J Korean Med Assoc.  2016 Apr;59(4):276-286. 10.5124/jkma.2016.59.4.276.

Management of long-term colorectal cancer survivors in Korea

• Kang HT
• Bahk HJ
• Shim JY
• Kim NK

• KMID: 2161708
• DOI: http://doi.org/10.5124/jkma.2016.59.4.276

Abstract

Colorectal cancer (CRC) is the third most common cancer in Korea. Its average growth rate has been 3.7% annually from 1999 to 2013. The 5-year relative survival rate is 75.6%. The number of CRC survivors is expected to increase steadily because of its high incidence and survival rate. Because CRC survivors are at risk for recurrence, metachronous cancer, and other cancers, they should be checked regularly. Recommended surveillance includes history-taking and physical examination, colonoscopy, carcinoembryonic antigen testing, and computed tomography. Routine complete blood counts, liver function test, and positron emission tomography are not recommended. CRC survival, which is associated with Lynch syndrome and familial adenomatous polyposis, is also related to a higher risk of other cancers such as gastrointestinal and gynecologic cancers. Additional surveillance should be taken. CRC survivors could complain of general health problems such as cancer-related fatigue and psychosocial/cognitive dysfunction, in addition to treatment-related problems including bowel/urologic/sexual dysfunction, peripheral neuropathy, and ostomy care. They are also at greater risk of cardiovascular diseases. The primary care physician should counsel CRC survivors about their health problems and make an effort to address these concerns. Primary care physicians should try to communicate with CRC survivors and all specialists for clinical follow-up care.

Keyword

Colorectal neoplasms; Cancer survivor; Secondary cancer; Primary care physicians

MeSH Terms

Adenomatous Polyposis Coli
Blood Cell Count
Carcinoembryonic Antigen
Cardiovascular Diseases
Colonoscopy
Colorectal Neoplasms*
Colorectal Neoplasms, Hereditary Nonpolyposis
Fatigue
Follow-Up Studies
Humans
Incidence
Korea*
Liver Function Tests
Ostomy
Peripheral Nervous System Diseases
Physical Examination
Physicians, Primary Care
Positron-Emission Tomography
Recurrence
Specialization
Survival Rate
Survivors*
Carcinoembryonic Antigen

Figure

• 

  Figure 1 Surveillance for colorectal cancer survivorships to check recurrence and screen second primary cancers. CEA, carcinoembryonic antigen; CT, computed tomography.

Reference

1. National Cancer Information Center. Cancer registration statistics program [Internet]. Goyang: National Cancer Information Center;cited 2015 Dec 23. Available from: http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_040402000000.

2. Park EC, Park JH. The analysis and reduction strategies of cancer burden in Korea. Seoul: Korean Foundation for Cancer Research;2012.

3. Sohn DK, Kim MJ, Park Y, Suh M, Shin A, Lee HY, Im JP, Cho HM, Hong SP, Kim BH, Kim Y, Kim JW, Kim HS, Nam CM, Park DI, Um JW, Oh SN, Lim HS, Chang HJ, Hahm SK, Chung JH, Kim SY, Kim Y, Lee WC, Jeong SY. The Korean guideline for colorectal cancer screening. J Korean Med Assoc. 2015; 58:420–432.

4. Korean Academy of Medical Sciences. Korean clinical practice guideline for colon and rectal cancer v.1.0. Seoul: Korean Academy of Medical Sciences;2012.

5. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. New York: Springer-Verlag;2009.

6. El-Shami K, Oeffinger KC, Erb NL, Willis A, Bretsch JK, Pratt-Chapman ML, Cannady RS, Wong SL, Rose J, Barbour AL, Stein KD, Sharpe KB, Brooks DD, Cowens-Alvarado RL. American Cancer Society colorectal cancer survivorship care guidelines. CA Cancer J Clin. 2015; 65:428–455.

7. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): colon cancer. Version 2. Fort Washington: National Comprehensive Cancer Network;2016.

8. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): rectal cancer. Version 1. National Comprehensive Cancer Network: Fort Washington;2016.

