Thursday, November 30, 2023
Recommendations for the Care of Cancer Survivors*
General Symptoms of Cancer Survivors (Not Related to Specific Cancer or Treatment)
Symptoms Most Common After Treatment of Rectal Cancer*
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Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
This activity is intended for primary care physicians, gastroenterologists, surgeons, radiation oncologists, and other physicians who care for patients with a history of colorectal cancer.
The goal of this activity is to describe common symptoms among survivors of colorectal cancer and the management of these patients.
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As an organization accredited by the ACCME, MedscapeCME requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
MedscapeCME encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine
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CME Released: 9/21/2009
Valid for credit through: 9/21/2010, 11:59 PM EST
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Abstract
With advances in treatment, colorectal cancer (CRC) is being transformed from a deadly disease into an illness that is increasingly curable. With this transformation has come increased interest in the unique problems, risks, needs, and concerns of survivors who have completed treatment and are cancer-free. Research has shown that physical and mental quality of life for CRC survivors was inferior compared with age-matched individuals without cancer. Although issues and symptoms were most prominent during the first 3 years, long-term effects of treatment can persist and include fatigue, sleep difficulty, fear of recurrence, anxiety, depression, negative body image, sensory neuropathy, gastrointestinal problems, urinary incontinence, and sexual dysfunction. The unique challenges and issues of CRC survivors can and should be addressed by health care providers and the research community to ensure effective interventions and models of care to manage these problems. This article discusses what is known about the long-term effects of CRC treatment on quality of life, the care of survivors, and existing models of survivorship care.
Introduction
With advances in cancer prevention, early detection, and treatment, the population of cancer survivors in the United States is greater than 11 million and growing.[1] However, colorectal cancer (CRC) remains the third most common cancer and cause of cancer death in both men and women, with an estimated 108,070 new cases of colon cancer and 40,740 new cases of rectal cancer, and an estimated 49,960 deaths attributed to CRC, in 2008.[2] More than 90% of invasive CRCs are diagnosed in patients older than 50 years, with 67% being diagnosed in patients older than 65 years. CRC is the most common cancer diagnosis in patients older than 75 years.[3,4]
Fortunately, most patients will be diagnosed with local or regional disease, and may be candidates for curative therapy.[3] Currently, 5-year survival rates for all stages of colon and rectal cancer are 65% and 66%, respectively.[2] This improvement in survival is likely from earlier detection of tumors and improved therapy.[5] The use of adjuvant 5-fluorouracil (5-FU) has resulted in an approximately 30% improvement in survival, with the addition of oxaliplatin in stage III colon cancer adding an additional 20% improvement.[6,7] The use of chemotherapy and radiation in rectal cancer has resulted in improved survival and local control.[8,9]
With improved treatment comes the potential for late and long-term side effects that can affect quality of life (QOL). Long-term follow-up, health maintenance, and lifestyle modifications remain important components of care for CRC survivors. Recommendations from the Institute of Medicine ( Table 1 ) can shape a high-quality approach to the care of cancer survivors.[10] Because a significant proportion of individuals treated for CRC are likely to be cancer-free for longer intervals, and potentially for the rest of their lives, this article focuses on the survivor experience of patients who have stage I through III CRC and have completed primary treatment and have no evidence of disease. This article discusses QOL after treatment, the late and long-term effects of treatment, lifestyle interventions, and models for long-term care of CRC survivors.
