Guidelines recommend tailored primary care follow-up after colorectal cancer treatment
Patients should receive a history and physical every 3 to 6 months in the first 2 years, and every 6 months in years 3 through 5, among other recommendations.
New guidelines offered 20 recommendations for primary care clinicians who provide follow-up care for patients who have had colorectal cancer.
The guidelines, tailored to assist primary care clinicians in delivering risk-based health care for patients who have completed active therapy for colorectal cancer, appeared online Sept. 8 at CA: A Cancer Journal for Clinicians. Among the 20 recommendations were the following:
- Clinical follow-up care should be individualized to diagnosis and treatment, and survivors should receive surveillance based on risk.
- Patients should receive a history and physical every 3 to 6 months in the first 2 years, and every 6 months in years 3 through 5.
- Carcinoembryonic antigen testing should be conducted every 3 to 6 months for the first 2 years and every 6 months for years 3 through 5, if a patient is a potential candidate for further intervention. Carcinoembryonic antigen testing is not recommended after 5 years.
- Chest/abdominal/pelvic computed tomography should be performed every 12 months in patients whose cancer was stages I-II (if at high risk for recurrence) or stage III, for up to 5 years. Routine positron emission tomography-computed tomography is not recommended at any stage. Routine computed tomography is not recommended after 5 years.
- Patients should receive age-appropriate and gender-appropriate screening for other cancer, except for female patients with Lynch syndrome. They should receive annual endometrial sampling and transvaginal ultrasound.
Physicians should ask patients whether they are experiencing diarrhea, rectal bleeding, rectal incontinence, or other bowel dysfunction; symptoms of mucositis, loss of taste, or dry mouth; and urinary incontinence and retention, and treat symptoms as they would in any other patient.
Physicians should screen patients for cognitive problems or depression and anxiety that may worsen cognition. They should also screen for psychosocial distress, depression, and anxiety using a validated screening tool. Special attention should be paid to patients with a stoma and those who report sexual dysfunction. In these patients, clinicians should monitor for sexual dysfunction, distress, depression, anxiety, and quality of life, and in all cases, refer for support when needed.
The guidelines call for physicians to assess patients with a validated fatigue instrument, recommend physical activity similar to that recommended for the general population, and refer for psychosocial support or rehabilitation as indicated. Primary care physicians should provide routine general medical care and health promotion recommendations and continue to treat patients' underlying chronic conditions, recognizing that cancer treatments often worsen their severity.
It's also recommended to maintain direct communication with all clinicians involved in a patient's oncology care and symptom management and request a treatment summary and follow-up care plan to guide coordination of follow-up care post-treatment.