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Cancer Epidemiology, Biomarkers & Prevention
Cancer Epidemiology, Biomarkers & Prevention
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CEBP Focus: Cancer Survivorship Research

Impact of Survivorship-Based Research on Defining Clinical Care Guidelines

Melissa M. Hudson, Wendy Landier and Patricia A. Ganz
Melissa M. Hudson
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Wendy Landier
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Patricia A. Ganz
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DOI: 10.1158/1055-9965.EPI-11-0642 Published October 2011
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    Pediatric cooperative groupa strategies for development, implementation, dissemination, and maintenance of health screening guidelines for childhood cancer survivors

    Establish aims and goals of guidelines▪ Provide guidance to clinicians caring for survivors.
    ▪ Standardize and enhance follow-up care of survivors.
    ▪ Facilitate early identification of late treatment effects.
    ▪ Promote timely intervention for late treatment effects.
    ▪ Educate survivors and families about health risks.
    ▪ Promote healthy lifestyle of survivors.
    Define target population for screening▪ By age at diagnosis (childhood, adolescent, young adult, and adult).
    ▪ By time from completion of therapy (≥2 years, ≥5 years, etc…).
    ▪ By disease status (maintained remission, stable disease, etc…).
    Consider intended users of guidelines▪ Hematology/oncology providers (pediatric/medical, surgical, radiation, nursing, etc…).
    ▪ Primary care providers (pediatricians, family physicians, internist, and gynecologists).
    ▪ Subspecialty providers (pediatric/medical, endocrine, cardiology, etc…).
    ▪ Cancer survivors and families.
    Identify expertise required to develop the guidelines▪ Hematology/oncology (pediatric/medical, surgery, radiation, nursing, and transplant).
    ▪ Primary care (pediatrics, family medicine, internal medicine, and gynecology).
    ▪ Subspecialty (pediatric/medical, endocrine, cardiology, etc…).
    ▪ Behavioral (psychology, social work).
    ▪ Supportive care (physical/occupational therapy, etc…).
    ▪ Patient/survivorship advocacy.
    ▪ Analytical (epidemiology, biostatistics, and public health services).
    Adopt guideline methodology▪ Systematic review of evidence with assessment of methodologic quality of studies.
    ▪ Translation of evidence and clinical experience into screening recommendations.
    Determine preferred guideline design▪ Therapy/exposure based
    ▪ Outcome based (by organ, tissue, or function)
    ▪ Disease based
    Establish guideline content▪ Address both medical and psychosocial outcomes.
    ▪ Comprehensive versus selected key late effects.
    ▪ Organization/venue of long-term follow-up care.
    ▪ Provider versus survivor (patient education) format.
    ▪ Treatment summary template.
    ▪ Medical citations to support recommendations.
    Implement and disseminate guidelines▪ Posting on internet website.
    ▪ Presentations at cooperative group and professional society meetings.
    ▪ Presentations in academic and community forums.
    ▪ Publication of review manuscripts.
    ▪ Incorporation into primary care pathways.
    ▪ Collaboration with health care and insurance organizations.
    Organize plan to maintain currency of guidelines▪ Ongoing monitoring of late effects literature.
    ▪ Biennial systematic review by multidisciplinary task forces.
    ▪ Consideration of guideline revisions by oversight committee.
    ▪ International collaboration to harmonize recommendations.
    • ↵aGuidelines from the following Pediatric Cooperative Groups were reviewed for inclusion in this summary: Children's Oncology Group (COG; ref. 25), Children's Cancer and Leukemia Group (CCLG; ref. 23), Dutch Childhood Oncology Group (DCOG; ref. 26), and Scottish Intercollegiate Guidelines Network (SIGN; ref. 24).

  • Table 2.

    Levels of long-term follow-up carea for childhood cancer survivors

    Risk of late effectsProposed levels of follow-up care
    Low▪ Postal or telephone follow-up every 1 to 2 years.
    Surgery only; low-risk chemotherapy (excluding alkylators, anthracyclines, bleomycin, and epipodophyllotoxins)▪ Single visit with cancer center long-term follow-up program followed by ongoing monitoring by primary care provider, according to follow-up plan established by cancer center.
    Moderate▪ Follow-up every 1 to 2 years with nurse or primary care physician.
    Other than high/low risk▪ Initial follow-up at cancer center for 5 to 10 years, followed by transition to primary care provider, who carries out ongoing monitoring according to follow-up plan established by cancer center.
    High▪ Ongoing annual follow-up in specialized long-term follow-up program at cancer center.
    Hematopoietic cell transplant; high-dose anthracyclines or alkylating agents; radiation ≥24 Gy

    Adapted from references 27–31.

    • ↵aLong-term follow-up begins 2 years following completion of therapy.

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Cancer Epidemiology Biomarkers & Prevention: 20 (10)
October 2011
Volume 20, Issue 10
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Impact of Survivorship-Based Research on Defining Clinical Care Guidelines
Melissa M. Hudson, Wendy Landier and Patricia A. Ganz
Cancer Epidemiol Biomarkers Prev October 1 2011 (20) (10) 2085-2092; DOI: 10.1158/1055-9965.EPI-11-0642

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Impact of Survivorship-Based Research on Defining Clinical Care Guidelines
Melissa M. Hudson, Wendy Landier and Patricia A. Ganz
Cancer Epidemiol Biomarkers Prev October 1 2011 (20) (10) 2085-2092; DOI: 10.1158/1055-9965.EPI-11-0642
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    • Abstract
    • Introduction
    • Screening Methodologies
    • Health Screening Recommendations for Long-term Survivors of Pediatric Malignancies
    • Health Monitoring/Surveillance Recommendations for Long-Term Survivors of Adult-Onset Malignancies
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  • Dissemination and Translation of Survivorship Research
  • Support for Caregivers of Cancer Patients
  • Quality of Life in Cancer Survivorship Research
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