UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Approach to the long-term survivor of colorectal cancer

Authors
David A Haggstrom, MD, MAS
Winson Y Cheung, MD, MPH
Section Editor
Larissa Nekhlyudov, MD, MPH
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

Death rates from colorectal cancer (CRC) have declined progressively since the mid1980s in the United States and in many other Western countries, and this has increased the number of long-term survivors. These survivors are experiencing the normal issues of aging, which may be compounded by the long-term effects of having had cancer and cancer therapy. Long-term survivors are at risk for a CRC recurrence (which is less common after the first five years following treatment), a new primary CRC, other cancers, and both short-term and long-term adverse effects of treatment. Additional issues for cancer survivors relate to psychological, reproductive, genetic, social, and employment concerns.

This topic review will provide an overview of the approach to the long-term adult survivor of CRC during the phase of care that follows the completion of active treatment. A general overview of cancer survivorship and a more detailed discussion of posttreatment surveillance for colorectal cancer recurrence following treatment is presented elsewhere. (See "Overview of cancer survivorship care for primary care and oncology providers" and "Surveillance after colorectal cancer resection".)

APPROACH TO CANCER SURVIVORSHIP

The transition from active treatment to posttreatment care is critical to long-term health. A committee established by the Institute of Medicine (IOM) to examine the range of medical and psychosocial issues faced by cancer survivors recommended the following components of survivorship care [1]. (See "Overview of cancer survivorship care for primary care and oncology providers", section on 'General issues'.)

Surveillance for cancer recurrence or second cancers; assessment of medical and psychosocial late effects

Prevention of recurrent and new cancers, and of other late effects

                                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Oct 11 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Hewitt, M, Greenfield, S, Stovall, E, et al. From cancer patient to cancer survivor: Lost in transition. (National Academies Press, Washington DC), 2006 http://www.iom.edu/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition.aspx (Accessed on January 31, 2011).
  2. Information about the National Coalition for Cancer survivorship available online at http://www.canceradvocacy.org/about/ (Accessed on March 15, 2016).
  3. Mullan F. Seasons of survival: reflections of a physician with cancer. N Engl J Med 1985; 313:270.
  4. http://seer.cancer.gov/csr/1975_2008/ (Accessed on August 03, 2011).
  5. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66:7.
  6. Rim SH, Seeff L, Ahmed F, et al. Colorectal cancer incidence in the United States, 1999-2004 : an updated analysis of data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program. Cancer 2009; 115:1967.
  7. Center MM, Jemal A, Smith RA, Ward E. Worldwide variations in colorectal cancer. CA Cancer J Clin 2009; 59:366.
  8. Ryerson AB, Eheman CR, Altekruse SF, et al. Annual Report to the Nation on the Status of Cancer, 1975-2012, featuring the increasing incidence of liver cancer. Cancer 2016; 122:1312.
  9. http://cancercontrol.cancer.gov/ocs/prevalence/prevalence.html#survivor (Accessed on October 18, 2011).
  10. Centers for Disease Control and Prevention (CDC). Cancer survivors--United States, 2007. MMWR Morb Mortal Wkly Rep 2011; 60:269.
  11. Hewitt M, Rowland JH, Yancik R. Cancer survivors in the United States: age, health, and disability. J Gerontol A Biol Sci Med Sci 2003; 58:82.
  12. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012; 62:10.
  13. Meyerhardt JA, Mayer RJ. Follow-up strategies after curative resection of colorectal cancer. Semin Oncol 2003; 30:349.
  14. Abulafi AM, Williams NS. Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 1994; 81:7.
  15. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013; 63:11.
  16. O'Connell JB, Maggard MA, Ko CY. Colon cancer survival rates with the new American Joint Committee on Cancer sixth edition staging. J Natl Cancer Inst 2004; 96:1420.
  17. AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 7th edition, Edge, SB, Byrd, DR, Compton, CC, et al (Eds) (Eds), Springer, New York 2010. p.143.
  18. Tarantino I, Achermann P, Güller U, et al. Relative survival is an adequate estimate of cancer-specific survival: baseline mortality-adjusted 10-year survival of 771 rectal cancer patients. Ann Surg Oncol 2013; 20:3877.
