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

M T King,K White,C Rutherford,Lisette M Wiltink

doi:10.1007/s00520-020-05301-7

M T King, K White + Show 2 more

Open Access

https://doi.org/10.1007/s00520-020-05301-7

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Abstract

PurposeDue 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.MethodsFour 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.ResultsWe 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.ConclusionsFew 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.

Highlights

Colon and rectal cancer combined are the third most commonly diagnosed cancer worldwide [1]
Since clinicians are often unaware of interventions designed to detect and manage symptoms [6], this systematic review aimed to investigate the extent to which clinical practice guidelines for colorectal cancer (CRC) provide recommendations for managing long-term symptoms and functioning impairments following treatment for CRC
Reference lists of studies identified were used to find other relevant guidelines, and 33 international cancer societies and guideline organization websites were searched for additional guidelines, consensus statements, or best practice recommendations

Summary

Introduction

Colon and rectal cancer combined are the third most commonly diagnosed cancer worldwide [1]. In 2018, 1,849,518 new Multiple long-term symptoms can be experienced after treatment for CRC. For bowel symptoms, these include rectal bleeding, diarrhea, fecal frequency, incontinence and urgency, and rectal tenesmus (feeling of incomplete defecation) [6]. All long-term symptoms contribute to increased symptom burden, in terms of both severity and frequency, which in turn is associated with decreased HRQL [9]. In order to decrease symptom burden and improve HRQL, evidence-based interventions should be used to manage long-term symptoms and functioning impairments. Since clinicians are often unaware of interventions designed to detect and manage symptoms [6], this systematic review aimed to investigate the extent to which clinical practice guidelines for CRC provide recommendations for managing long-term symptoms and functioning impairments following treatment for CRC

Methods

Results

Discussion

Conclusion