Systematic review of clinical practice guidelines for colorectal and anal cancer: the extent of recommendations for managing long-term symptoms and functional impairments

Abstract

Purpose Due to increasing numbers of colorectal and anal cancer survivors, more individuals are living with long-term symptoms after treatment. A systematic review was undertaken to assess the extent to which practice guidelines for colorectal and anal cancer provide recommendations for managing long-term symptoms and functioning impairments. Methods Four electronic databases and websites of 30 international cancer societies were searched for clinical practice guidelines, consensus statements, or best practice recommendations for colorectal or anal cancer. Quality of included guidelines was evaluated with the Appraisal of Guidelines for Research & Evaluation II tool. Results were narratively summarized. Results We included 51 guidelines or consensus statements. Recommendations for managing long-term symptoms or functioning impairments were reported in 13 guidelines (25.4%). All 13 recommend a healthy lifestyle, diet, body weight, and physical activity. The ASCO Colorectal Cancer Survivorship Care Guideline is the most comprehensive, including interventions targeting sexual and bowel function to pain and cognitive issues, and also highlights limited evidence for informing management strategies. Other guidelines recommend treating incontinence, chronic diarrhea, and distress, and stress the need for greater awareness for sexual dysfunction, survivorship clinics, and referrals to specific supportive care interventions. Conclusions Few clinical practice guidelines include recommendations for managing long-term symptoms and functioning impairments. It is unclear if this is due to limited evidence or absence of management strategies and interventions. Clear recommendations for managing long-term symptoms and functioning to help health professionals in supporting colorectal and anal cancer survivors are needed.

Health professionals’ perceptions of colorectal cancer patients’ treatment burden and their supportive work to ameliorate the burden – a qualitative study

“…The transition from acute treatment to cancer survivorship at home or in the community setting is often poorly managed, and cancer survivors report that they often feel unprepared for the post-treatment period [ 17 , 18 ]. CRC treatment guidelines do not provide recommendations for how to reduce and manage symptom burden and increase health-related quality of life [ 19 ]. Such recommendations could be useful to HPs in supporting CRC patients to live well and ameliorate the burden.…”

Is 18F-FDG PET/CT an Accurate Way to Detect Lymph Node Metastasis in Colorectal Cancer: A Systematic Review and Meta-Analysis

“…We evaluated the pretreatment function of 18 F-FDG PET/CT as a staging modality to detect metastatic LNs in CRC. A previous meta-analysis investigating the role of 18 F-FDG PET/CT in rectal cancer focused on detecting recurrent disease [ 39 ] or detecting metastasis in a population with early or recurrent cancer [ 4 , 40 ]. The present meta-analysis provided a comprehensive overview of the literature, highlighted the causes of heterogeneity, and explored the clinical application of 18 F-FDG PET/CT function in staging in this neoplasm in previous articles.…”

“…The five-year survival coefficient is >95% in patients with CRC without LN metastasis but is reduced to 50–70% in patients with LN metastasis [ 3 ]. In addition, the LN stage of CRC is one of the most important determinants for adjuvant chemotherapy and LN dissection [ 4 , 5 ]. Elective surgery for CRC patients with treatment stage N0 or N1 is total mesorectal excision, which is the excision of the mesorectal fat with all LNs.…”

“…Surgery and chemotherapy are two main ways to treat CRC. However, treatment outcomes for CRC have not been satisfactory due to high recurrence rate and metastasis, especially in patients with advanced CRC [3][4][5][6].…”

“…In addition, survival is directly related to the presence of residual metastatic LNs after primary surgery. Accurate diagnosis of LN metastasis at early stage may improve diagnosis and prompt the initiation of second-line treatment in patients with rectal cancer [4]. Conventional imaging techniques play an important role in the detection of malignant lymph node metastases [7,8].…”