Being discharged from oncology care after treatment for breast cancer face concerns about the future. New guidelines look to provide a clearer picture for the years after original treatments.
Breast cancer is the most common cancer among American woman, and more than 90% are considered cured after treatment. That is, they live cancer-free for 5 years. This makes survivorship a key issue. Often, patients are discharged from oncology care and return to their primary care providers. Many studies have identified these care transfers as difficult, sometimes confusing, and often anxiety-provoking for patients (and sometimes, for clinicians).
In December 2015, the American Cancer Society/American Society of Clinical Oncology published a unique document—the Breast Cancer Survivorship Care Guideline—to help healthcare clinicians identify the best choices with female breast cancer patients in recovery.
The guideline, published in the journals Cancer and the Journal of Clinical Oncology, describes the systematic literature review used by a multidisciplinary expert workgroup to create the recommendations. They reviewed 1073 articles published as recently as April 2015, and included 237 as the evidence base.
The expert workgroup makes recommendations in 5 areas:
· Surveillance for breast cancer recurrence
· Screening for second primary cancers
· Assessment and management of physical and psychosocial long-term and late effects of breast cancer and treatment
· Health promotion, and
· Care coordination and practice implications.
The guideline contains a concise table that describes the elements of each.
The recommendations for routine surveillance for recurrence are specific. They recommend a cancer-related history and physical examination every 3 to 6 months for 3 years after primary therapy, every 6-12 months for the next 2 years, and annually thereafter. Of specific note, the guideline indicates that asymptomatic patients have no need for routine laboratory tests or imaging to evaluate for breast cancer recurrence.
The 12 recommendations on long-term and late side effects of breast cancer treatment are extensive. They cover every affected system including heart, bone, and mental health concerns. Most indicate when referral to a specialist is important.
Because treatment for cancer puts patients at risk for recurrence or secondary cancers, counseling promoting healthy lifestyles is critical. Adherence to endocrine therapy can prevent recurrence, and needs to be addressed routinely.
Surgeons should be aware of this guideline, and refer primary care providers to it as they transfer patients from their care back to mainstream medicine.