  19. Kjeldsen BJ, Kronborg O, Fenger C, Jørgensen OD. The pattern of recurrent colorectal cancer in a prospective randomised study and the characteristics of diagnostic tests. Int J Colorectal Dis 1997; 12:329.
  20. Renouf DJ, Woods R, Speers C, et al. Improvements in 5-year outcomes of stage II/III rectal cancer relative to colon cancer. Am J Clin Oncol 2013; 36:558.
  21. Sargent D, Sobrero A, Grothey A, et al. Evidence for cure by adjuvant therapy in colon cancer: observations based on individual patient data from 20,898 patients on 18 randomized trials. J Clin Oncol 2009; 27:872.
  22. Meyerhardt JA, Mangu PB, Flynn PJ, et al. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol 2013; 31:4465.
  23. Labianca R, Nordlinger B, Beretta GD, et al. Primary colon cancer: ESMO Clinical Practice Guidelines for diagnosis, adjuvant treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v70.
  24. Gall CA, Weller D, Esterman A, et al. Patient satisfaction and health-related quality of life after treatment for colon cancer. Dis Colon Rectum 2007; 50:801.
  25. Ramsey SD, Berry K, Moinpour C, et al. Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol 2002; 97:1228.
  26. Schag CA, Ganz PA, Wing DS, et al. Quality of life in adult survivors of lung, colon and prostate cancer. Qual Life Res 1994; 3:127.
  27. Caravati-Jouvenceaux A, Launoy G, Klein D, et al. Health-related quality of life among long-term survivors of colorectal cancer: a population-based study. Oncologist 2011; 16:1626.
  28. Jansen L, Koch L, Brenner H, Arndt V. Quality of life among long-term (≥5 years) colorectal cancer survivors--systematic review. Eur J Cancer 2010; 46:2879.
  29. Pucciarelli S, Del Bianco P, Toppan P, et al. Health-related quality of life outcomes in disease-free survivors of mid-low rectal cancer after curative surgery. Ann Surg Oncol 2008; 15:1846.
  30. Trentham-Dietz A, Remington PL, Moinpour CM, et al. Health-related quality of life in female long-term colorectal cancer survivors. Oncologist 2003; 8:342.
  31. Hoerske C, Weber K, Goehl J, et al. Long-term outcomes and quality of life after rectal carcinoma surgery. Br J Surg 2010; 97:1295.
  32. Hornbrook MC, Wendel CS, Coons SJ, et al. Complications among colorectal cancer survivors: SF-6D preference-weighted quality of life scores. Med Care 2011; 49:321.
  33. El-Shami K, Oeffinger KC, Erb NL, et al. American Cancer Society Colorectal Cancer Survivorship Care Guidelines. CA Cancer J Clin 2015; 65:428.
  34. Welch-McCaffrey D, Hoffman B, Leigh SA, et al. Surviving adult cancers. Part 2: Psychosocial implications. Ann Intern Med 1989; 111:517.
  35. Lynch BM, Steginga SK, Hawkes AL, et al. Describing and predicting psychological distress after colorectal cancer. Cancer 2008; 112:1363.
  36. Kurtz ME, Kurtz JC, Stommel M, et al. Predictors of depressive symptomatology of geriatric patients with colorectal cancer: a longitudinal view. Support Care Cancer 2002; 10:494.
  37. Clark CJ, Fino NF, Liang JH, et al. Depressive symptoms in older long-term colorectal cancer survivors: a population-based analysis using the SEER-Medicare healthcare outcomes survey. Support Care Cancer 2016; 24:3907.
  38. Deimling GT, Wagner LJ, Bowman KF, et al. Coping among older-adult, long-term cancer survivors. Psychooncology 2006; 15:143.
  39. Taskila-Brandt T, Martikainen R, Virtanen SV, et al. The impact of education and occupation on the employment status of cancer survivors. Eur J Cancer 2004; 40:2488.
  40. Earle CC, Chretien Y, Morris C, et al. Employment among survivors of lung cancer and colorectal cancer. J Clin Oncol 2010; 28:1700.
  41. Zheng Z, Yabroff KR, Guy GP Jr, et al. Annual Medical Expenditure and Productivity Loss Among Colorectal, Female Breast, and Prostate Cancer Survivors in the United States. J Natl Cancer Inst 2016; 108.
