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New Long-Term Care Guidelines for Prostate Cancer Survivors

American Cancer Society issues recommendations

An estimated 2.8 million men in the U.S. are living with prostate cancer or have had the disease at one time, and that number is growing. Prostate cancer is the most common cancer in American men after skin cancer — but long-term survival is common. However, even long after diagnosis and treatment, survivors have continuing needs for follow-up care to manage treatment side effects, to test to see whether the cancer has returned, and to treat other health conditions.

To help primary care physicians (PCPs) and prostate cancer survivors better manage long-term care, the American Cancer Society has issued its first-ever Prostate Cancer Survivorship Care Guidelines, published June 10 in CA: A Cancer Journal for Clinicians. The newly developed recommendations provide information regarding nutrition, physical activity, cancer testing, the management of treatment side effects, and the coordination of care among PCPs and specialists.

The guidelines recommend that PCPs talk to prostate cancer survivors about their lifestyle habits and give them advice on how to make changes. Increasingly, studies show that healthy eating and maintaining an active lifestyle after a diagnosis of prostate cancer can lower the chances of the cancer returning. Healthy behaviors include:

  • Achieving and maintaining a healthy weight by limiting high-calorie foods and beverages, and by being more physically active
  • Regardless of current weight, getting at least 150 minutes of physical activity every week, with a doctor’s approval
  • Eating a diet rich in vegetables, fruits, and whole grains, and low in saturated fats, with adequate calcium and vitamin D
  • Limiting alcohol consumption to no more than two drinks per day
  • Avoiding tobacco

Depending on their treatment, prostate cancer survivors must have regular follow-up tests to check whether their prostate cancer has come back or worsened, and must follow testing guidelines to check for any new cancer, according to the guidelines. Men who have undergone radiation therapy may have a slightly higher risk for bladder or colon cancer, and they may need different screening than people at average risk.

Most prostate cancer survivors should receive a prostate-specific antigen (PSA) test every 6 to 12 months during the first 5 years after active treatment ends, and then every year after that, according to the guidelines. They should also receive a digital rectal examination every year. Prostate cancer survivors on active surveillance may have a different schedule of tests.

Men should report any new symptoms, including blood in the urine, rectal bleeding, or pain, to their doctors.

Surgery, radiation, chemotherapy, and hormone treatments for prostate cancer can cause urinary, bowel, and sexual side effects. In addition, hormone therapy can cause anemia and hot flashes, and can increase the risk for heart problems and bone fractures.

It is not unusual for people who have had cancer to experience anxiety or depression. Feelings of sadness or distress should be discussed with a physician, who can evaluate whether they are signs of clinical depression. Clinical depression can reduce a person’s quality of life, and it also makes people less able to take care of their own health. Many treatment options for clinical depression are available, including medicine, counseling, and a combination of both.

When active cancer treatment ends, patients should ask their oncologist for a written follow-up care plan that they can share with their primary care physician, the guidelines say. This plan should include an explanation of which provider — oncologist, primary care physician, or other specialist — should be in charge of cancer-related and other medical care.

A study from the National Cancer Institute found that PCPs who received a written plan from the patient’s oncologist were nine times more likely to discuss recommendations for survivorship with the patient than were PCPs who received no written plan.

Beginning next year, the American College of Surgeons Commission on Cancer will require that every cancer patient receive a written survivorship care plan from their oncologists.

Source: American Cancer Society; June 10, 2014.

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