Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner.

To examine the most common long-term and late effects of breast cancer treatment, the American Society of Clinical Oncology guidelines for surveillance, and recommendations for the primary care provider's role in delivering breast cancer survivorship care. A comprehensive literature review was conducted using CINAHL, PubMed, Google Scholar, and hand searches using the search terms breast cancer, survivor, and long-term or late effects. Articles published in English from 2002 to 2012 that addressed the long-term or late effects of adults with breast cancer were included. Findings are discussed categorically, including the most common late and long-term psychosocial effects from relevant studies. Topics relevant to survivors included challenges to psychosocial, emotional, and cognitive well-being; satisfaction with life; sexuality; body image; anxiety; fear of recurrence and post-traumatic stress disorder; depression; cognitive dysfunction challenges to physical well-being; adverse cardiovascular events; fatigue; lymphedema; musculoskeletal symptoms; accelerated bone loss and fractures; pain; skin changes due to radiation; disease recurrence; and new breast cancers. With earlier detection methods and improvements in treatment options making breast cancer a highly survivable disease, there are more survivors of breast cancer than ever. The clinicians' role in survivorship care is more important than ever to manage the potential long-term and late effects of treatment, physical and emotional well-being, and recurrent disease surveillance. However, the clinician's role in cancer follow-up care is often poorly defined leading to a lack of awareness about the needs of survivors of breast cancer, suboptimal communication between providers and survivors, and an overall deficiency in quality care.

Kenyon M ，Mayer DK ，Owens AK 《-》

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1,073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on 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 its treatment, health promotion, and care coordination/practice implications are made.This guideline was developed through a collaboration between the American Cancer Society and the American Society of Clinical Oncology and has been published jointly by invitation and consent in both CA: A Cancer Journal for Clinicians and Journal of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology.

Runowicz CD ，Leach CR ，Henry NL ，Henry KS ，Mackey HT ，Cowens-Alvarado RL ，Cannady RS ，Pratt-Chapman ML ，Edge SB ，Jacobs LA ，Hurria A ，Marks LB ，LaMonte SJ ，Warner E ，Lyman GH ，Ganz PA ... -  《-》

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on 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 its treatment, health promotion, and care coordination/practice implications are made.

Runowicz CD ，Leach CR ，Henry NL ，Henry KS ，Mackey HT ，Cowens-Alvarado RL ，Cannady RS ，Pratt-Chapman ML ，Edge SB ，Jacobs LA ，Hurria A ，Marks LB ，LaMonte SJ ，Warner E ，Lyman GH ，Ganz PA ... -  《-》

A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting.

Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care. The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings. This study consisted of an extensive search, appraisal and synthesis of CPGs for post-treatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care. The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care. This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.

Luctkar-Flude M ，Aiken A ，McColl MA ，Tranmer J ... -  《-》

Advancing survivorship care through the National Cancer Survivorship Resource Center: developing American Cancer Society guidelines for primary care providers.

The National Cancer Survivorship Resource Center (The Survivorship Center) began in 2010 as a collaboration between the American Cancer Society and the George Washington University Cancer Institute and was funded by the Centers for Disease Control and Prevention. The Survivorship Center aims to improve the overall health and quality of life of posttreatment cancer survivors. One key to addressing the needs of this ever-growing population is to develop clinical follow-up care guidelines that emphasize not only the importance of surveillance for cancer recurrence, but also address the assessment and management of the physical and psychosocial long-term and late effects that may result from having cancer and undergoing cancer treatment as well as highlight the importance of healthy behaviors that can reduce the risk of cancer recurrence, second primary cancers, and other chronic diseases. Currently, The Survivorship Center is coordinating the work of experts in oncology, primary care, and other health care professions to develop follow-up care guidelines for 10 priority cancer sites.

Cowens-Alvarado R ，Sharpe K ，Pratt-Chapman M ，Willis A ，Gansler T ，Ganz PA ，Edge SB ，McCabe MS ，Stein K ... -  《-》