Introduction
Definition of colorectal cancer survivor and stratification
Recommendations for follow-up of colorectal cancer survivors
Colonoscopy
Clinical guidelines | Cancer | Type/stage | 1st follow-up | 2nd follow-up | Successive |
---|---|---|---|---|---|
US Multi-Society Task Force, 2016 [8] | CRC | I–III | 1 year | 3 years | 5 years |
ESMO, 2013 [9] | Colon | Early | 1 year | 3–5 years | |
ESMO, 2010 [10] | Colon | Primary | 1 year | 3–5 years | |
ESMO, 2017 [11] | Rectal | I–III | 1 year | 3–5 years | |
ASCO, 2013 [6] | CRC | I–III | 1 year | 5 years | |
ACS, 2015 [5] | CRC | I–III | 1 | 3 years | 5 years |
NCCN, 2018 [12] 12 | Colon | I–III | 1 | 3 years | 5 years |
NCCN, 2018 [13] 13 | Rectal | I–III | 1 | 3 years | 5 years |
Laboratory tests, imaging, and clinical follow-up
Clinical guidelines | Clinic visit and CEA | Abdomen and pelvis examination | Chest examination |
---|---|---|---|
ASCO, 2013 [6] | Every 3–6 months/5 years | Yearly for 3 years (pelvic in rectal cancer) If high risk, every 6–12 months | Yearly for 5 years |
NCCN, 2018 [12] | Every 3–6 months/2 years Every 6 months up to 5 years | Every 6–12 months/5 years (category 2B < 12 months) | Every 6–12 months/5 years |
ASCRS, 2015 [17] | Every 3–6 months/2 years Every 6 months up to 5 years | Yearly for 5 years | Yearly for 5 years |
ESMO, 2013 [9] | Every 3–6 months/3 years Every 6 months up to 5 years | Every 6–12 months/3 years (pelvis in rectal) | Every 6–12 months/3 years |
Every 3 months/3 years Every 6 months up to 5 years | Every 6 months/3 years If high risk, yearly (pelvis in rectal) | Every 6 months/3 years |
Clinical follow-up and CEA
Radiological follow-up
Sequelae due to previous colorectal cancer treatment
Intestinal, anal and rectal problems | Diarrhoea, bleeding, mucus discharge in faeces, rectal tenesmus, incontinence |
Derived from radiotherapy | Proctitis, bleeding, tenesmus, rectal/anal stenosis, osteoporosis, bone and pelvic fractures, prostate, cervical or vaginal neoplasia |
Urinary dysfunction | Infections, incontinence |
Sexual dysfunction | Men: impotence, erectile dysfunction Women: dyspareunia, dryness of the vaginal mucosa |
Medical sequelae
Surgical sequelae
Intestinal and anorectal problems
Complications due to radiotherapy
Urinary dysfunction
Sexual dysfunction
Lifestyle modifications and recommendations for primary and secondary prevention of recurrences in colorectal cancer survivors
Lifestyle modification and primary and secondary prevention
Recommendations on diet Maintaining a diet rich in vegetables, fruits, and whole grains Reduce the frequent consumption of red meat and processed meat Limit sugar consumption and avoid sugary drinks |
Recommendations on physical activity Engage in regular physical exercise, with at least 150 min per week of moderate aerobic activity Limit the time spent sitting For patients who choose walking as exercise, a rate of 100 steps per minute is consistent with moderate activity, so that a useful guideline would be 1000 steps in 10 min or 3000 in 30 min A patient who wants to lose weight should increase the usual physical activity to about 250–300 min per week A patient who has a disability should discuss options with a counsellor |
Recommendations on tobacco and alcohol consumption Quit smoking Limit alcohol consumption, although it is best to avoid alcoholic beverages |
Recommendations on secondary cancer prevention Persons who have had colorectal cancer and have had 5 years of disease–free survival are recommended to participate in colorectal cancer screening programmes Women are recommended to participate in population-based breast and cervical cancer screening programmes |
Functional assessment in elderly colon cancer survivors
Coordination between levels of care for optimal colorectal cancer survivor follow-up
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A description of the onset of the disease
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The diagnostic tests carried out
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Perioperative and surgical treatments
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Radiotherapy and chemotherapy treatments, if administered
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Presence or absence of metastases
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Results of genetic testing, if carried out
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Guidelines for the prevention of possible adverse effects of the treatment(s)
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Information on whether or not the patient is included in a clinical trial
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Estimate of the approximate duration of any temporary disability
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Date of the next visit
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Information on the risks of long-term sequelae
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Course of the disease
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Plans for follow-up diagnostic tests
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Ostomy care, if applicable
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Recommendations for a healthy lifestyle
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Assessment of psychosocial and family support
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Recommendations for resuming social life and work
Conclusions
The recommendations from this consensus should be individually modified according to the type of treatment received and the risk of recurrence. To this end, it is convenient to stratify colorectal cancer survivors into groups: |
Stage I colon cancer |
Stage I rectal cancer |
Stages II and III colon cancer |
Stages II and III rectal cancer |
Colonoscopy monitoring of colorectal cancer survivors requires obtaining an initial high-quality endoscopy in the perioperative setting. Thereafter, the follow-up can be done at one year after the initial colonoscopy, and then subsequently every 5 years as long as there are no individual indications for testing before that |
Intestinal and anorectal sequelae (diarrhoea, incontinence, etc...), as well as those derived from radiotherapy, can be managed through medication, with surgical options as an alternative if medication treatment fails. Similar recommendations can be established for urological or sexual sequelae, although these will require more precise evaluation by a specialist |
Healthcare professionals who care for colorectal cancer survivors should encourage those patients to eat a healthy diet, maintain weight (or reduce weight in the case of obese patients), reduce sedentary habits, and increase their physical activity. Opportunities should be taken to review and reinforce the participation by these patients in screening programmes that are currently underway |
It is necessary to carry out a global assessment of the patient in all areas to be able to propose an adequate programme of therapeutic management |
Coordination between different levels of care (primary care and hospital care) is essential to guarantee rapid access to diagnostic/therapeutic care in response to any sign of suspected recurrence, a second tumour, or the appearance of sequelae due to the treatment given for the original tumour |
To enable the monitoring of surviving colorectal cancer patients starting from the primary care level, it is necessary to have clinical reports that, in addition to data on the patient's disease, include indications for the adverse effects of long-term treatments, indications for follow-up diagnostic tests, and recommendations for monitoring sequelae |