Head and Neck Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline

Abstract

Purpose This guideline provides recommendations on the management of adults after head and neck cancer (HNC) treatment, focusing on surveillance and screening for recurrence or second primary cancers, assessment and management of long-term and late effects, health promotion, care coordination, and practice implications. Methods ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The American Cancer Society (ACS) HNC Survivorship Care Guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. Results The ASCO Expert Panel determined that the ACS HNC Survivorship Care Guideline, published in 2016, is clear, thorough, clinically practical, and helpful, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorsed the ACS HNC Survivorship Care Guideline, adding qualifying statements aimed at promoting team-based, multispecialty, multidisciplinary, collaborative head and neck survivorship care. Recommendations The ASCO Expert Panel emphasized that caring for HNC survivors requires a team-based approach that includes primary care clinicians, oncology specialists, otolaryngologists, dentists, and other allied professionals. The HNC treatment team should educate the primary care clinicians and patients about the type(s) of treatment received, the likelihood of potential recurrence, and the potential late and long-term complications. Primary care clinicians should recognize symptoms of recurrence and coordinate a prompt evaluation. They should also be prepared to manage late effects either directly or by referral to appropriate specialists. Health promotion is critical, particularly regarding tobacco cessation and dental care. Additional information is available at www.asco.org/HNC-Survivorship-endorsement and www.asco.org/guidelineswiki .

Burden of comorbidities is higher among elderly survivors of oropharyngeal cancer compared with controls

“…Not only are comorbidities more likely at baseline, but the cumulative risk of developing the majority (74%) of conditions analyzed is moderately high (10%‐19%) or high (≥20%) in the 5 years after diagnosis. Present guidelines offered by the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology, and American Cancer Society include long‐term, targeted oncologic surveillance and screening for treatment effects . However, these guidelines offer no specific recommendations regarding the evaluation of medical comorbidities for which survivors are at increased risk during early survivorship.…”

“…The current study was designed to examine the prevalence of comorbid conditions at the time of OPC diagnosis, the incidence of new comorbid conditions during survivorship, and how each compares with controls. Comparing differences in comorbidity between survivors of OPC and noncancer controls is important to identify conditions for which survivors of OPC may benefit from additional focused surveillance beyond what currently is recommended …”

Alcohol‐related head and neck cancer: Summary of the literature

“…Given this overwhelming evidence that alcohol consumption of varying degrees in HNC survivors is associated with the development of second primary malignancies, recurrences, and poor outcomes, several organizations have provided guidelines recommending that individuals with HNC reduce or avoid alcohol altogether. In 2016, the American Cancer Society published guidelines for HNC survivorship recommending that “primary care physicians counsel HNC survivors to achieve a dietary pattern that is high in fruits, vegetables, and whole grains, and low in saturated fats, sufficient in dietary fiber, and avoids alcohol consumption .…”

Contribution of psychiatric diagnoses to extent of opioid prescription in the first year post‐head and neck cancer diagnosis: A longitudinal study

“…One may want to use a stepped‐care approach for anxiety management in HNC clinics, whereby all patients are presented with anxiety self‐management information and tools (ie, computer‐based programs and/or pamphlets) and are systematically screened for anxiety (including lifetime and upon HNC AD) along the full care trajectory . This screening can be reviewed by the attending physician and/or nurse, who can refer patients early‐on for further treatment in psycho‐oncology (ie, psychologist, psychiatrist, social worker) …”