The number of long-term colorectal cancer (CRC) survivors has increased substantially over the past three decades due to both ongoing advances in early detection and improvements in cancer therapies. Adult survivors of CRC experience chronic health conditions due to normal issues associated with aging, which is further compounded by the long-term adverse effects of having had cancer and anti-cancer therapies. In addition, they are at a higher risk for CRC recurrences, new primary cancers, and other co-morbidities. This article will provide an overview of the clinical care of adult survivors of CRC. Epidemiologic data will be presented followed by a discussion of the approach to the care of long-term adult survivors of CRC, including surveillance of recurrences and new primary cancers, interventions to manage both physical and psychological consequences of cancer and its treatments, and strategies to address concerns related to unemployment and disability. Finally, we will explore the challenges of healthcare delivery, especially with respect to the coordination of follow-up between cancer specialists and primary care physicians, so as to ensure that all of the survivor’s health needs are met promptly and appropriately.
S. H. Rim, L. Seeff, F. Ahmed, J. B. King and S. S. Coughlin, “Colorectal Cancer Incidence in the United States, 1999-2004: An Updated Analysis of Data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program,” Cancer, Vol. 115, No. 9, 2009, pp. 1967-1976.
B. A. Kohler, E. Ward, B. J. McCarthy, M. J. Schymura, L. A. Ries and C. Eheman, “Annual Report to the Nation on the Status of Cancer, 1975-2007, Featuring Tumors of the Brain and Other Nervous System,” Journal of the National Cancer Institute, Vol. 103, No. 9, 2011, pp. 714-736. doi:10.1093/jnci/djr077
B. J. Kjeldsen, O. Kronborg, C. Fenger and O. D. Jorgensen, “The Pattern of Recurrent Colorectal Cancer in a Prospective Randomised Study and the Characteristics of Diagnostic Tests,” International Journal of Colorectal Disease, Vol. 12, No. 6, 1997, pp. 329-334.
D. Sargent, A. Sobrero, A. Grothey, M. J. O’Connell, M. Buyse and T. Andre, “Evidence for Cure by Adjuvant Therapy in Colon Cancer: Observations Based on Individual Patient Data from 20,898 Patients on 18 Randomized Trials,” Journal of Clinical Oncology, Vol. 27, No. 6, 2009, pp. 872-877. doi:10.1200/JCO.2008.19.5362
J. B. O’Connell, M. A. Maggard and C. Y. Ko, “Colon Cancer Survival Rates with the New American Joint Committee on Cancer Sixth Edition Staging,” Journal of the National Cancer Institute, Vol. 96, No. 19, 2004, pp. 1420-1425.
M. K. McAfee, M. S. Allen, V. F. Trastek, D, M. Ilstrup, C. Deschamps and P. C. Pairolero, “Colorectal Lung Metastases: Results of Surgical Excision,” The Annals of Thoracic Surgery, Vol. 53, No. 5, 1992, pp. 780-785; Discussion, pp. 785-786.
Y. Saito, H. Omiya, K. Kohno, T. Kobayashi, K. Itoi and M. Teramachi, “Pulmonary Metastasectomy for 165 Patients with Colorectal Carcinoma: A Prognostic Assessment,” Journal of Thoracic and Cardiovascular Surgery, Vol. 124, No. 5, 2002, pp. 1007-1013.
R. M. Goldberg, T. R. Fleming, C. M. Tangen, C. G. Moertel, J. S. Macdonald and D. G. Haller, “Surgery for Recurrent Colon Cancer: Strategies for Identifying Resectable Recurrence and Success Rates after Resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group,” Annals of Internal Medicine, Vol. 129, No. 1, 1998, pp. 27-35.
A. Quentmeier, P. Schlag, M. Smok and C. Herfarth, “Re-Operation for Recurrent Colorectal Cancer: The Importance of Early Diagnosis for Resectability and Survival,” European Journal of Surgical Oncology, Vol. 16, No. 4, 1990, pp. 319-325.
J. Ovaska, H. Jarvinen, H. Kujari, I. Perttila and J. P. Mecklin, “Follow-Up of Patients Operated on for Colorectal Carcinoma,” The American Journal of Surgery, Vol. 159, No. 6, 1990, pp. 593-596.
G. M. Jeffery, B. E. Hickey, P. Hider, “Follow-Up Strategies for Patients Treated for Non-Metastatic Colorectal Cancer,” Cochrane Database of Systematic Reviews, Vol. 1, No. 1, 2002, Article ID: CD002200.
A. G. Renehan, M. Egger, M. P. Saunders and S. T. O’Dwyer, “Impact on Survival of Intensive Follow up after Curative Resection for Colorectal Cancer: Systematic Review and Meta-Analysis of Randomised Trials,” BMJ Journals, Vol. 324, No. 7341, 2002, p. 813.
