08/09/2017

CCN has published updates to the NCCN Guidelines for Survivorship

NCCN has published updates to the NCCN Guidelines for Survivorship. These NCCN Guidelines are currently available as Version 2.2017. 

• The algorithms were updated for the following sections:
  • Menopause-related Symptoms
  • Immunizations and Infections
• Menopause-related Symptoms
  • Principles of Menopause Management in Female Survivors (SMP-1)
    • This page was extensively revised and became a separate section for "Principles of Menopause Management in Female Survivors." Previously, it contained recommendations for both females and males.
  • Principles of Menopausal Symptoms In Male Survivors (SMP-2)
    • This section was extensively revised and renamed "Principles of Menopausal Symptoms In Male Survivors." Formerly it was entitled "Male Menopause-related Symptoms Due to Androgen Deprivation Therapy (ADT)."
  • Treatment (SMP-3)
    • “Gynecomastia" and "Anemia" were added to the list of symptoms to treat for males.
    • Footnote "g" is new: "ADT-associated anemia is generally responsive to blood transfusions and erythropoietin and should be treated as per the NCCN Guidelines for Cancer- and Chemotherapy-Induced Anemia."
  • ADT-Related Symptoms (SMP-6)
    • A new pathway and treatment options were added for "Gynecomastia."
    • Treatment bullets were reorganized and the following revisions were made:
      • "Modification to ADT (See NCCN Guidelines for Prostate Cancer)" added.
      • Medroxyprogesterone, cyproterone acetate, and estrogen (eg, diethylstilbestrol) added as hormone therapies.
      • Venlafaxine and gabapentin added as non-hormonal therapies.
      • The list of specific categories for non-hormonal pharmacologic treatments was removed: “Low-dose antidepressants, anti-convulsants, neuropathic pain relievers, and certain anti-hypertensives.”
• Immunizations and Infections
  • Interventions (SIMIN-2)
    • Footnote g regarding zoonosis was revised, “Safe pet care tips include washing hands with soap and running water after handling animals and their feces. If possible, survivors at high risk for immune suppression should avoid direct contact with animal feces and other bodily secretions. Survivors with elevated risk of infection and those who are immunocompromised are at higher risk for zoonoses and should use extra caution.”
  • Treatment with Inactivated, purified antigen vaccines or Bacterial components vaccines (SIMIN-3)
    • "Pneumococcal vaccine" was removed from the "Recommended for all cancer survivors" pathway and added to the "Recommended if some special circumstance or risk factor is present" pathway.
    • Footnote o was revised: "PCV-13 and PPSV-23 are recommended for adults with immunocompromising conditions 65 years or older and for younger adults who are immunocompromised (ie, HCT and functional or anatomic asplenia)."
  • Vaccines Contraindicated Or To Be Used With Caution in Actively Immunocompromised Survivors (SIMIN-A)
    • Live attenuated vaccines: 
      • "Influenza: live, attenuated influenza vaccine (LAIV)" was removed from the list of vaccines.
      • Footnote 4 regarding oral polio is new: “Live oral polio vaccine should not be administered to close contacts of immunocompromised survivors.”
  • Live Vaccines that can be Used With Caution in Close Contacts of Immunocompromised Survivors (SIMIN-A)
    • "Influenza: live, attenuated influenza vaccine (LAIV)" was removed from the list of vaccines.
  • General Principles of Vaccines in Cancer Survivors (SIMIN-B)
    • Under “Vaccination in Non-Transplant Survivors,” two new bullets were added regarding pneumococcal vaccine:
      • “Recommended for adults 65 years or older and for younger adults who are immunocompromised.
      • A second dose of PPSV23 is recommended 5 years after the first dose for immunocompromised survivors and those with functional or anatomic asplenia.”
    • The following recommendation was revised: “Consider human papillomavirus (HPV) vaccine in survivors 11-26 years of through age 26 years. For dosing and schedules, see https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html 3
  • Vaccines Considered Safe for Cancer and Transplant Survivors and Close Contacts
    • Footnote 9 regarding the influenza vaccine was revised: "This vaccine is recommended for patients with egg allergies Administration of the flu vaccine to survivors with egg allergy symptoms (other than hives) should be done at a center that can manage severe allergic reactions.”
• The Discussion section has been updated to reflect the changes in the algorithm. (MS-1)

*For your reference, the previous update (Version 1.2017) to the NCCN Guidelines for Survivorship, published on March 21, 2017, is available at the following link: https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf