Guidelines for care for survivors of cancer are often unclear

An unidentified patient gets a mammogram.


Guidelines for the treatment and care for survivors of the most common forms of cancer often lack specific information or offer conflicting advice about when or how often you use certain testing, a review of the recent recommendations of the findings.

Researchers examined cancer guidelines from North America and Europe that have been published since 2010 to advise doctors about the best ways to care for survivors of nine malignancies: breast, colorectal, lung, prostate, melanoma, uterus, bladder, thyroid and testicle.

They find ambiguous recommendations in 83 percent of the guidelines.

In particular, different guidelines for the same form of cancer, often not all the same monitoring tests, and some tests are universally recommended, noted lead study author Dr. Ryan Merkow of the Memorial Sloan Kettering Cancer Center in New York. When guidelines did endorse tests, they rarely specified how long the patients should be tested.

“Often our instincts as providers are order more tests – it gives us the feeling that we care for the patient, and it makes the patient feel that they are taken care of,” Merkow said by e-mail.

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“In some cases, this is absolutely the correct approach, in others, can lead to additional and unnecessary procedures and patient anxiety,” Merkow added. “We have a approach supervision in a deliberate and thoughtful manner, as the risk of over-and under-treatment is real.”

Worldwide, an estimated 33 million people are cancer survivors, and their ranks are expected to grow as a result of the rising cases of cancer in an aging population as well as improved survival chances, with the advancement in the diagnosis and treatment, researchers note in JAMA Internal Medicine.

For the current study, Merkow, the team focused on what is known as surveillance, or the efforts to detect the return of cancer or the development of tumors in other parts of the body. This may include invasive tests such as biopsies that come with their own risks and side effects as well as expensive imaging such as positron emission tomographic (PET) scan.

They assessed 41 guidelines for post treatment surveillance, with three to six recommendations aimed at each of the nine types of cancer examined.

Overall, 37 of these guidelines, or 90 percent, recommended physical exams and medical history. Most of them focus on a certain form of imaging (83 percent), while 63 percent under the so-called endoscopic procedures pertaining to doctors with the help of a flexible tube with a camera to examine the inside of the gastrointestinal tract.

In 23 of the guidelines, or 56 percent, recommendations touched on lab tests to look for biomarkers of certain types of tumors, which are typically found in the blood, urine, or tissue.

Guidelines for the use of PET scans provide a snapshot of the mixed messages in surveillance recommendations. Only one of the guidelines in the study recommended that patients get this scan, and it was for bladder cancer.

Other guidelines, or didn ” t address of PET scans or advised against them, which was the case for 67 percent of uterine cancer recommendations and 60 percent of lung cancer recommendations.

The most ambiguous recommendations for PET-scan were used for tumors of the bladder, prostate and breast cancer.

European guidelines are more likely than the North American guidelines contain ambiguous recommendations, the study also found.

Limitations of the research the focus on national recommendations, which have been excluded on a large scale followed provincial guidelines in Canada, the authors note. The study also didn’t are published recommendations by the end of February 2016.

Even so, the results highlight the work that still needs to be done to better standardize care for patients who have undergone the treatment of cancer, said Dr. Alexander Kutikov, a researcher at Fox Chase Cancer Center in Philadelphia who is not involved in the study.

“Clinical utility versus patient expectations versus costs must be carefully balanced,” Kutikov said by e-mail. “Now our approach to after the treatment of cancer surveillance is somewhat arbitrary.”

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