Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY.
J Clin Oncol. 2017 May 10;35(14):1606-1621. doi: 10.1200/JCO.2016.71.8478. Epub 2017 Feb 27.
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 .
目的 本指南提供了关于头颈部癌症(HNC)治疗后成人管理的建议,重点关注复发或第二原发癌症的监测和筛查、长期和晚期效应的评估和管理、健康促进、护理协调以及实践意义。
方法 ASCO 有一项政策和一套程序,用于认可由其他专业组织制定的临床实践指南。方法学家对美国癌症协会(ACS)HNC 生存指南的制定进行了严格的审查。ASCO 专家小组审查了内容和建议,在认为必要时提供修改和/或限定性陈述。
结果 ASCO 专家小组确定,2016 年发布的 ACS HNC 生存指南清晰、全面、临床实用且有帮助,尽管许多建议缺乏高质量证据支持。ASCO 认可了 ACS HNC 生存指南,增加了限定性陈述,旨在促进以团队为基础、多专业、多学科、协作的头颈部生存护理。
建议 ASCO 专家小组强调,HNC 幸存者的护理需要采用团队方法,包括初级保健临床医生、肿瘤专家、耳鼻喉科医生和其他专业人员。HNC 治疗团队应向初级保健临床医生和患者传授所接受的治疗类型、潜在复发的可能性以及潜在的晚期和长期并发症。初级保健临床医生应识别复发症状并及时安排评估。他们还应准备直接或通过转介给适当的专家来管理晚期效应。健康促进至关重要,特别是关于戒烟和口腔保健。更多信息可在 www.asco.org/HNC-Survivorship-endorsement 和 www.asco.org/guidelineswiki 上获得。