A. Figueredo, R. B. Rumble, J. Maroun, C. C. Earle, B. Cummings and R. McLeod, “Follow-Up of Patients with Curatively Resected Colorectal Cancer: A Practice Guideline,” BMC Cancer, Vol. 3, No. 26, 2003.
C. E. Desch, A. B. Benson, M. R. Somerfield, P. J. Flynn, C. Krause and C. L. Loprinzi, “Colorectal Cancer Surveillance: 2005 Update of an American Society of Clinical Oncology Practice Guideline,” Journal of Clinical Oncology, Vol. 23, No. 33, 2005, pp. 8512-8519.
V. L. Tsikitis, K. Malireddy, E. A. Green, B. Christensen, R. Whelan and J. Hyder, “Postoperative Surveillance Recommendations for Early Stage Colon Cancer Based on Results from the Clinical Outcomes of Surgical Therapy Trial,” Journal of Clinical Oncology, Vol. 27, No. 22, 2009, pp. 3671-3676. doi:10.1200/JCO.2008.20.7050
W. E. Longo, K. S. Virgo, F. E. Johnson, C. A. Oprian, A. M. Vernava and T. P. Wade, “Risk Factors for Morbidity and Mortality after Colectomy for Colon Cancer,” Diseases of the Colon & Rectum, Vol. 43, No. 1, 2000, pp. 83-91. doi:10.1007/BF02237249
M. W. Hinojosa, V. R. Konyalian, Z. A. Murrell, J. E. Varela, M. J. Stamos and N. T. Nguyen, “Outcomes of Right and Left Colectomy at Academic Centers,” The American Surgeon, Vol. 73, No. 10, 2007, pp. 945-948.
M. E. Cinat, S. E. Wilson and A. M. Din, “Determinants for Successful Percutaneous Image-Guided Drainage of Intra-Abdominal Abscess,” Archives of Surgery, Vol. 137, No. 7, 2002, pp. 845-849.
S. D. Holubar, J. K. Wang, B. G. Wolff, D. M. Nagorney, E. J. Dozois and R. R. Cima, “Splenic Salvage after Intraoperative Splenic Injury during Colectomy,” Archives of Surgery, Vol. 144, No. 11, 2009, pp. 1040-1045.
H. Masoomi, J. C. Carmichael, S. Mills, N. Ketana, M. O. Dolich and M. J. Stamos, “Predictive Factors of Splenic Injury in Colorectal Surgery: Data from the Nationwide Inpatient Sample, 2006-2008,” Archives of Surgery, Vol. 147, No. 4, 2012, pp. 324-329.
P. P. Varty, I. P. Linehan and P. B. Boulos, “Does Concurrent Splenectomy at Colorectal Cancer Resection Influence Survival?” Diseases of the Colon & Rectum, Vol.36, No. 6, 1993, pp. 602-606.
J. Rose, C. Schneider, C. Yildirim, P. Geers, H. Scheidbach and F. Kockerling, “Complications in Laparoscopic Colorectal Surgery: Results of a Multicentre Trial,” Techniques in Coloproctology, Vol. 8, Suppl. 1, 2004, pp. s25-s28. doi:10.1007/s10151-004-0103-3
J. Franko, B. G. O’Connell, J. R. Mehall, S. G. Harper, J. H. Nejman and D. M. Zebley, “The Influence of Prior Abdominal Operations on Conversion and Complication Rates in Laparoscopic Colorectal Surgery,” Journal of the Society of Laparoendscopic Surgeons, Vol. 10, No. 2, 2006, pp. 169-175.
J. Blumetti, M. Luu, G. Sarosi, K. Hartless, J. McFarlin and B. Parker, “Surgical Site Infections after Colorectal Surgery: Do Risk Factors Vary Depending on the Type of Infection Considered?” Surgery, Vol.142, No. 5, 2007, pp. 704-711. doi:10.1016/j.surg.2007.05.012
K. L. Leung, S. P. Kwok, S. C. Lam, J. F. Lee, R. Y. Yiu and S. S. Ng, “Laparoscopic Resection of Rectosigmoid Carcinoma: Prospective Randomised Trial,” Lancet, Vol. 363, No. 9416, 2004, pp. 1187-1192.
J. Pachler and P. Wille-Jorgensen, “Quality of Life after Rectal Resection for Cancer, with or Without Permanent Colostomy,” Cochrane Database of Systematic Reviews, Vol. 2, 2005, Article ID: CD004323.
J. A. Cornish, H. S. Tilney, A. G. Heriot, I. C. Lavery, V. W. Fazio and P. P. Tekkis, “A Meta-Analysis of Quality of Life for Abdominoperineal Excision of Rectum versus Anterior Resection for Rectal Cancer,” Annals of Surgical Oncology, Vol. 14, No. 7, 2007, pp. 2056-2068.
