A Work in Progress: Developing the New NCCN Guidelines for Survivorship
Authors: Crystal S. Denlinger, Jennifer Ligibel
Journal: Journal of the National Comprehensive Cancer Network (2014)

The National Coalition for Cancer Survivorship and the NCI consider a person to be a cancer survivor from diagnosis throughout the balance of his or her life, and include family, friends, and caregivers impacted by the diagnosis in the definition. 1 In this context, the number of cancer survivors living in the United States is increasing.Currently estimated to be approximately 13.7 million, it is anticipated to increase to almost 18 million within the next decade.Many of these survivors will be older than 65 years, diagnosed more than 5 years ago, and survivors of melanoma, breast cancer, prostate cancer, or colorectal cancer. 2,3][6] In light of this, the Institute of Medicine (IOM) brought the issues of cancer survivorship to the forefront in 2006 and defined 4 essential aspects of survivorship care: 1) surveillance for recurrence, second cancers, and medical or psychosocial late effects; 2) prevention of recurrence or new cancers or other late effects of cancer and its treatment; 3) intervention for the long-term and late effects of cancer and its treatment, including medical problems, psychosocial concerns, and practical issues related to employment and finances; and 4) coordination of care among health care providers to ensure all needs are met. 7ancer survivors face a myriad of potential concerns and issues.These include the possible physical effects of cancer and its treatment and the potential emotional fallout of being diagnosed with a life-threatening illness.Survivors also must adhere to or adopt healthy lifestyle behaviors, such as tobacco cessation, maintaining a healthy weight, engaging in regular physical activity, and consuming a healthy diet. 8Finally, survivors face practical issues related to employment, disability, and insurance. 7ith the increasing number of cancer survivors, the oncology community's focus on cancer survivorship turns much needed attention to these many issues. 2,9nfortunately, many of these are addressed piecemeal by various health care providers who may not be well equipped to handle the aftermath of cancer and its treatment. 10Survivors may have a primary care provider, multiple oncology providers of various disciplines, and other subspecialists.Additionally, advanced practice clinicians and allied health professionals such as physical therapists and mental health professionals may be involved in their care. 11,12Because of this complexity, ASCO recently cited a need for standardized, evidence-based practice guidelines for the management of effects after treatment and for health promotion of survivors. 13urrently, very little evidence or standards of practice exist to guide care during this important period in the survivor's life.Guidelines on physical activity and nutrition have been published by the American College of Sports Medicine and American Cancer Society. 8,14However, current guidelines lack practical implementation recommendations for providers.In addition, very few guidelines or standards of practice exist for the management of late or long-term effects of cancer and its treatment.Given the wide range of potential health care providers for a given cancer survivor, the growing use of advanced practice clinicians as providers of survivorship care, the potential for transitioning survivors back to primary care for most of their health care, and the projected shortage of oncologists in the notso-distant future, 9,12,15 many believed it was the right time to develop a guideline to