Scientific evidence underlying the National Comprehensive Cancer Network Guidelines for Supportive Care.

Abstract

e19506 Background: The National Comprehensive Cancer Network (NCCN) has published guidelines for supportive care of cancer patients. However, the level of scientific evidence on which these guidelines are based has not been systematically investigated. We performed this study to describe the distribution of categories of evidence and consensus (EC) among the 10 supportive care guidelines with regards to screening, treatment, and follow-up. Methods: We obtained the latest versions (January 18, 2011) of relevant supportive care guidelines from the NCCN website. The definitions for various categories of EC used by NCCN panel members were as follows: category 1 (high level evidence such as randomized controlled trials with uniform consensus), category 2A (lower level of evidence with uniform consensus), category 2B (lower level of evidence without a uniform consensus but with no major disagreement) and category 3 (any level of evidence but with major disagreement). Results: Amongst the 680 recommendations, 21%, 58%, and 21% were for screening, treatment, and follow-up respectively. Overall, the proportions of category I, IIA, IIB, and III EC were 5%, 92%, 3%, and 0% respectively. Category I EC were available for myeloid growth factors (16%), prevention and treatment of cancer-related infection (14%), cancer-related fatigue (12%), antiemesis (7%), venous thromboembolism (4%) and distress management (2%) but absent for palliative care, senior adult oncology, cancer and chemotherapy-induced anemia, and adult cancer pain. Amongst therapeutic recommendations, 9% were category I EC and were found in myeloid growth factors (33%), prevention and treatment of cancer-related infections (20%), cancer-related fatigue (18%), antiemesis (11%), venous thromboembolism (7%), and distress management (4%). There was no category I EC for screening or follow-up. Conclusions: NCCN supportive care guidelines are based predominantly on lower level of evidence but with uniform expert consensus. A huge opportunity exists for research to make the guidelines more evidence-based.