  42. Nekhlyudov L, Walker R, Ziebell R, et al. Cancer survivors' experiences with insurance, finances, and employment: results from a multisite study. J Cancer Surviv 2016; 10:1104.
  43. Liu L, Herrinton LJ, Hornbrook MC, et al. Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis. Dis Colon Rectum 2010; 53:200.
  44. McMullen CK, Hornbrook MC, Grant M, et al. The greatest challenges reported by long-term colorectal cancer survivors with stomas. J Support Oncol 2008; 6:175.
  45. Krouse R, Grant M, Ferrell B, et al. Quality of life outcomes in 599 cancer and non-cancer patients with colostomies. J Surg Res 2007; 138:79.
  46. Fucini C, Gattai R, Urena C, et al. Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol 2008; 15:1099.
  47. Krouse RS, Herrinton LJ, Grant M, et al. Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex. J Clin Oncol 2009; 27:4664.
  48. Downing A, Morris EJ, Richards M, et al. Health-related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12 to 36 months after diagnosis. J Clin Oncol 2015; 33:616.
  49. Kramish Campbell M, Meier A, Carr C, et al. Health behavior changes after colon cancer: a comparison of findings from face-to-face and on-line focus groups. Fam Community Health 2001; 24:88.
  50. Emmertsen KJ, Laurberg S, Rectal Cancer Function Study Group. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg 2013; 100:1377.
  51. Guren MG, Eriksen MT, Wiig JN, et al. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol 2005; 31:735.
  52. Brændengen M, Tveit KM, Bruheim K, et al. Late patient-reported toxicity after preoperative radiotherapy or chemoradiotherapy in nonresectable rectal cancer: results from a randomized Phase III study. Int J Radiat Oncol Biol Phys 2011; 81:1017.
  53. Lange MM, Martz JE, Ramdeen B, et al. Long-term results of rectal cancer surgery with a systematical operative approach. Ann Surg Oncol 2013; 20:1806.
  54. Peeters KC, van de Velde CJ, Leer JW, et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 2005; 23:6199.
  55. Kollmorgen CF, Meagher AP, Wolff BG, et al. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg 1994; 220:676.
  56. Gami B, Harrington K, Blake P, et al. How patients manage gastrointestinal symptoms after pelvic radiotherapy. Aliment Pharmacol Ther 2003; 18:987.
  57. McGough C, Baldwin C, Frost G, Andreyev HJ. Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy. Br J Cancer 2004; 90:2278.
  58. Lange MM, Maas CP, Marijnen CA, et al. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg 2008; 95:1020.
  59. Donovan KA, Thompson LM, Hoffe SE. Sexual function in colorectal cancer survivors. Cancer Control 2010; 17:44.
  60. Hendren SK, O'Connor BI, Liu M, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005; 242:212.
  61. Ho VP, Lee Y, Stein SL, Temple LK. Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum 2011; 54:113.
  62. Traa MJ, Orsini RG, Den Oudsten BL, et al. Measuring the health-related quality of life and sexual functioning of patients with rectal cancer: does type of treatment matter? Int J Cancer 2014; 134:979.
  63. Di Fabio F, Koller M, Nascimbeni R, et al. Long-term outcome after colorectal cancer resection. Patients' self-reported quality of life, sexual dysfunction and surgeons' awareness of patients' needs. Tumori 2008; 94:30.
  64. Bruheim K, Guren MG, Dahl AA, et al. Sexual function in males after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2010; 76:1012.
  65. Lange MM, Marijnen CA, Maas CP, et al. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer 2009; 45:1578.
  66. Dowswell G, Ismail T, Greenfield S, et al. Men's experience of erectile dysfunction after treatment for colorectal cancer: qualitative interview study. BMJ 2011; 343:d5824.
  67. Park ER, Bober SL, Campbell EG, et al. General internist communication about sexual function with cancer survivors. J Gen Intern Med 2009; 24 Suppl 2:S407.
  68. White ID, Allan H, Faithfull S. Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy? Br J Cancer 2011; 105:903.
  69. Lindsey I, George B, Kettlewell M, Mortensen N. Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease. Dis Colon Rectum 2002; 45:727.
