OBJECTIVE: To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period.
METHODS: Consistent with the Program in Evidence-Based Medicine's standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers.
RESULTS: Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations.
CONCLUSIONS: Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited evidence to support a shared care model for follow-up, this approach is deemed to be best suited to meet patient needs; however, the roles and responsibilities of care providers need to be clearly defined, and patients need to know when and how to contact them. Although there is insufficient evidence to recommend any individual or combination of signs or symptoms as strong predictor(s) of recurrence, patients should be educated about these and know which care provider to contact if they develop any new or concerning symptoms. Psychosocial support and empathetic, effective, and coordinated communication are most valued by patients for their post-treatment follow-up care. Continuing professional education should emphasize the importance of communication skills and coordination of communication between the patient, family, and healthcare providers.
OBJECTIVE: Colorectal cancer (CRC) survivors have reported a number of concerns and unmet needs after treatment completion. This paper aims to explore existing survivorship interventions after CRC treatment according to the American Cancer Society CRC Survivorship Care Guidelines, to identify study gaps, and provide valuable evidence directing future research.
METHODS: Five electronic databases, including CINAHL, PsycINFO, Embase, PubMed, and Cochrane Library databases from 2005 to October 2020, were systematically searched to identify English or Chinese literature on CRC post-treatment survivorship interventions. Manual searching through the articles' references lists was also conducted.
RESULTS: Thirty studies met the criteria, and focused on addressing issues in four CRC Survivorship Care Guidelines domains. Several issues for CRC surveillance programmes remain to be explored. Regarding the long-term physical and psychosocial effects of CRC treatment, we found mounting evidence for various interventions to solve ostomy issues and improve distress/depression/anxiety, strong evidence for exercise to improve fatigue, and limited evidence in addressing CRC patient sexual concerns. For health promotion, high-quality evidence was found for exercises to improve cardiopulmonary fitness, metabolism, tumour-related biomarkers, and short-term improvement in physical fitness and QOL. Emerging evidence was found for a survivorship care plan to improve patient perceptions of care coordination.
CONCLUSIONS: Further refinements based on the existing evidence, and the development of comprehensive CRC survivorship care comprising multiple essential survivorship components, are required. Furthermore, considering both survivor and caregiver cancer survivorship needs, future research may optimise the care delivered, and help survivors and their families live better with cancer.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
En el presente estudio, hemos sintetizado la literatura publicada sobre los aspectos psicosociales de la supervivencia del cáncer colorrectal (crc) para apoyar una actualización de la base probatoria de los planes de supervivencia creados en nuestra jurisdicción. MÉTODOS: Se utilizaron como criterios de búsqueda los temas psicosociales identificados en los crc scps creados por dos iniciativas diferentes en nuestra provincia: calidad de vida (qol), función sexual, fatiga y comportamientos de estilo de vida. Se realizó una revisión general para obtener la mejor evidencia posible. Sólo se incluyeron las revisiones que investigaron los resultados esperados en sobrevivientes crc y aquellos con puntuaciones de calidad metodológica de moderada a alta. RESULTADOS: De 462 informes recuperados, ocho revisiones cumplieron con los criterios de inclusión para la síntesis. De los ocho, seis investigaron los desafíos de los sobrevivientes de crc y dos investigaron el efecto de la actividad física sobre el bienestar de los sobrevivientes. Nuestros resultados indican que los desafíos emocionales y físicos son comunes en los supervivientes de crc y que la actividad física está asociada con beneficios clínicamente importantes para la fatiga y el funcionamiento físico de los supervivientes de CRC. CONCLUSIONES: Los hallazgos de nuestro estudio actualizan la evidencia e indican que las exploraciones existentes en nuestra provincia en relación con los desafíos físicos y emocionales de los supervivientes de crc reflejan la evidencia en el momento de su emisión. Sin embargo, la literatura sobre los riesgos de cáncer específicos de CRC supervivientes es deficiente. Aunque las revisiones sistemáticas se consideran el "estándar de oro" en la síntesis del conocimiento, nuestros hallazgos sugieren que queda mucho por hacer en el área de la investigación de síntesis para guiar mejor la práctica en la supervivencia del cáncer.
To provide recommendations for preferred models of follow-up care for stage I-IV colorectal (CRC) cancer survivors in Ontario; to identify signs and symptoms of potential recurrence and when to investigate; and to evaluate patient information and support needs during the post-treatment survivorship period.
METHODS:
Consistent with the Program in Evidence-Based Medicine's standardized approach, MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO databases were systematically searched. The authors drafted recommendations and revised them based on the comments from internal and external reviewers.
RESULTS:
Four guidelines, three systematic reviews, three randomized controlled trials, and three cohort studies provided evidence to develop recommendations.
CONCLUSIONS:
Colorectal cancer follow-up care is complex and requires multidisciplinary, coordinated care delivered by the cancer specialist, primary care provider, and allied health professionals. While there is limited evidence to support a shared care model for follow-up, this approach is deemed to be best suited to meet patient needs; however, the roles and responsibilities of care providers need to be clearly defined, and patients need to know when and how to contact them. Although there is insufficient evidence to recommend any individual or combination of signs or symptoms as strong predictor(s) of recurrence, patients should be educated about these and know which care provider to contact if they develop any new or concerning symptoms. Psychosocial support and empathetic, effective, and coordinated communication are most valued by patients for their post-treatment follow-up care. Continuing professional education should emphasize the importance of communication skills and coordination of communication between the patient, family, and healthcare providers.
