NCCN Updates Guidelines for Cancer Survivorship

08/04/17

The National Comprehensive Cancer Network (NCCN) has updated their guidelines for survivorship to reflect recommendation changes in long-term psychosocial and physical problems as well as preventive health.

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The previous edition of the guideline contained a section within the late effects/long-term psychosocial and physical problems for menopause-related symptoms for both females and males. The first part of this section was extensively revised and titled “Principles of Menopause Management in Female Survivors.” It includes defining characteristics of menopause and its relationship with cancer survivors, signs and symptoms (including vasomotor symptoms such as hot flashes and night sweats), and treatment options for such symptoms.

The second part—formerly named “Male Menopause-Related Symptoms Due to Androgen Deprivation Therapy”—is now titled “Principles of Menopausal Symptoms in Male Survivors.” It includes screening recommendations for male menopause symptoms, androgen deprivation therapy symptoms, and treatment options for vasomotor symptoms.

The section for screening of menopause-related symptoms was divided into “Females,” “Males,” and “Females and Males.” Gynecomastia and anemia were added to the list of screened symptoms to treat for males.

In the “ADT-Related Symptoms” section, a new pathway and treatment options were added for gynecomastia, including hormone therapies (medroxyprogesterone, cyproterone acetate, and estrogen) and non-hormonal therapies (venlafaxine and gabapentin). Multiple non-hormonal pharmacologic treatments were removed: low-dose antidepressants, anti-convulsants, neuropathic pain relievers, and some anti-hypertensives.

In the preventive health section of the guidelines, various immunizations and infections were added and removed. Pneumococcal vaccine is no longer recommended for all cancer survivors, but only for those with some special circumstances or risk factors presenting. Live, attenuated influenza vaccine was removed from “Vaccines Contraindicated or to Be Used With Caution in Actively Immunocompromised Survivors” and “Live Vaccines That Can Be Used With Caution” lists.

For vaccination in non-transplant survivors, new recommendations were added for pneumococcal vaccine, including suggested use for adult patients aged 65 years or older and for younger adults who are immunocompromised. Furthermore, a second dose of PPSV23 is suggested 5 years after the first dose for immunocompromised survivors and those with functional or anatomic asplenia.—Zachary Bessette