After undergoing a lumpectomy, Karen McGowan of Swedesboro faced questions that thousands of women face every year. Will I need chemo? Radiation? Some other treatment? And because it was March 2020, another question was on her mind. Would she be comfortable going to a hospital for treatment just as COVID-19 was arriving in South Jersey?
The National Comprehensive Cancer Network® (NCCN®) has issued its first ever NCCN Clinical Practice Guidelines in Oncology for Survivorship. The new NCCN Guidelines were recently presented at the NCCN 18th Annual Conference: Advancing the Standard of Cancer Care™ by NCCN Guidelines panel chair and Fox Chase Cancer Center medical oncologist, Crystal S. Denlinger, M.D., as well as NCCN Guidelines panel member, Jennifer A. Ligibel, M.D., of Dana-Farber/Brigham and Women’s Cancer Center and Harvard Medical School.
The new NCCN Guidelines were recently presented at the NCCN 18th Annual Conference: Advancing the Standard of Cancer Care™ by NCCN Guidelines panel chair and Fox Chase Cancer Center medical oncologist, Crystal S. Denlinger, M.D., as well as NCCN Guidelines panel member, Jennifer A. Ligibel, M.D., of Dana-Farber/Brigham and Women’s Cancer Center and Harvard Medical School.
According to the National Cancer Institute, there are more than 12 million American cancer survivors. Recognizing and managing the healthcare needs of these survivors has become a significant responsibility of oncologists and primary care providers.
How a ‘survivor’ is defined
“An individual is considered a cancer survivor from the time of diagnosis through the balance of his or her life,” said Dr. Ligibel. “The NCCN Guidelines for Survivorship focus on the vast and persistent impact both the diagnosis and treatment of cancer have on the adult survivor, particularly after they have completed their initial cancer treatment.”
“Survivorship issues are of particular relevance to us in the community hospital setting as we are a lifelong, go-to resource for many in the area we serve,” noted Staci Oertle, A.N.P.-B.C., M.S.N., O.C.N., survivorship nurse at Inspira Frank and Edith Scarpa Regional Cancer Pavilion. “We are pleased to be able to use these new guidelines to improve the care we give to our patients.”
Areas of concern within survivorship care
Key to proper survivorship care, noted Dr. Denlinger, is accurate assessment of survivors’ needs and concerns on a routine basis. The NCCN Guidelines for Survivorship cover 8 distinct areas: anxiety and depression, cognitive function, exercise, fatigue, immunizations and infections, pain, sexual function, and sleep disorders. The NCCN Guidelines include a sample assessment tool with 2-3 questions on each of these 8 areas.
For accurate assessment of cognitive function, the NCCN Guidelines for Survivorship recommend getting a complete, focused history and reviewing factors, such as medication side effects, hormonal interaction, and distress. These evaluations can lead to ways of providing survivor and/or family education, including, but not limited to, supportive self-management, enhanced organizational strategies, and regular exercise.
Survivorship and sexual health
“Sexual health is an important part of an individual’s overall physical and emotional well-being,” said Dr. Denlinger. The NCCN Guidelines for Survivorship provide symptom checklists to assess sexual function in both male and female cancer survivors, and recommend that doctors regularly have proactive discussions with their patients about sexual function, including topics such as sexual desire, pain, and ability to maintain erection. Recommendations for the management of common symptoms are also included.
Survivorship and exercise
“Exercise plays a distinct role in post-cancer health,” noted Dr. Ligibel. “Physical activity should be discussed at every physician visit and survivors should be encouraged to avoid inactivity. Exercise should be tailored to survivors’ ability and preference.”
The NCCN Guidelines for Survivorship recommend that doctors determine survivors’ ability to exercise by taking a focused history, and assessing factors that hinder physical activity, including, but not limited to, physical limitations, social support, environmental factors, pain, fatigue, emotional distress, and co-morbidities. General recommendations include engaging in at least 75-150 minutes of exercise per week, depending on intensity, as well as 2-3 weekly sessions of strength training and stretching that includes major muscle groups. An algorithm is presented to guide physicians in ways to improve exercise tolerance in cancer survivors.
At Inspira an IRB (Institutional Review Board) approved nursing study entitled, “The Impact of Exercise on Cancer Related Fatigue,” is offered to all patients completing treatment at its Frank and Edith Scarpa Regional Cancer Pavilion. The study is a 60-day exercise program aimed at reducing fatigue caused by cancer and cancer treatment and improving the survivors’ overall quality of life. For information about this study, please contact Staci Oertle at (856) 641-7988.
Immunizations in cancer survivors
“All cancer survivors should undergo all medically appropriate vaccinations,” said Dr. Denlinger. Ideally, vaccines should be given prior to the initiation of cancer therapy if possible. The NCCN Guidelines for Survivorship provide recommendations on appropriate vaccinations for cancer survivors, with specific recommendations on the zoster vaccine in the survivor population.
The NCCN Guidelines are developed and updated through an evidence-based process in which the expert panels integrate comprehensive clinical and scientific data with the judgment of the multidisciplinary panel members and other experts drawn from NCCN member institutions. The NCCN Guidelines for Survivorship panel is a multidisciplinary team comprised of experts in oncology, infectious disease, genitourinary diseases, psychosocial disorders, exercise physiology, and symptom management.
Learn more about the NCCN Guidelines for Survivorship at nccn.org. Learn more about survivorship care and resources at foxchase.org and InspiraHealthNetwork.org/cancer.
As a Fox Chase Cancer Center Partner, Inspira Health Network has early access to new research discoveries on cancer prevention and treatment. Fox Chase Cancer Center Partners is a select group of community hospitals in Pennsylvania and New Jersey affiliated with Fox Chase Cancer Center—part of Temple University Health System—to provide the latest in cancer research, prevention, diagnosis, and treatment in their own communities. Fox Chase Cancer Center Partners offers patients, families, and their physicians enhanced resources to deal with the burden of cancer, including the newest clinical trials.
Inspira Health Network is a charitable nonprofit health care organization formed in November 2012 by the merger of South Jersey Healthcare and Underwood-Memorial Hospital. The network, which traces its roots to 1899, now comprises three hospitals, four multi-specialty health centers and a total of more than 60 locations. These include outpatient imaging and rehabilitation centers; urgent care; numerous specialty centers, including sleep medicine, cardiac testing and wound care; home care and hospice; and more than two dozen primary and specialty physician practices in Cumberland, Gloucester and Salem counties.
Together with its medical staff of more than 1,100 physicians and other care providers, Inspira Health Network provides evidence-based care to help each patient achieve the best possible outcome. Clinical and support staffs are focused on providing safe care in a safe environment.