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NCCN Flash Update: NCCN Guidelines® for Genetic/Familial High-Risk Assessment: Breast and Ovarian & Survivorship and NCCN Biomarkers Compendium® for Head and Neck Cancer

NCCN has published updates to the NCCN Biomarkers Compendium®, based on updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancer Version 2.2018.

 

NCCN has published updates to the NCCN Guidelines® for Genetic/Familial High-Risk Assessment: Breast and Ovarian. These NCCN Guidelines are currently available as Version 2.2019.

  • BRCA-Related Breast and/or Ovarian Cancer Syndrome
    • BRCA1/2 Testing Criteria (BRCA-1)
      • Under the 2nd bullet, Personal history of breast cancer + one or more of the following:
        • The 1st sub-bullet was revised as, “Diagnosed ≤50 46-50 y with:”
          • The 3rd tertiary bullet was added, “≥1 close blood relative with high-grade (Gleason score ≥7) prostate cancer”
        • Under the 4th sub-bullet, Diagnosed at any age with ≥1 close blood relative with:
          • The criterion was revised by removing, “high-grade (Gleason score ≥7) or” from “metastatic prostate cancer”

 

Previous updates to the NCCN Guidelines for Genetic/Familial High-Risk Assessment: Breast and Ovarian can be found in the UPDATES section of the current version.

 

NCCN has published updates to the NCCN Guidelines for Survivorship. These NCCN Guidelines are currently available as Version 1.2018.

  • The algorithms were updated for the following sections: General Survivorship Principles, Anthracycline-Induced Cardiac Toxicity, Anxiety/Depression/Distress, Cognitive Function, Fatigue, Lymphedema, Hormone-Related Symptoms, Pain, Sexual Function (female and male), Sleep Disorders, and Healthy Lifestyles (Physical Activity, Nutrition and Weight Management, and Supplement Use).
  • General Survivorship Principles
    • Definition of Survivorship: New footnote b added, "These Guidelines focus on disease-free survivors; however, they can also be applicable to those living with metastatic disease.” (SURV-1)
    • Page title changed: “Screening for Second Primary Cancers.” (SURV-3)
    • Survivorship Assessment (Patient Version): Fatigue question revised, “How would you rate your fatigue on a scale of 0 (none) to 10 (extreme) over the past month week? 0–10.” (SURV-A)

LATE EFFECTS/LONG-TERM PSYCHOSOCIAL AND PHYSICAL PROBLEMS

  • Anxiety, Depression, and Distress
    • Screening: Anxiety and Depression (SANXDE-2)
      • Sub-bullet revised: “…had difficulty performing or withdrawn from daily activities because of these (above-mentioned) feelings or problems?"
    • Management and Treatment (SANXDE-8)
      • For Adjustment Disorder or Distress Without Safety Risk, Mania, or Psychosis: Sub-bullet revised: "Refer for therapy to a therapist, preferably one with psycho-oncology training if available (social worker, psychologist, psychiatrist, advanced practice clinician, licensed therapist)."
    • Safety Evaluation: This page has been extensively revised, including adding a new section for "Consider Protective Factors to Balance with Risks." (SANXDE-A)
    • Risk Factors for PTSD: New bullet added, "Significant change in life stressors including health, interpersonal, financial, and occupational." (SANXDE-B)
  • Fatigue
    • Primary Evaluation, Fatigue Score Moderate or Severe (4-10) (SFAT-3)
      • H&P: Gastrointestinal dysfunction, hepatic dysfunction, and infection added to the list of comorbidities.
    • Interventions for Cancer Survivors
      • Other Interventions: Mindfulness-based stress reduction (category 1) was added to the list of psychosocial interventions. (SFAT-5)
  • Hormone-Related Symptoms
    • The algorithm title was revised: "Menopause Hormone-Related Symptoms."
    • Principles of Menopause Management in Female Survivors (SMP-1)
      • Under “Menopause” a new bullet was added: "For peri- or pre-menopausal female survivors who have become amenorrheic and later develop bleeding, serial estradiol levels can be useful to determine return of ovarian function. Other markers including follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), and inhibin may provide additional information on ovarian status in female cancer survivors with prior chemotherapy or those on tamoxifen, but alone are not reliable to ensure menopausal status."
    • Treatment (Females)
      • Footnote i regarding non-pharmacologic treatments (SMP-4)
        • First bullet revised: "Compounds with limited evidence of safety and efficacy (all category 2B)."
        • New bullet added: "Data are limited on the effectiveness and safety of these nonpharmacologic treatments in survivors of some cancers. The panel consensus is that the efficacy and safety data for these treatments are too limited to make a recommendation for use." A similar change was made to footnote p for males on page SMP-6.
      • Vaginal dryness: Third bullet revised, "Other topical prescriptions hormones (ie, testosterone, DHEA).” (SMP-5)
      • Footnote m is new: “DHEA should be used with caution in survivors with a history of estrogen-dependent cancers.” (SMP-5)
    • Non-hormonal Pharmacologic Treatments and Dosing (SMP-A)
      • Antidepressants
        • Venlafaxine listed as preferred.
        • For escitalopram and citalopram the following comment was removed, "Use with caution for women on tamoxifen."
      • Anticonvulsant: Gabapentin listed as preferred.
      • Under the "Comments" heading for all drugs, the following statement was added, "For maximum benefit, may increase to higher doses after a week as tolerated.”
  • Pain
    • Principles of Opioid Use in Long-term Survivors (SPAIN-2)
      • A new sub-bullet was added: "Management of opioid adverse events (ie, constipation, nausea, pruritus, delirium, motor and cognitive impairment, respiratory depression, sedation) or opioid-induced symptoms (See PAIN-F of the NCCN Guidelines for Adult Cancer Pain)."
  • Sexual Function
    • Female (SSF-2)
      • Symptoms of pain with sexual activity: Treatment revised, "Prasterone DHEA.”
      • Footnote f is new: “DHEA should be used with caution in survivors with a history of estrogen-dependent cancers.”
  • Sleep Disorders
    • Screening: (SSD-1)
      • Under H&P, sub-bullets for Comorbidities were revised:
        • Hot flashes Vasomotor symptoms (SSD-1)
        • Review sleep/wake timing and/or sleep log/diary if available.
    • Insomnia Disorder Treatment (SSD-2)
      • Cognitive behavioral therapy listed as preferred.
      • New footnote added “Cognitive behavioral therapy is preferred over pharmacologic interventions as first-line therapy.
    • Treatment for Restless Leg Syndrome (SSD-3)
      • Gabapentin, enacarbil, and dopamine agonists listed as "Initial preferred therapy."
      • Clonazepam added.
      • Benzodiazepines removed.

