practice guidelines in oncology (NCCN guidelines): colon cancer. NCCN evidence blocks, version 3.2017. March 13, 2017. https://www.nccn.org/professionals/physician_gls/pdf/colon_blocks.pdf [registration required]. Accessed October 30, 2017.

8. Mishra SI, Scherer RW, Geigle PM, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;(8):CD007566.

9. Meyerhardt JA, Sato K, Niedzwiecki D, et al. Dietary glycemic load and cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Natl Cancer Inst. 2012;104(22):1702–1711.

10. Yang B, Jacobs EJ, Gapstur SM, Stevens V, Campbell PT. Active smoking and mortality among colorectal cancer survivors: the Cancer Prevention Study II nutrition cohort. J Clin Oncol. 2015;33(8):885–893.

11. Li P, Wu H, Zhang H, et al. Aspirin use after diagnosis but not prediagnosis improves established colorectal cancer survival: a meta-analysis. Gut. 2015;64(9):1419–1425.

12. Bibbins-Domingo K. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(12):836–845.

13. Omar MI, Alexander CE. Drug treatment for faecal incontinence in adults. Cochrane Database Syst Rev. 2013;(6):CD002116.

14. Hanson B, MacDonald R, Shaukat A. Endoscopic and medical therapy for chronic radiation proctopathy: a systematic review. Dis Colon Rectum. 2012;55(10):1081–1095.

15. Cruzado JA, López-Santiago S, Martínez-Marín V, José-Moreno G, Custodio AB, Feliu J. Longitudinal study of cognitive dysfunctions induced by adjuvant chemotherapy in colon cancer patients. Support Care Cancer. 2014;22(7):1815–1823.

16. Kroenke K, Spitzer RL, Williams JB, Löwe B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–359.

17. Hatzichristou D, Rosen RC, Derogatis LR, et al. Recommendations for the clinical evaluation of men and women with sexual dysfunction. J Sex Med. 2010;7(1 pt 2):337–348.

18. Cappelleri JC, Rosen RC. The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. Int J Impot Res. 2005;17(4):307–319.

19. Pachler J, Wille-Jørgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev. 2012;(12):CD004323.

20. Berger AM, Mooney K, Banerjee C, et al. NCCN clinical practice guidelines in oncology (NCCN guidelines): cancer-related fatigue, version 2.2017. April 10, 2017. https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf [registration required]. Accessed October 30, 2017.

21. Peoples AR, Garland SN, Perlis ML, et al. Effects of cognitive behavioral therapy for insomnia and armodafinil on quality of life in cancer survivors: a randomized placebo-controlled trial. J Cancer Surviv. 2017;11(3):401–409.

22. Piccolo J, Kolesar JM. Prevention and treatment of chemotherapy-induced peripheral neuropathy. Am J Health Syst Pharm. 2014;71(1):19–25.

23. Baxter NN, Habermann EB, Tepper JE, Durham SB, Virnig BA. Risk of pelvic fractures in older women following pelvic irradiation. JAMA. 2005;294(20):2587–2593.

24. Denlinger CS, Carlson RW, Are M, et al.; National Comprehensive Cancer Network. Survivorship: sexual dysfunction (female), version 1.2013. J Natl Compr Canc Netw. 2014;12(2):184–192.

25. Yang EJ, Lim JY, Rah UW, Kim YB. Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial. Gynecol Oncol. 2012;125(3):705–711.

26. Den Oudsten BL, Traa MJ, Thong MS, et al. Higher prevalence of sexual dysfunction in colon and rectal cancer survivors compared with the normative population: a population-based study. Eur J Cancer. 2012;48(17):3161–3170.

27. Mayer DK, Birken SA, Check DK, Chen RC. Summing it up: an integrative review of studies of cancer survivorship care plans (2006–2013). Cancer. 2015;121(7):978–996.

 

 

Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Nov 15, 2018

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article