Survivorship Care Plans for People with Colorectal Cancer: Do They Reflect the Research Evidence?

Abstract

AimIn the present study, we synthesized the published literature about the psychosocial aspects of colorectal cancer (crc) survivorship to support an update of the evidentiary base of the survivorship care plans (scps) created in our jurisdiction. MethodsThe psychosocial topics identified in the crc scps created by two different initiatives in our province were used as search criteria: quality of life (qol), sexual function, fatigue, and lifestyle behaviors. An umbrella review was conducted to retrieve the best possible evidence. Only reviews that investigated the intended outcomes in crc survivors and those with moderate-to-high methodologic quality scores were included. ResultsOf 462 retrieved reports, eight reviews met the inclusion criteria for the synthesis. Of those eight, six investigated the challenges of crc survivors and two investigated the effect of physical activity on survivor wellbeing. Our results indicate that emotional and physical challenges are common in crc survivors and that physical activity is associated with clinically important benefits for the fatigue and physical functioning of crc survivors. ConclusionsOur study findings update the evidence and indicate that existing scps in our province concerning the physical and emotional challenges of crc survivors reflect the evidence at the time of their issue. However, the literature concerning cancer risks specific to crc survivors is lacking. Although systematic reviews are considered to be the "gold standard" in knowledge synthesis, our findings suggest that much remains to be done in the area of synthesis research to better guide practice in cancer survivorship.

A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005‐2017)

“…Information was extracted and synthesized from 51 articles. Table 2 provides a summary of the included studies [15‐65]. Quality analysis, revealed a mean score of 7.7 (±2.0), and median of 8 with a range of 3‐11.…”

“…Some reviews cited that many of the studies examined failed to meet the definition of physical activity [25], whereas others reported well‐defined, if disparate, exercise parameters [15,57,58,63]. The mode of exercise varied widely in reports, spanning both aerobic and resistive training protocols [15,26,27,30,32,35,36,39,45,57,59,60,63,66], as well as described mixed (aerobic plus resistance training) interventions [16,17,19,20,22,24,28,31,32,37,41,43,47,48,53,58,60], yoga [38,47,50,54,64,65,67], tai chi [42,64,65], dance [18], progressive resistive exercise (PRE) [21,30,53], and therapeutic exercises (focused on targeted body region impairments) [21,23,44,53,62]. Exercise programs were structured in various settings (home‐based, outpatient ambulatory clinic, hospital‐based) and provided various levels of provider supervision.…”

“…Some reviews focused on exercise interventions targeting one specific cancer treatment‐related impairment, such as CRF [27,41,45,48,58,61] or lymphedema [34,66], and many reported on the impact of exercise on common treatment‐related side effects, such as body weight and body mass index (BMI) [19,28,30,32,36,43,58], depression [16,24,38,67], anxiety [16,32,38,47,50,67], bone density [63], other physical and functional impairments [18,21,22,30,31,35,50,40,60,62,66], and various biomarkers associated with cancer progression [22,32,36,42,46,57,58,59,64].…”

“…In general, exercise interventions at moderate and vigorous intensity are safe in supervised settings, with small numbers of adverse events noted [16,57]. Moderate and vigorous exercise resulted in improvements in measures of fitness, including peak oxygen consumption [30,32,43], maximum rate of oxygen consumption [28], muscle strength and endurance [30,39], and in measures of function, including 6‐ and 12‐minute walk distance outcomes [35,56], as well as improved measures of immune function [32,36,46,57]. Although moderate‐to‐vigorous exercise interventions significantly improved various physical and functional indicators, the impact on cognitive recovery, depression, and anxiety was mixed in several reports, with some noting no significant impact from exercise [24,35,38,47,61].…”

Empowering survivors after colorectal and lung cancer treatment: Pilot study of a Self-Management Survivorship Care Planning intervention

“…Baseline anxiety and depression were low overall in this study, similar to findings in a recent RCT of a nurse-led supportive care intervention in colorectal cancer survivors (Jefford et al, 2016). However, other studies found that CRC survivors experience significant levels of anxiety and distress (D’Souza et al, 2016). Studies show that SCP may lead to improved follow-up care, better long-term physical well-being, positive self-efficacy, improved survivor knowledge on survivorship care, and positive lifestyle changes (Chrischilles et al, 2015; Klemanski et al, 2016; Nissen et al, 2013).…”