Systematic review of colorectal/anal cancer guidelines: managing long-term symptoms and functioning
PO-1079
Abstract
Systematic review of colorectal/anal cancer guidelines: managing long-term symptoms and functioning
Authors: Wiltink|, Lisette(1)*[l.m.wiltink@lumc.nl];White|, Kate(2);King|, Madeleine(3);Rutherford|, Claudia(1);
(1)University of Sydney, Quality of Life Office and Cancer Nursing Research Unit, Sydney, Australia;(2)University of Sydney, Cancer Nursing Research Unit, Sydney, Australia;(3)University of Sydney, Quality of Life Office, Sydney, Australia;
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Purpose or Objective
The number of colorectal and anal cancer survivors is increasing, leading to more patients with long-term symptoms after treatment. A systematic review was conducted to investigate the extent to which clinical practice guidelines for colorectal and anal cancer provide recommendations for managing long-term symptoms and functioning impairments.
Material and Methods
Four electronic databases were searched from database inception to July 2019 and websites of more than 30 international cancer societies. We included papers on clinical practice guideline, consensus statement or best practice recommendation for colorectal or anal cancer. The AGREE II tool was used to assess the quality of included guidelines. Information about recommendations for management strategies or interventions for long-term symptoms and functioning impairments were extracted and narratively synthesized.
Results
We found 51 guidelines or consensus statements; 20 through electronic searches and 31 from websites. Only 25.4% of guidelines included recommendations for managing long-term symptoms or functioning impairments. The guidelines that did include recommendations were published by the NCCN, ESMO, ASCO, Cancer Care Ontario, Alberta provincial GI tumor team, German Guideline program in oncology, and the NHMRC. All 13 guidelines recommend physical activity and a healthy lifestyle, diet and body weight. The ASCO Colorectal Cancer Survivorship Care Guideline is the most comprehensive, including recommendations for interventions ranging from cognitive and pain to bowel and sexual issues, but also acknowledges that evidence is limited to inform management strategies. Other guidelines include some suggestions for treating chronic diarrhea, incontinence and distress, and highlight need for greater awareness for sexual dysfunction and survivorship clinics and referrals to specific supportive care interventions.
Conclusion
Few clinical practice guidelines for colorectal or anal cancer provide recommendations for how to manage or treat long-term symptoms and functioning impairments. What is unclear is whether the lack of inclusion is due to limited evidence or lack of appropriate management strategies and interventions for these patient-centered outcomes. There is need for clear recommendations for managing long-term symptoms and functioning to assist health professionals in supporting colorectal and anal cancer survivors, and to ameliorate suffering due to persistent symptoms and functioning impairments that often go unmanaged.