Management of treatment‐related sequelae following colorectal cancer

Abstract

Aim Colorectal cancer survivors are one of the most rapidly growing groups of patients living with and beyond cancer. In a national multidisciplinary setting, we have examined the extent of late treatment‐related sequelae in colorectal cancer survivors and present the scientific evidence for management of these conditions in this patient category with the aim of facilitating identification and treatment. Method A systematic search for existing guidelines and relevant studies was performed across 16 and 4 databases, respectively, from inception to 2021. This yielded 13 guidelines and 886 abstracts, of which 188 were included in the finalized guideline (231 included for full text review). Secondarily, bibliographies were cross‐referenced and 53 additional articles were included. Results Symptoms have been divided into overall categories including psychosocial, bowel‐related, urinary, sexual (male and female), pain/neuropathy and fatigue symptoms or complaints that are examined individually. Merging and grading of data resulted in 22 recommendations and 42 management strategies across categories. Recommendations are of a more general character, whereas management strategies provide more practical advice suited for initiation on site before referral to specialized units. Conclusion Treatment‐related sequelae in colorectal cancer survivors are common and attention needs to be focused on identifying patients with unmet treatment needs and the development of evidence‐based treatment algorithms.

Practical management algorithms for late complications after colorectal and anal cancer—Basic treatment of late complications

“…This information will be available in the coming years. Because there is currently little evidence in this field and since the health care providers do not agree on what late complication treatment should cover [15, 32, 43], we did not find it possible to do a formal consensus agreement about basic treatment. However, in the future, when there will be more evidence about the basic treatment of late complications, we would recommend that formal clinical guideline development for basic treatment such as international Delphi rounds should be performed [44].…”

“…We conducted a literature search to identify basic treatment guidelines for late complications [5]. Furthermore, we participated in the development of two recent available treatment guidelines, which were made with a thorough literature search [15,32]. They covered specialized treatment and not the initial and basic treatment for late complications because such literature did not exist.…”

“…The specialist can examine and treat for other causes of incomplete emptying, such as mucosal prolapse, rectocele, or ulceration after radiation therapy. Moreover, loose stool could be caused by other medical conditions, such as colitis, bile acid malabsorption, or small bowel bacterial overgrowth [32]. Patients can also use pelvic floor muscle exercises with or without biofeedback and trans-anal irrigation.…”

The impact of intestinal stoma formation on patient quality of life after emergency surgery—A systematic review

“…It has previously been demonstrated that increased levels of self‐care and stoma self‐management can help to improve HR‐QoL and QoL in the elective stoma cohort, particularly in those diagnosed with colorectal cancer [8, 58, 59]. The role of the stoma nurse specialist should not be underestimated for these patients in order to increase stoma self‐efficacy.…”

“…In this systematic review, only three papers used PROMs that were stomaspecific, with the rest of the PROMs being based on general QoL or HR-QoL. Therefore, stoma-specific outcomes for patients who undergo emergency stoma surgery are somewhat lacking and could be a focus for further research.It has previously been demonstrated that increased levels of selfcare and stoma self-management can help to improve HR-QoL and QoL in the elective stoma cohort, particularly in those diagnosed with colorectal cancer[8,58,59]. The role of the stoma nurse specialist should not be underestimated for these patients in order to increase stoma self-efficacy.…”