9. Meyerhardt JA, Mangu PB, Flynn PJ, Korde L, Loprinzi CL, Minsky BD, Petrelli NJ, Ryan K, Schrag DH, Wong SL, Benson AB. 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; 31:4465–4470.

10. Lynch HT, Lynch JF. Hereditary nonpolyposis colorectal cancer. Semin Surg Oncol. 2000; 18:305–313.

11. Forlenza MJ, Hall P, Lichtenstein P, Evengard B, Sullivan PF. Epidemiology of cancer-related fatigue in the Swedish twin registry. Cancer. 2005; 104:2022–2031.

12. Wang XS, Zhao F, Fisch MJ, O'Mara AM, Cella D, Mendoza TR, Cleeland CS. Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors. Cancer. 2014; 120:425–432.

13. Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev. 2012; 8:CD008465.

14. Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C. Cancer-related fatigue, version 2.2015. J Natl Compr Canc Netw. 2015; 13:1012–1039.

15. Weaver KE, Foraker RE, Alfano CM, Rowland JH, Arora NK, Bellizzi KM, Hamilton AS, Oakley-Girvan I, Keel G, Aziz NM. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care. J Cancer Surviv. 2013; 7:253–261.

16. Giovannucci E, Ascherio A, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med. 1995; 122:327–334.

17. Jensen SA, Sorensen JB. 5-Fluorouracil-based therapy induces endovascular injury having potential significance to development of clinically overt cardiotoxicity. Cancer Chemother Pharmacol. 2012; 69:57–64.

18. Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw. 2009; 7:883–893.

19. Shim EJ, Shin YW, Jeon HJ, Hahm BJ. Distress and its correlates in Korean cancer patients: pilot use of the distress thermometer and the problem list. Psychooncology. 2008; 17:548–555.

20. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67:361–370.

21. Khan NF, Mant D, Carpenter L, Forman D, Rose PW. Long-term health outcomes in a British cohort of breast, colorectal and prostate cancer survivors: a database study. Br J Cancer. 2011; 105:Suppl 1. S29–S37.

22. Jansen L, Hoffmeister M, Chang-Claude J, Koch M, Brenner H, Arndt V. Age-specific administration of chemotherapy and long-term quality of life in stage II and III colorectal cancer patients: a population-based prospective cohort. Oncologist. 2011; 16:1741–1751.

23. 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; 100:1377–1387.

24. Guren MG, Eriksen MT, Wiig JN, Carlsen E, Nesbakken A, Sigurdsson HK, Wibe A, Tveit KM. Norwegian Rectal Cancer Group. Quality of life and functional outcome following anterior or abdominoperineal resection for rectal cancer. Eur J Surg Oncol. 2005; 31:735–742.

25. Mercadante S. Diarrhea in terminally ill patients: pathophysiology and treatment. J Pain Symptom Manage. 1995; 10:298–309.

26. Hassan I, Larson DW, Wolff BG, Cima RR, Chua HK, Hahnloser D, O'Byrne MM, Larson DR, Pemberton JH. Impact of pelvic radiotherapy on morbidity and durability of sphincter preservation after coloanal anastomosis for rectal cancers. Dis Colon Rectum. 2008; 51:32–37.

27. Lindgren R, Hallbook O, Rutegard J, Sjodahl R, Matthiessen P. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum. 2011; 54:41–47.

28. Maggiori L, Bretagnol F, Lefevre JH, Ferron M, Vicaut E, Panis Y. Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis. 2011; 13:632–637.

29. Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis. 2008; 10:785–788.

30. Nelson RS, Boland E, Ewing BM, Blatchford GJ, Ternent C, Shashidharan M, Tran NA, Beaty J, Thorson AG. Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer. Am J Surg. 2009; 198:765–770.

31. Danielsen AK, Burcharth J, Rosenberg J. Patient education has a positive effect in patients with a stoma: a systematic review. Colorectal Dis. 2013; 15:e276–e283.

32. Liu L, Herrinton LJ, Hornbrook MC, Wendel CS, Grant M, Krouse RS. Early and late complications among long-term colorectal cancer survivors with ostomy or anastomosis. Dis Colon Rectum. 2010; 53:200–212.

