ACS Releases Long-term Care Guidelines for Colon and Rectal Cancer Survivors

The American Cancer Society has released its first ever Colorectal Cancer Survivorship Care Guidelines to help colon and rectal cancer survivors and their primary care providers better manage their long-term care. The guidelines were published September 8, 2015 in CA: A Cancer Journal for Clinicians. They provide detailed recommendations for managing side effects, testing to see if the cancer has come back, making healthy lifestyle changes, and coordinating care among primary care providers and specialists.

The guidelines are the second in a series of cancer survivorship guidelines developed by the American Cancer Society. The first, published last year, made recommendations for survivors of prostate cancer. The Society is developing survivorship care guidelines for other cancer types as well, based on the number of survivors and the severity of health problems survivors face.

More than 1 million people in the United States are survivors of colon or rectal cancer. The rate of new colorectal cancer cases has been dropping for more than 2 decades thanks in large part to increased screening, which can detect and remove some polyps before they become cancer. However, this is still the second most common cancer type among men who are cancer survivors and the third most common cancer type among women who are cancer survivors.

“Considering the potential significant impacts of cancer and its treatment on colorectal cancer survivor health and quality of life, it is imperative that clinicians have credible guidance to help ensure that cancer survivors receive high-quality, comprehensive, coordinated clinical follow-up care,” said Catherine Alfano, PhD, principal investigator and project director for the National Cancer Survivorship Resource Center, and vice president, Survivorship, in the Office of Cancer Control at the American Cancer Society, in a statement. “While there are still important gaps in research, enough evidence exists to provide these consensus-based guidelines to improve post-treatment care, which we expect to help cancer survivors mitigate the known impacts of colorectal cancer and its treatment.”

Testing for cancer

The most common treatment for colorectal cancer is surgery, which is sometimes followed by chemotherapy and/or radiation. After treatment, the new guidelines recommend that survivors get regular physical exams and follow-up tests to report any new symptoms, coordinate after-treatment care, and check whether their cancer has come back.

In most cases, colonoscopy is recommended 1 year after surgery. If no abnormalities are found, a repeat colonoscopy is recommended 3 years later, and then every 5 years after that. Depending on the stage of the cancer at diagnosis, other tests including CT scans may be recommended.

Survivors should also follow testing guidelines to check for other cancers. Unless there is a family history or known genetic syndrome, colorectal cancer survivors are at average risk for other cancers and should follow the same testing schedule for their age and gender as the general population.

Managing side effects

Surgery, radiation, and chemotherapy for colorectal cancer can cause bowel and gastrointestinal issues including diarrhea and rectal bleeding. Chemotherapy may also cause side effects that include memory and thinking problems, mouth and dental problems, fatigue, nerve damage (peripheral neuropathy), pain, sexual or fertility problems (in men or women), and urinary or bladder problems. It’s important to discuss these side effects with a medical provider so they can be evaluated and when possible, treated.

Some of these problems are more common in survivors who are living with an ostomy, an opening in the abdomen made during surgery that allows waste to leave the body. A trained ostomy therapist can address many of these problems, as well as the challenges of routine ostomy care that include skin irritation, equipment problems, and dietary considerations.

It is not unusual for people who’ve had cancer to experience anxiety or depression. Feelings of sadness or distress should be discussed with a doctor, who can evaluate whether they are signs of clinical depression. Clinical depression can lower quality of life, and also make people less able to take care of their own health. There are many ways to treat clinical depression, including medicine, counseling, or a combination of both.

Encouraging healthy behaviors

The new colorectal cancer survivorship guidelines recommend that primary care doctors talk to colorectal cancer survivors about their lifestyle habits and give them advice on how to make changes, if needed. Increasingly, studies show that having a healthy lifestyle after a colorectal cancer diagnosis can lower the chances of the cancer coming back and of developing a new cancer. Healthy behaviors include:

  • Getting to and staying at a healthy weight by limiting high-calorie foods and beverages, and getting more physical activity.
  • Regardless of current weight, getting at least 150 minutes of physical activity every week, with a doctor’s approval. This should include strength training at least two days a week.
  • Eating a diet rich in vegetables, fruits, and whole grains, and low in saturated fats, with adequate calcium and vitamin D. Survivors who face challenges to good nutrition should talk to their doctor or ask for a referral to a registered dietician.
  • Eating less red meat (beef, pork, or lamb), less processed meats (hot dogs and some luncheon meats), less refined grains (including white bread, rice, and pasta), and fewer sweets.
  • Limiting alcohol consumption to no more than 1 drink per day for women and 2 drinks per day for men.
  • Avoiding tobacco.

Coordinating medical care

When cancer treatment ends, patients should ask their oncologist for a written follow-up care plan that they can share with their primary care doctor and other doctors. It should include an explanation of which provider – oncologist, primary care doctor, or other specialist – should be in charge of cancer-related and other medical care.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Cancer Society Colorectal Cancer Survivorship Care Guidelines. Published September 8, 2015 in CA: A Cancer Journal for Clinicians. First author: Khaled El-Shami, MD, PhD, The George Washington University, Washington, DC.


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