ACS/ASCO Offer Guidelines for Primary Care Clinicians Caring for Survivors of Breast Cancer

Surabhi Dangi-Garimella, PhD

Healthcare providers managing the needs of survivors of breast cancer may not always be aware of the nuances of clinical management that these patients need. With a 90% 5-year survival rate, breast cancer survivors make up nearly 40% of the overall women cancer survivors. To support primary care physicians as they guide patients through their wellness and quality of life (QoL) concerns, the American Cancer Society (ACS) and the American Society of Clinical Oncology (ASCO) released an updated ACS/ASCO Breast Cancer Survivorship Care Guideline, which, the committee writes in the Journal of Clinical Oncology (JCO), “will provide comprehensive, holistic recommendations specific to post-treatment breast cancer clinical care to help primary care clinicians better manage potential long-term and late effects and to provide timely and appropriate screening and surveillance to improve the overall health and QoL of breast cancer survivors.”

The workgroup included experts in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing, along with a cancer survivor who provided a patient perspective. Of more than a 1000 articles that were reviewed, 237 met the inclusion criteria. The final recommendations were then a compendium of literature-based evidence and expert consensus opinion.

The guideline makes recommendations that address the following:
1.      Surveillance for breast cancer recurrence
a.       History and physical
b.      Screening the breast for local recurrence or a new primary breast cancer
c.       Laboratory testing and imaging
d.      Signs of recurrence
e.       Risk evaluation and genetic counseling
f.       Endocrine treatment impacts, ymptom management
2.      Screening for second primary cancers
a.       Cancer screenings in the average-risk patient
3.      Assessment and management of physical and psychosocial long-term and late effects of breast cancer and treatment
a.       Body image concerns
b.      Lymphedema
c.       Cardiotoxicty
d.      Cognitive impairment
e.       Distress, depression, anxiety
f.       Fatigue
g.       Bone health
h.      Musculoskeletal health
i.        Pain and neuropathy
j.        Infertility
k.      Sexual health
l.        Premature menopause/hot flashes
4.      Health promotion
a.       Information
b.      Obesity
c.       Physical activity
d.      Nutrition
e.       Smoking cessation
5.      Care coordination/practice implications
a.       Survivorship care plan
b.      Communication with oncology team
c.       Inclusion of family
In addition to being published in the JCO, the guideline has also been published in CA: A Cancer Journal for Clinicians. Both ACS and ASCO have of course posted these guidelines on the organizations’ respective websites, and the ASCO Practice Implementation Network is ensuring wide distribution of the guideline. 
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