PREVENTIVE HEALTH

  • Healthy Lifestyles (including Physical Activity, Nutrition and Weight Management, and Supplement Use)
    • Physical Activity
      • Implementation of Recommendations (SPA-4)
        • For survivors not meeting guideline recommendations, “Evaluate and address barriers” was added as an option.
        • A new pathway was added for survivors not tolerating or not progressing after implementation of physical activity recommendations.
      • Considerations for Specific Populations: The sections regarding stem cell transplant and poor bone health were removed. (SPA-C)
      • Nutrition and Weight Management Interventions: This page was extensively revised. (SNWM-4)
  • Immunizations and Infections
    • General Principles of Immunizations (SIMIN-1)
      • Third bullet revised: "...live attenuated vaccines might also be contraindicated in survivors’ close contacts Live viral vaccines should be avoided in survivors with lymphomas, other malignant neoplasms affecting the bone marrow or lymphatic system, or history of cellular immunodeficiency. When other vaccine options exist, they should be preferred over live attenuated vaccines in survivors (eg, recombinant zoster vaccine)."
    • Treatment with inactivated, purified agents or components (SIMIN-3)
      • Recombinant zoster vaccine in all survivors 50 years or older” was added as a recommendation for all cancer survivors.
      • Footnote o revised: "PCV-13 and PPSV-23 are recommended for adults 65 years or older and for younger adults who are immunocompromised (ie, HCT and functional or anatomic asplenia) or for lung cancer survivors or those who had lung resection.”
    • Vaccines Contraindicated or to be Used with Caution in Actively Immunocompromised Survivors (SIMIN-A)
      • "Oral polio" was removed from the list of live attenuated vaccines.
      • Footnote 4 is new: "A new recombinant zoster vaccine has become available in the United States and should be considered the preferred zoster vaccine for cancer survivors."
    • Vaccines Considered Safe for Cancer and Transplant Survivors and Close Contacts (SIMIN-B)
      • "Zoster (RZV)" added to the list of recombinant viral antigens.
    • Principles of Zoster (Shingles) Vaccine Use In Cancer or Transplant Survivors (SIMIN-D)
      • A new section for "Recombinant zoster vaccine" was added.
      • A new section heading was added: "Live attenuated zoster vaccine."
      • Zoster vaccine clarified as "Live attenuated zoster vaccine."
      • A new bullet was added: "Although the recombinant zoster vaccine is preferred, the live attenuated zoster vaccine can be given if the recombinant vaccine is unavailable or access to the recombinant vaccine is an issue."

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium®), the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android smartphones & tablets are now available! Visit NCCN.org/apps

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