33. Lange MM, van de Velde CJ. Faecal and urinary incontinence after multimodality treatment of rectal cancer. PLoS Med. 2008; 5:e202.

34. Delacroix SE Jr, Winters JC. Voiding dysfunction after pelvic colorectal surgery. Clin Colon Rectal Surg. 2010; 23:119–127.

35. Smith AL, Wein AJ. Urinary incontinence: pharmacotherapy options. Ann Med. 2011; 43:461–476.

36. Beijers AJ, Mols F, Vreugdenhil G. A systematic review on chronic oxaliplatin-induced peripheral neuropathy and the relation with oxaliplatin administration. Support Care Cancer. 2014; 22:1999–2007.

37. Mols F, Beijers T, Lemmens V, van den Hurk CJ, Vreugdenhil G, van de Poll-Franse LV. 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; 31:2699–2707.

38. Vatandoust S, Joshi R, Pittman KB, Esterman A, Broadbridge V, Adams J, Singhal N, Yeend S, Price TJ. A descriptive study of persistent oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer. Support Care Cancer. 2014; 22:513–518.

39. Hershman DL, Lacchetti C, Dworkin RH, Lavoie Smith EM, Bleeker J, Cavaletti G, Chauhan C, Gavin P, Lavino A, Lustberg MB, Paice J, Schneider B, Smith ML, Smith T, Terstriep S, Wagner-Johnston N, Bak K, Loprinzi CL. American Society of Clinical Oncology. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2014; 32:1941–1967.

40. Smith EM, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, Bressler LR, Fadul CE, Knox C, Le-Lindqwister N, Gilman PB, Shapiro CL. Alliance for Clinical Trials in Oncology. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013; 309:1359–1367.

41. Den Oudsten BL, Traa MJ, Thong MS, Martijn H, De Hingh IH, Bosscha K, van de Poll-Franse LV. Higher prevalence of sexual dysfunction in colon and rectal cancer survivors compared with the normative population: a population-based study. Eur J Cancer. 2012; 48:3161–3170.

42. Donovan KA, Thompson LM, Hoffe SE. Sexual function in colorectal cancer survivors. Cancer Control. 2010; 17:44–51.

43. Milbury K, Cohen L, Jenkins R, Skibber JM, Schover LR. The association between psychosocial and medical factors with long-term sexual dysfunction after treatment for colorectal cancer. Support Care Cancer. 2013; 21:793–802.

44. Lange MM, Marijnen CA, Maas CP, Putter H, Rutten HJ, Stiggelbout AM, Meershoek-Klein Kranenbarg E, van de Velde CJ. Cooperative clinical investigators of the Dutch. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer. 2009; 45:1578–1588.

45. Park SY, Choi GS, Park JS, Kim HJ, Park JA, Choi JI. Efficacy and safety of udenafil for the treatment of erectile dysfunction after total mesorectal excision of rectal cancer: a randomized, double-blind, placebo-controlled trial. Surgery. 2015; 157:64–71.

46. Hermann RM, Henkel K, Christiansen H, Vorwerk H, Hille A, Hess CF, Schmidberger H. Testicular dose and hormonal changes after radiotherapy of rectal cancer. Radiother Oncol. 2005; 75:83–88.

47. Cercek A, Siegel CL, Capanu M, Reidy-Lagunes D, Saltz LB. Incidence of chemotherapy-induced amenorrhea in premen-opausal women treated with adjuvant FOLFOX for colorectal cancer. Clin Colorectal Cancer. 2013; 12:163–167.

48. Spanos CP, Mamopoulos A, Tsapas A, Syrakos T, Kiskinis D. Female fertility and colorectal cancer. Int J Colorectal Dis. 2008; 23:735–743.

49. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat. 2014; 46:109–123.

50. Walter V, Jansen L, Hoffmeister M, Ulrich A, Chang-Claude J, Brenner H. Smoking and survival of colorectal cancer patients: population-based study from Germany. Int J Cancer. 2015; 137:1433–1445.

