Assistant Professor of Urology, Department of Urology, University of Michigan, Research Investigator, HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
CA Cancer J Clin. 2014 Jul-Aug;64(4):225-49. doi: 10.3322/caac.21234. Epub 2014 Jun 10.
Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.
前列腺癌幸存者人数达到 280 万,占美国所有癌症幸存者的 1/5。虽然有关于及时治疗和监测复发性疾病的指南,但对于提供治疗后临床随访护理以解决幸存者可能面临的众多长期和晚期影响的指南却有限。基于国家癌症生存资源中心专家小组提出的建议,美国癌症协会制定了临床随访护理指南,以促进初级保健临床医生提供治疗后护理。这些指南是使用证据综合和专家共识相结合的方法制定的。在可用时,参考了现有的健康促进、监测和筛查第二原发癌的指南。为了促进治疗后幸存者的全面随访护理和最佳健康和生活质量,该指南涉及健康促进、前列腺癌复发监测、第二原发癌筛查、长期和晚期影响评估和管理、社会心理问题以及肿瘤团队、初级保健临床医生和非肿瘤专家之间的护理协调。制定这些指南的一个主要挑战是治疗后前列腺癌幸存者管理方面发表的证据有限。许多证据依赖于样本量小的研究和对特定机构和人群数据库的回顾性分析。