ASCO publishes guidelines on survivorship -- finally?

This week the American Society of Clinical Oncology (ASCO) issued three evidence-based guidelines for cancer survivorship. You can read them here. ASCO offers oncologists and others in the healthcare community recommendations on a vast array of issues. With these three added, there are now four guidelines concerning survivorship. The three areas they address in the new guidelines are neuropathy, fatigue and depression, and anxiety. Not that I want to sound ungrateful, but it's about time. First, in regard to peripheral neuropathy. In the summer issue of CURE you will read my article on peripheral neuropathy and how sufferers are faced with a very debilitating long-term and late effect for which there is little effective treatment. In fact, the press release about the guidelines issued by ASCO says they "provide evidence-based recommendations for prevention and treatment of chemotherapy-based peripheral neuropathy." Then, in the guidelines themselves, they say that due to "lack of high-quality, consistent evidence, no established agents are recommended for the prevention of CIPN in people with cancer undergoing treatment with neurotoxic agents." This means that they don't have any ways to stop CPIN from occurring – yet. There are some new ideas in the works but nothing has been approved. For treatment, the guidelines say clinicians can offer Cymbalta (duloxetine), and then gives a list of other options that have shown some efficacy. Ultimately, there is nothing new here. But what is new is that it is here. Getting ASCO to post guidelines, even if they don't give us anything helpful is a start in recognizing that survivors have a number of issues that impact our lives significantly, or as one professional says, we don't have cancer anymore but cancer has us. In regard to fatigue, the second guideline they add, the recommendation is that survivors be screened for fatigue from point of diagnosis onward. In addition, the guideline says that "given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient's specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors."Read "exercise" there. The hopeful part of this guideline is that it will lead our cancer professionals to recognize that they need to know where to refer us to get help with fatigue. I am a major proponent of rehabilitation services for many of these needs as the rehab folks understand not only the physical but also the emotional changes that may need rehab. For the third and final new guideline, Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults With Cancer, the ASCO pros adapted a Pan-Canadian Practice Guideline. In general the guideline says cancer patients "be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care." Do we see a pattern here?This evaluation should use good measures and different approaches depending on the levels of symptoms. It concludes with an overview of what happens when there is failure to identify and treat anxiety and depression. We feel rotten and have a much-reduced quality of life. The options for care given with these guidelines are really thin, and my recommendation is that they use the Oncology Nursing Society Putting Evidence into Practice which seems to be ahead of ASCO in recommending interventions for each one of these. Once again, the nurses beat the docs to the punch. Overall these guidelines are a disappointment. They don't give us anything new and the disclaimer that runs with each one is double the length of the guideline. Come on ASCO, you can do better than this. We now have four, count them, four survivorship guidelines. The first one posted by ASCO in 2013 had to do with fertility and said oncologists should talk with patients of childbearing age about the impact of treatment and their options for preserving fertility.A study late in the year says oncologists are not doing a great job of that. Cancer survivors are growing in numbers and we would like to think that someone is paying attention to our quality of life and not just patting themselves on the back for keeping us alive. Fatigue, depression, anxiety, neuropathy and many other issues may follow us after treatment ends. It's time we put some energy into researching them and coming up with some real answers.