A 10-year history of lung cancer practice guideline development: Process, productivity and impact

Abstract

17044 Background: CCO's Program in Evidence-based Care at McMaster University, has developed and disseminated clinical guidance documents through provincial DSGs for 10 years. The 37 member Lung DSG includes medical oncologists (17), radiation oncologists (11), thoracic surgeons (4), nurses (2), and a research coordinator. Pathologists (3), community/patient representatives (2), a medical resident and medical sociologist have previously been members. Methods: The LDSG has used the practice guideline (PG) development cycle described by Browman GP et al (JCO 1998; 16(3):1226–31). Results: 31 reports have been published in peer-reviewed journals, including 25 guidelines; all PGs are posted on the CCO website. Topics were initially selected on the basis of known practice variability (chemotherapy for Stage IV NSCLC) or clinical controversy (combined modality therapy for Stage III NSCLC); PGs for single chemotherapy drugs (6) or chemotherapy usage in specific situations (7) have dominated DSG activity; 5 PGs on radiotherapy alone and 3 on RT as part of CMT have been completed; recent PGs have been written for rare tumours (mesothelioma, thymoma) and diagnostic imaging (PET). Initially, PGs were based solely on published RCT evidence. Evidence from publicly accessible abstracts/meeting presentations, and Phase II trials (in the absence of higher quality evidence) is now considered. For rare tumours (thymoma), the DSG has used a Delphi consensus methodology. Knowledge transfer occurs through the DSG meeting process (twice yearly face-to-face; 2–4 teleconferences), practitioner feedback (PF), publications, presentations and web posting. PF using a standardized feedback questionnaire is generally high (59.9%) but varies by PG and discipline; PF is incorporated into final guideline documents. Guideline recommendations for the use of vinorelbine, gemcitabine, taxanes and erlotinib in NSCLC have been successful in securing government funding. No significant financial relationships to disclose.