New ASCO Survivorship Guidelines Acknowledge Successes Against Cancer

The American Society of Clinical Oncology has issued a trio of new clinical guidelines for issues that cancer survivors often must deal with, signaling a measure of success in the war against cancer.

The new guidelines confront three problems for survivors, with varying degrees of success: fatigue, depression, and peripheral neuropathy. They are the first of a planned 18 clinical practice guidelines that the ASCO intends to issue in the coming months.

In a statement, ASCO officials said,

The recommendations reinforce the need to care for both the physical and psychological needs of cancer survivors. The release of these guidelines come at a time when the number of people with a history of cancer in the US has increased dramatically, from 3 million in 1971 to about 13.7 million today. Despite these important gains, cancer survivors still face a range of long-term challenges from their disease and its treatment. Cancer survivors face an increased risk for other health problems, premature morbidity, and side effects from treatment.

In developing guidelines for anxiety and depression, the ASCO panel simply adapted the recommendations made by the Pan-Canadian Practice Guidelines on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults with Cancer (those Canadian guidelines can be seen at this link, which opens as a PDF file).

In developing guidelines for fatigue, the ASCO panel found no evidence that supported the use of drug therapy like using psychostumulants; rather, the evidence supported non-drug interventions such as exercise, yoga, acupuncture, and social activity.

Neuropathy poses problems

The problematic guideline was for peripheral neuropathy. This panel could find no good evidence supporting the use of any treatment that was aimed at prevention or management of the development of peripheral neuropathy, and in fact they noted several drugs that should not be used to prevent chemotherapy-induced neuropathy, including ALC, amitripyline, calcium, glutathione, and vitamin E, among others.

In all, they concluded that the only recommended treatment for chemo-induced peripheral neuropathy is duloxetine.

To underscore the difficulty in this area, Gary Lyman, M.D., from Fred Hutchinson Cancer Center and acting chair of the ASCO Survivorship Guidelines Advisory Committee, said in a statement, "There is no clear panacea for neuropathy ... Some of the drugs used for prevention or treatment of neuropathy may cause side effects or interfere with other drugs."

To view the guidelines in their entirety, visit this page at the ASCO website.

Photo credit: NCI