M. S. Kasparek, I. Hassan, R. R. Cima, D. R. Larson, R. E. Gullerud and B. G. Wolff, “Long-Term Quality of Life and Sexual and Urinary Function after Abdominoperineal Resection for Distal Rectal Cancer,” Diseases of the Colon & Rectum, Vol. 55, No. 2, 2012, pp. 147-154.
I. C. Lavery, F. Lopez-Kostner, V. W. Fazio, M. Fernandez-Martin, J. W. Milsom and J. M. Church, “Chances of Cure Are Not Compromised with Sphincter-Saving Procedures for Cancer of the Lower Third of the Rectum,” Surgery, Vol. 122, No. 4, 1997, pp. 779-784; Discussion 784-185. doi:10.1016/S0039-6060(97)90087-8
S. T. Martin, H. M. Heneghan and D. C. Winter, “Systematic Review of Outcomes after Intersphincteric Resection for Low Rectal Cancer,” British Journal of Surgery, Vol. 99, No. 5, 2012, pp. 603-612.
C. Y. Ko, J. Tong, R. E. Lehman, A. A. Shelton, T. R. Schrock and M. L. Welton, “Biofeedback Is Effective Therapy for Fecal Incontinence and Constipation,” Archives of Surgery, Vol. 132, No. 8, 1997, pp. 829-833; discussion 833-834.
F. Guillemot, B. Bouche, C. Gower-Rousseau, M. Chartier, E. Wolschies and M. D. Lamblin, “Biofeedback for the Treatment of Fecal Incontinence. Long-Term Clinical Results,” Diseases of the Colon & Rectum, Vol. 38, No. 4, 1995, pp. 393-397. doi:10.1007/BF02054228
C. M. Byrne, M. J. Solomon, J. M. Young, J. Rex and C. L. Merlino, “Biofeedback for Fecal Incontinence: Short-Term Outcomes of 513 Consecutive Patients and Predictors of Successful Treatment,” Diseases of the Colon & Rectum, Vol. 50, No. 4, 2007, pp. 417-427.
M. Pocard, F. Zinzindohoue, F. Haab, S. Caplin, R. Parc and E. Tiret, “A Prospective Study of Sexual and Urinary Function before and after Total Mesorectal Excision with Autonomic Nerve Preservation for Rectal Cancer,” Surgery, Vol. 131, No. 4, 2002, pp. 368-372.
J. A. Cornish, E. Tan, J. Teare, T. G. Teoh, R. Rai and A. W. Darzi, “The Effect of Restorative Proctocolectomy on Sexual Function, Urinary Function, Fertility, Pregnancy and Delivery: A Systematic Review,” Diseases of the Colon & Rectum, Vol. 50, No. 8, 2007, pp. 1128-1138.
I. Lindsey, B. D. George, M. G. Kettlewell and N. J. Mortensen, “Impotence after Mesorectal and Close Rectal Dissection for Inflammatory Bowel Disease,” Diseases of the Colon & Rectum, Vol. 44, No. 6, 2001, pp. 831-835.
V. P. Ho, Y. Lee, S. L. Stein and L. K. Temple, “Sexual Function after Treatment for Rectal Cancer: A Review,” Diseases of the Colon & Rectum, Vol. 54, No. 1, 2011, pp. 113-125. doi:10.1007/DCR.0b013e3181fb7b82
E. R. Park, S. L. Bober, E. G. Campbell, C. J. Recklitis, J. S Kutner and L. Diller, “General Internist Communication about Sexual Function with Cancer Survivors,” Journal of General Internal Medicine, Vol. 24, Suppl. 2, 2009, pp. S407-S411. doi:10.1007/s11606-009-1026-5
I. D. White, H. Allan and S. Faithfull, “Assessment of Treatment-Induced Female Sexual Morbidity in Oncology: Is This a Part of Routine Medical Follow-Up after Radical Pelvic Radiotherapy?” British Journal of Cancer, Vol. 105, No. 7, 2011, pp. 903-910.
L. Liu, L. J. Herrinton, M. C. Hornbrook, C. S. Wendel, M. Grant and R. S. Krouse, “Early and Late Complications among Long-Term Colorectal Cancer Survivors with Ostomy or Anastomosis,” Diseases of the Colon & Rectum, Vol. 53, No. 2, 2010, pp. 200-212.
C. K. McMullen, M. C. Hornbrook, M. Grant, C. M. Baldwin, C. S. Wendel and M. J. Mohler, “The Greatest Challenges Reported by Long-Term Colorectal Cancer Survivors with Stomas,” The Journal of Supportive Oncology, Vol. 6, No. 4, 2008, pp. 175-182.