  70. Sterk P, Shekarriz B, Günter S, et al. Voiding and sexual dysfunction after deep rectal resection and total mesorectal excision: prospective study on 52 patients. Int J Colorectal Dis 2005; 20:423.
  71. Denton AS, Maher EJ. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database Syst Rev 2003; :CD003750.
  72. Schneider EC, Malin JL, Kahn KL, et al. Surviving colorectal cancer : patient-reported symptoms 4 years after diagnosis. Cancer 2007; 110:2075.
  73. Thong MS, Mols F, Wang XS, et al. Quantifying fatigue in (long-term) colorectal cancer survivors: a study from the population-based patient reported outcomes following initial treatment and long term evaluation of survivorship registry. Eur J Cancer 2013; 49:1957.
  74. Mols F, Beijers T, Lemmens V, et al. Chemotherapy-induced neuropathy and its association with quality of life among 2- to 11-year colorectal cancer survivors: results from the population-based PROFILES registry. J Clin Oncol 2013; 31:2699.
  75. Mols F, Beijers AJ, Vreugdenhil G, et al. Chemotherapy-induced peripheral neuropathy, physical activity and health-related quality of life among colorectal cancer survivors from the PROFILES registry. J Cancer Surviv 2015; 9:512.
  76. Kaley TJ, Deangelis LM. Therapy of chemotherapy-induced peripheral neuropathy. Br J Haematol 2009; 145:3.
  77. Babb RR. Radiation proctitis: a review. Am J Gastroenterol 1996; 91:1309.
  78. Haddock MG, Sloan JA, Bollinger JW, et al. Patient assessment of bowel function during and after pelvic radiotherapy: results of a prospective phase III North Central Cancer Treatment Group clinical trial. J Clin Oncol 2007; 25:1255.
  79. Baxter NN, Habermann EB, Tepper JE, et al. Risk of pelvic fractures in older women following pelvic irradiation. JAMA 2005; 294:2587.
  80. Small W Jr, Kachnic L. Postradiotherapy pelvic fractures: cause for concern or opportunity for future research? JAMA 2005; 294:2635.
  81. Wright JD, St Clair CM, Deutsch I, et al. Pelvic radiotherapy and the risk of secondary leukemia and multiple myeloma. Cancer 2010; 116:2486.
  82. Baxter NN, Tepper JE, Durham SB, et al. Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology 2005; 128:819.
  83. Wiltink LM, Nout RA, Fiocco M, et al. No Increased Risk of Second Cancer After Radiotherapy in Patients Treated for Rectal or Endometrial Cancer in the Randomized TME, PORTEC-1, and PORTEC-2 Trials. J Clin Oncol 2015; 33:1640.
  84. Birgisson H, Påhlman L, Gunnarsson U, Glimelius B. Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol 2005; 23:6126.
  85. Kendal WS, Nicholas G. A population-based analysis of second primary cancers after irradiation for rectal cancer. Am J Clin Oncol 2007; 30:333.
  86. Singh S, Earle CC, Bae SJ, et al. Incidence of Diabetes in Colorectal Cancer Survivors. J Natl Cancer Inst 2016; 108:djv402.
  87. Feng JP, Yuan XL, Li M, et al. Secondary diabetes associated with 5-fluorouracil-based chemotherapy regimens in non-diabetic patients with colorectal cancer: results from a single-centre cohort study. Colorectal Dis 2013; 15:27.
  88. Stoffel EM, Mangu PB, Gruber SB, et al. Hereditary colorectal cancer syndromes: American Society of Clinical Oncology Clinical Practice Guideline endorsement of the familial risk-colorectal cancer: European Society for Medical Oncology Clinical Practice Guidelines. J Clin Oncol 2015; 33:209.
  89. Giardiello FM, Allen JI, Axilbund JE, et al. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on Colorectal Cancer. Dis Colon Rectum 2014; 57:1025.
  90. Balmaña J, Balaguer F, Cervantes A, et al. Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2013; 24 Suppl 6:vi73.
  91. Jackson NA, Fuchs CS, Niedzwicki D, et al. TRhe impact of smoking on cancer recurrence and survival in patients with stage III colon cancer: findings from Intergroup trial CALGB 89803 (abstract 4039). J Clin Oncol 2008; 26:187s. Abstract available online at http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=55&abstractID=33374 (Accessed on October 27, 2011).
  92. Phipps AI, Baron J, Newcomb PA. Prediagnostic smoking history, alcohol consumption, and colorectal cancer survival: the Seattle Colon Cancer Family Registry. Cancer 2011; 117:4948.
  93. Phipps AI, Shi Q, Newcomb PA, et al. Associations between cigarette smoking status and colon cancer prognosis among participants in North Central Cancer Treatment Group Phase III Trial N0147. J Clin Oncol 2013; 31:2016.
  94. Boyle T, Fritschi L, Platell C, Heyworth J. Lifestyle factors associated with survival after colorectal cancer diagnosis. Br J Cancer 2013; 109:814.
  95. Yang B, Jacobs EJ, Gapstur SM, et al. Active smoking and mortality among colorectal cancer survivors: the Cancer Prevention Study II nutrition cohort. J Clin Oncol 2015; 33:885.
  96. Walter V, Jansen L, Hoffmeister M, et al. Smoking and survival of colorectal cancer patients: population-based study from Germany. Int J Cancer 2015; 137:1433.
  97. Hawkes AL, Chambers SK, Pakenham KI, et al. Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol 2013; 31:2313.
  98. Courneya KS, Friedenreich CM, Quinney HA, et al. A randomized trial of exercise and quality of life in colorectal cancer survivors. Eur J Cancer Care (Engl) 2003; 12:347.
  99. Pinto BM, Papandonatos GD, Goldstein MG, et al. Home-based physical activity intervention for colorectal cancer survivors. Psychooncology 2013; 22:54.
  100. Campbell MK, Carr C, Devellis B, et al. A randomized trial of tailoring and motivational interviewing to promote fruit and vegetable consumption for cancer prevention and control. Ann Behav Med 2009; 38:71.
  101. Emmons KM, McBride CM, Puleo E, et al. Project PREVENT: a randomized trial to reduce multiple behavioral risk factors for colon cancer. Cancer Epidemiol Biomarkers Prev 2005; 14:1453.
  102. Lynch BM, Courneya KS, Sethi P, et al. A randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors: effects on sedentary behavior. Cancer 2014; 120:2665.
  103. Wattchow DA, Weller DP, Esterman A, et al. General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial. Br J Cancer 2006; 94:1116.
  104. Snyder CF, Earle CC, Herbert RJ, et al. Preventive care for colorectal cancer survivors: a 5-year longitudinal study. J Clin Oncol 2008; 26:1073.
  105. Earle CC, Neville BA. Under use of necessary care among cancer survivors. Cancer 2004; 101:1712.
  106. Nekhlyudov L. "Doc, should I see you or my oncologist?": a primary care perspective on opportunities and challenges in providing comprehensive care for cancer survivors. J Clin Oncol 2009; 27:2424.
  107. Nekhlyudov L, Aziz N, Lerro KS. Oncologists' and primary care providers' awareness of late effects of cancer treatment: Implications for survivorship care. J Clin Oncol 30, 2012 (suppl; abstr 6008). Abstract available online at http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=114&abstractID=96601 (Accessed on July 06, 2012).
  108. McCabe MS, Bhatia S, Oeffinger KC, et al. American Society of Clinical Oncology statement: achieving high-quality cancer survivorship care. J Clin Oncol 2013; 31:631.
  109. Committee on Cancer Survivorship: Improving Care and Quality of Life, Institute of Medicine and National Research Council, and National Cancer Policy Board. Cancer Patient to Cancer survivor: Lost in Transition, Hewitt M, Greenfield S, Stovall E (Eds), National Academies Press, Washington, DC 2005.
  110. Cheung WY, Neville BA, Cameron DB, et al. Comparisons of patient and physician expectations for cancer survivorship care. J Clin Oncol 2009; 27:2489.
  111. Virgo KS, Lerro CC, Klabunde CN, et al. Barriers to breast and colorectal cancer survivorship care: perceptions of primary care physicians and medical oncologists in the United States. J Clin Oncol 2013; 31:2322.