This week the American Society of Clinical Oncology (ASCO) issued three evidence-based guidelines for cancer survivorship. You can read them here. ASCO offers oncologists and others in the healthcare community recommendations on a vast array of issues. With these three added, there are now four guidelines concerning survivorship. The three areas they address in the new guidelines are neuropathy, fatigue and depression, and anxiety. Not that I want to sound ungrateful, but it’s about time.
First, in regard to peripheral neuropathy. In the summer issue of CURE you will read my article on peripheral neuropathy and how sufferers are faced with a very debilitating long-term and late effect for which there is little effective treatment. In fact, the press release about the guidelines issued by ASCO says they “provide evidence-based recommendations for prevention and treatment of chemotherapy-based peripheral neuropathy.”
Then, in the guidelines themselves, they say that due to “lack of high-quality, consistent evidence, no established agents are recommended for the prevention of CIPN in people with cancer undergoing treatment with neurotoxic agents.” This means that they don’t have any ways to stop CPIN from occurring – yet. There are some new ideas in the works but nothing has been approved.
For treatment, the guidelines say clinicians can offer Cymbalta (duloxetine), and then gives a list of other options that have shown some efficacy.
Ultimately, there is nothing new here. But what is new is that it is here. Getting ASCO to post guidelines, even if they don’t give us anything helpful is a start in recognizing that survivors have a number of issues that impact our lives significantly, or as one professional says, we don’t have cancer anymore but cancer has us.
In regard to fatigue, the second guideline they add, the recommendation is that survivors be screened for fatigue from point of diagnosis onward.
In addition, the guideline says that “given the multiple factors contributing to post-treatment fatigue, interventions should be tailored to each patient’s specific needs. In particular, a number of nonpharmacologic treatment approaches have demonstrated efficacy in cancer survivors.”
Read “exercise” there. The hopeful part of this guideline is that it will lead our cancer professionals to recognize that they need to know where to refer us to get help with fatigue. I am a major proponent of rehabilitation services for many of these needs as the rehab folks understand not only the physical but also the emotional changes that may need rehab.