51. Yang B, Jacobs EJ, Gapstur SM, Stevens V, Campbell PT. Active smoking and mortality among colorectal cancer survivors: the Cancer Prevention Study II nutrition cohort. J Clin Oncol. 2015; 33:885–893.

52. Oh MG, Han MA, Park J, Ryu SY, Park CY, Choi SW. Health behaviors of cancer survivors: the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV, 2007-09). Jpn J Clin Oncol. 2013; 43:981–987.

53. Yi SW, Sull JW, Linton JA, Nam CM, Ohrr H. Alcohol consumption and digestive cancer mortality in Koreans: the Kangwha Cohort Study. J Epidemiol. 2010; 20:204–211.

54. Bardou M, Barkun AN, Martel M. Obesity and colorectal cancer. Gut. 2013; 62:933–947.

55. Renehan AG, Soerjomataram I, Tyson M, Egger M, Zwahlen M, Coebergh JW, Buchan I. Incident cancer burden attributable to excess body mass index in 30 European countries. Int J Cancer. 2010; 126:692–702.

56. Sinicrope FA, Foster NR, Yothers G, Benson A, Seitz JF, Labianca R, Goldberg RM, Degramont A, O'Connell MJ, Sargent DJ. Adjuvant Colon Cancer Endpoints (ACCENT) Group. Body mass index at diagnosis and survival among colon cancer patients enrolled in clinical trials of adjuvant chemotherapy. Cancer. 2013; 119:1528–1536.

57. Dignam JJ, Polite BN, Yothers G, Raich P, Colangelo L, O'Connell MJ, Wolmark N. Body mass index and outcomes in patients who receive adjuvant chemotherapy for colon cancer. J Natl Cancer Inst. 2006; 98:1647–1654.

58. Gibson TM, Park Y, Robien K, Shiels MS, Black A, Sampson JN, Purdue MP, Freeman LE, Andreotti G, Weinstein SJ, Albanes D, Fraumeni JF Jr, Curtis RE, Berrington de Gonzalez A, Morton LM. Body mass index and risk of second obesity-associated cancers after colorectal cancer: a pooled analysis of prospective cohort studies. J Clin Oncol. 2014; 32:4004–4011.

59. Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. J Clin Oncol. 2015; 33:1825–1834.

60. Van Roekel EH, Bours MJ, Breedveld-Peters JJ, Meijer K, Kant I, Van Den Brandt PA, Sanduleanu S, Beets GL, Weijenberg MP. Light physical activity is associated with quality of life after colorectal cancer. Med Sci Sports Exerc. 2015; 47:2493–2503.

61. Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, Nelson H, Whittom R, Hantel A, Thomas J, Fuchs CS. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA. 2007; 298:754–764.

62. Meyerhardt JA, Sato K, Niedzwiecki D, Ye C, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Wigler DS, Venook A, Fuchs CS. Dietary glycemic load and cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Natl Cancer Inst. 2012; 104:1702–1711.

63. Yang B, McCullough ML, Gapstur SM, Jacobs EJ, Bostick RM, Fedirko V, Flanders WD, Campbell PT. Calcium, vitamin D, dairy products, and mortality among colorectal cancer survivors: the Cancer Prevention Study-II Nutrition Cohort. J Clin Oncol. 2014; 32:2335–2343.

64. Provenzale D, Jasperson K, Ahnen DJ, Aslanian H, Bray T, Cannon JA, David DS, Early DS, Erwin D, Ford JM, Giardiello FM, Gupta S, Halverson AL, Hamilton SR, Hampel H, Ismail MK, Klapman JB, Larson DW, Lazenby AJ, Lynch PM, Mayer RJ, Ness RM, Rao MS, Regenbogen SE, Shike M, Steinbach G, Weinberg D, Dwyer MA, Freedman-Cass DA, Darlow S. Colorectal Cancer Screening, Version 1.2015. J Natl Compr Canc Netw. 2015; 13:959–968.

65. Jasperson KW, Tuohy TM, Neklason DW, Burt RW. Hereditary and familial colon cancer. Gastroenterology. 2010; 138:2044–2058.