T. E. Schultheiss, W. R. Lee, M. A. Hunt, A. L. Hanlon, R. S. Peter and G. E. Hanks, “Late GI and GU Complications in the Treatment of Prostate Cancer,” International Journal of Radiation Oncology, Biology and Physics, Vol. 37, No. 1, 1997, pp. 3-11.
C. Henson, “Chronic Radiation Proctitis: Issues Surrounding Delayed Bowel Dysfunction Post-Pelvic Radiotherapy and an Update on Medical Treatment,” Therapeutic Advances in Gastroenterology, Vol. 3, No. 6, 2010, pp. 359-365. doi:10.1177/1756283X10371558
N. H. Gilinsky, D. G. Burns, G. O. Barbezat, W. Levin, H. S. Myers and I. N. Marks, “The Natural History of Radiation-Induced Proctosigmoiditis: An Analysis of 88 Patients,” The Quarterly Journal of Medicine, Vol. 52, No. 205, 1983, pp. 40-53.
W. Small Jr. and L. Kachnic, “Postradiotherapy Pelvic Fractures: Cause for Concern or Opportunity for Future Research?” The Journal of the American Medical Association, Vol. 294, No. 20, 2005, pp. 2635-2637.
N. N. Baxter, E. B. Habermann, J. E. Tepper, S. B. Durham and B. A. Virnig, “Risk of Pelvic Fractures in Older Women following Pelvic Irradiation,” The Journal of the American Medical Association, Vol. 294, No. 20, 2005, pp. 2587-2593. doi:10.1001/jama.294.20.2587
J. D. Wright, C. M. St Clair, I. Deutsch, W. M. Burke, P. Gorrochurn, X. Sun, “Pelvic Radiotherapy and the Risk of Secondary Leukemia and Multiple Myeloma,” Cancer, Vol. 116, No. 10, 2010, pp. 2486-2492.
C. M. Sapp and P. DeSimone, “Palmar-Plantar Erythrodysesthesia Associated with Scrotal and Penile Involvement with Capecitabine,” Clinical Colorectal Cancer, Vol. 6, No. 5, 2007, pp. 382-385.
W. Scheithauer and J. Blum, “Coming to Grips with Hand- Foot Syndrome. Insights from Clinical Trials Evaluating Capecitabine,” Oncology (Williston Park), Vol. 18, No. 9, 2004, pp. 1161-1168, 1173; Discussion, pp. 1173-1176, 1181-1184.
E. Gamelin, L. Gamelin, L. Bossi and S. Quasthoff, “Clinical Aspects and Molecular Basis of Oxaliplatin Neurotoxicity: Current Management and Development of Preventive Measures,” Seminars in Oncology, Vol. 29, Suppl. 15, 2002, pp. 21-33. doi:10.1053/sonc.2002.35525
A. Caraceni, E. Zecca, C. Bonezzi, E. Arcuri, R. Y. Tur and M. Maltoni, “Gabapentin for Neuropathic Cancer Pain: A Randomized Controlled Trial from the Gabapentin Cancer Pain Study Group,” Journal of Clinical Oncology, Vol. 22, No. 14, 2004, pp. 2909-2917.
B. M. Lynch, S. K. Steginga, A. L. Hawkes, K. I. Pakenham and J. Dunn, “Describing and Predicting Psychological Distress after Colorectal Cancer,” Cancer, Vol. 112, No. 6, 2008, pp. 1363-1370.
M. E. Kurtz, J. C. Kurtz, M. Stommel, C. W. Given and B. Given, “Predictors of Depressive Symptomatology of Geriatric Patients with Colorectal Cancer: A Longitudinal View,” Support Care Cancer, Vol. 10, No. 6, 2002, pp. 494-501. doi:10.1007/s00520-001-0338-8
K. R. Yabroff, W. F. Lawrence, S. Clauser, W. W. Davis and M. L. Brown, “Burden of Illness in Cancer Survivors: Findings from a Population-Based National Sample,” Journal of the National Cancer Institute, Vol. 96, No. 17, 2004, pp. 1322-1330. doi:10.1093/jnci/djh255
C. C. Earle, Y. Chretien, C. Morris, J. Z. Ayanian, N. L. Keating and L. A. Polgreen, “Employment among Survivors of Lung Cancer and Colorectal Cancer,” Journal of Clinical Oncology, Vol. 28, No. 10, 2010, pp. 1700-1705.
W. Y. Cheung, B. A. Neville, D. B. Cameron, E. F. Cook and C. C. Earle, “Comparisons of Patient and Physician Expectations for Cancer Survivorship Care,” Journal of Clinical Oncology, Vol. 27, No. 15, 2009, pp. 2489-2495.