Healthcare providers caring for colon cancer survivors need personalized survival plans for patients that monitor for cancer recurrence while also managing other long-term effects, according to a review published in It is necessary to formulate a clinical colorectal cancer.1
Although colon cancer remains one of the most commonly diagnosed cancers in the United States, the number of colon cancer survivors has increased over the past decade as a result of early detection and better treatment options. Many patients with stage III or high-risk stage II colon cancer also receive adjuvant chemotherapy to reduce the risk of cancer recurrence. A team of researchers at the University of Nebraska Medical Center conducted a study to assess survival rates in colon cancer patients and surveillance in patients receiving adjuvant chemotherapy.
If surgery is not included in the treatment plan, the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS) recommend colonoscopy within 1 to 2 years during the post-surgery or diagnostic surveillance timeline. We recommend performing a mirror examination. 1st year. In years 3 to 5, a colonoscopy should be performed in year 4. For more than 5 years, a colonoscopy should be performed every 5 years starting at the 9th year. The European Society of Medical Oncology guidelines recommend that patients undergo a colonoscopy every 3 to 5 years after the first colonoscopy in the first year. Clinical oncology experts recommend having a colonoscopy every five years after your first colonoscopy in your first year. However, they say this is determined by the results of a previous colonoscopy. All of these guidelines have some differences, but if adenomatous polyps are detected during surveillance, they recommend increasing the frequency of colonoscopies (usually within a year) .
“The optimal surveillance to improve survival through early detection and treatment of colon cancer recurrence remains unclear, as clinical trial data do not provide consistent answers,” the review authors wrote. . Heterogeneity in clinical trials impedes accurate assessment of the benefits of different surveillance strategies, resulting in slight differences in recommendations by different organizations.
Because more than 60% of colon cancer recurrences occur within the first 2 years and more than 91% within the first 5 years, surveillance should be conducted intensively during the first 2 to 3 years and after 5 years. It is recommended that surveillance be discontinued afterwards. Patients at high risk of recurrence should be tested more frequently, while those with significant comorbidities, limited life expectancy, or ineligibility for future systemic therapy or surgery should avoid surveillance. is needed.
Managing physical effects related to cancer or treatment
Peripheral neuropathy is a common side effect of certain chemotherapy treatments, such as oxaliplatin. Because oxaliplatin has dose-related toxicity, shortening the duration of oxaliplatin administration is effective in reducing the risk of neurotoxicity. However, the coasting phenomenon in which oxaliplatin-induced neuropathy worsens 2 to 3 months after discontinuation can persist for months or years. For patients with conditions such as diabetes, alcoholism, or inherited neuropathies, it is important to determine whether they are predisposed to an increased risk of developing peripheral neuropathy. Despite numerous studies evaluating treatment options for chemotherapy-induced peripheral neuropathy, strong evidence against standard treatment is lacking. The best available dates suggest that duloxetine should be used in the treatment of chemotherapy-induced peripheral neuropathy. However, if discontinued, the dose should be reduced slowly to avoid withdrawal symptoms associated with serotonin-norepinephrine reuptake inhibitors.
Some patients with colon cancer may need a stoma, which can cause physical and emotional stress and reduce the patient’s quality of life. Loss of bowel control associated with stoma creation can lead to anxiety, depression, sexual dysfunction, and social isolation in patients. Appropriate education, counseling, support, and resources from appropriate health care providers can help most survivors adjust successfully over time.
Patients may also experience gastrointestinal and urinary complications. Chemotherapy can disrupt the normal flora in the intestine, but gastrointestinal complications are more frequent in patients who have undergone radiation therapy, low anterior resection, or lower surgical anastomosis, such as rectal cancer. It often happens. Referral to a gastroenterologist may be helpful for patients with persistent or refractory symptoms. On the other hand, urinary complications such as incontinence and urinary retention may be treated with anticholinergic drugs, bladder exercises, and evaluation by a urologist.
Other adverse events seen in colon cancer survivors include sleep disturbances or insomnia, fatigue, sexual dysfunction, and reduced fertility. Cognitive behavioral therapy for insomnia is the preferred and recommended treatment, and pharmacological interventions should only be considered if non-pharmacological interventions remain ineffective. Treatment of fatigue must first include diagnostic tests to exclude organ function and endocrine abnormalities. Physical activity, psychosocial interventions, and other non-pharmacological interventions are often recommended. If that doesn’t work, psychostimulants may be considered. However, no significant benefit has been widely demonstrated in most studies. Historically, the number of colon cancer patients who were treated during their reproductive years or who had not yet given birth was relatively small. Although research in this population is limited, more patients are being treated during their reproductive years because new colorectal cancer is being diagnosed in younger people.
Managing psychological effects related to cancer or treatment
Anxiety, depression, and psychological distress are often increased in colon cancer survivors and usually increase even more during chemotherapy. The review authors noted that 67% of survivors surveyed reported fear of recurrence one year after diagnosis. Compared to the general population, cancer patients have a higher 12-month prevalence of all psychiatric disorders, including major depressive disorder and dysthymia. Screening tools such as the NCCN Distress Thermometer, Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire (PHQ)-2 and PHQ9, and Generalized Anxiety Disorder (GAD)-7 are all used to assess psychological distress in patients. available. “Interventions that address psychological issues are critical to improving the overall health and quality of life of colon cancer survivors,” the authors added.
Cancer patients often develop cognitive and memory problems. However, although there is significant data supporting the decline in cancer patients, there is no standard protocol for detecting or treating cognitive complications in this patient population. Imaging tests may be helpful for people with focal neurological deficits, but there is no proven cure for cognitive decline. “Methylphenidate, modafinil, [and] “While donepezil can be tried, there is a lack of high-quality evidence to support the use of these drugs in cancer survivors,” the authors write. Counseling, education, validation of the patient’s cognitive impairment, and coping strategies can all be beneficial and are encouraged.
Managing socio-economic impacts related to cancer or treatment
Other factors to consider are the management of non-health concerns, such as the management of social and economic impacts. The financial burden of high out-of-pocket costs associated with medications, doctor visits, and hospital treatment can all increase stress for cancer survivors. Furthermore, patients with treatment-related complications are often at higher risk of financial burden. Patients often avoid discussing financial burden with their doctors. Returning to work and being able to work after cancer treatment may be another burden for patients. Introducing financial health assessments into routine clinical evaluations has the potential to identify patients who need financial assistance early. Additionally, whenever applicable, providing treatment recommendations that address specific work-related considerations can also help patients obtain expectations regarding the duration and management of symptoms upon return to work. There is a possibility.
Finally, promoting overall health such as physical activity, nutrition, weight loss (if applicable), smoking cessation, and screening for second primary cancers can all help reduce comorbidities and possible future events for patients. There is a possibility.
“Survivor care plans should not only be clearly explained to patients, but also available to all physicians involved in long-term care, including primary care and specialty care,” the researchers noted.
“The key to optimal treatment lies in comprehensive coordination between oncologists, primary care providers, and specialists with clearly defined roles.”
“Further research is needed to improve survivorship guidelines and cancer treatment delivery,” the researchers concluded.