Cancer Guideline Development Research Articles

Engaging cancer patients in clinical practice guideline development: a pilot study.

Patient engagement is a key quality component of cancer guideline development; however, the optimal strategy for engaging patients in guideline development remains unclear. The feasibility and efficacy of two patient engagement models was tested by Cancer Care Ontario's cancer guideline development program, the Program in Evidence-Based Care (pebc). In model 1, patients participated in the guideline development process as active members of a working group. In model 2, patients formed a separate consultation group to review project plans and recommendations generated by multiple working groups. Training included online resources (model 1) and an in-person orientation (model 2). The pebc's standard patient engagement process acted as a control. The study was conducted for 1 year. Surveys measured the satisfaction of patients and members of the guideline working groups with the process and the outcome of each model. Three guideline projects used model 1 to engage patients, six projects used model 2 to receive feedback, and one project was used as a control group (14 patients total). Most participants, whatever the model, reported satisfaction with their experience. Key challenges to implementation included patient recruitment and long wait times between meetings (model 1), and difficulty focusing on the discussion topic and poor meeting attendance on the part of patients (model 2). The pilot study demonstrated that, although both models are feasible and effective for the engagement of patients in cancer guideline development, modifications are required to optimize their continued interest. The pebc will use the study results to inform the implementation of a patient engagement strategy for its program.

CoCanCPG. Coordination of cancer clinical practice in Europe.

All European countries are facing common challenges for delivering appropriate, evidence-based care to patients with cancer. Despite tangible improvements in diagnosis and treatment, marked differences in cancer survival exist throughout Europe. The reliable translation of new research evidence into consistent patient-oriented strategies is a key endeavour to overcome inequalities in healthcare. Clinical-practice guidelines are important tools for improving quality of care by informing professionals and patients about the most appropriate clinical practice. Guideline programmes in different countries use similar strategies to achieve similar goals. This results in unnecessary duplication of effort and inefficient use of resources. While different initiatives at the international level have attempted to improve the quality of guidelines, less investment has been made to overcome existing fragmentation and duplication of effort in cancer guideline development and research. To provide added value to existing initiatives and foster equitable access to evidence-based cancer care in Europe, CoCanCPG will establish cooperation between cancer guideline programmes. CoCanCPG is an ERA-Net coordinated by the French National Cancer Institute with 17 partners from 11 countries. The CoCanCPG partners will achieve their goal through an ambitious, stepwise approach with a long-term perspective, involving: 1. implementing a common framework for sharing knowledge and skills; 2. developing shared activities for guideline development; 3. assembling a critical mass for pertinent research into guideline methods; 4. implementing an appropriate framework for cooperation. Successful development of joint activities involves learning how to adopt common quality standards and how to share responsibilities, while taking into account the cultural and organisational diversity of the participating organisations. Languages barriers and different organisational settings add a level of complexity to setting up transnational collaboration. Through its activities, CoCanCPG will make an important contribution towards better access to evidence-based cancer practices and thus contribute to reducing inequalities and improving care for patients with cancer across Europe.

Exercise for people with cancer: a systematic review

Background This systematic review was completed by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario’s Program in Evidence-Based Care (pebc). It provides background and guidance for clinicians with respect to exercise for people living with cancer in active and post treatment. It focuses on the benefits of specific types of exercise, pre-screening requirements for new referrals, safety concerns, and delivery models.Methods Using the pebc’s standardized approach, medline and embase were systematically searched for existing guidelines, systematic reviews, and primary literature.Results The search identified two guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present review provides conclusions about the duration, frequency, and intensity of exercise appropriate for people living with cancer.Conclusions The evidence shows that exercise is safe and provides benefit in quality of life and in muscular and aerobic fitness for people with cancer both during and after treatment. The evidence is sufficient to support the promotion of exercise for adults with cancer, and some evidence supports the promotion of exercise in group or supervised settings and for a long period of time to improve quality of life and muscular and aerobic fitness. Exercise at moderate intensities could also be sustainable for longer periods and could encourage exercise to be continued over an individual’s lifetime. It is important that a pre-screening assessment be conducted to evaluate the effects of disease, treatments, and comorbidities.

Exercise for people with cancer: a systematic review.

This systematic review was completed by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario's Program in Evidence-Based Care (pebc). It provides background and guidance for clinicians with respect to exercise for people living with cancer in active and post treatment. It focuses on the benefits of specific types of exercise, pre-screening requirements for new referrals, safety concerns, and delivery models. Using the pebc's standardized approach, medline and embase were systematically searched for existing guidelines, systematic reviews, and primary literature. The search identified two guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present review provides conclusions about the duration, frequency, and intensity of exercise appropriate for people living with cancer. The evidence shows that exercise is safe and provides benefit in quality of life and in muscular and aerobic fitness for people with cancer both during and after treatment. The evidence is sufficient to support the promotion of exercise for adults with cancer, and some evidence supports the promotion of exercise in group or supervised settings and for a long period of time to improve quality of life and muscular and aerobic fitness. Exercise at moderate intensities could also be sustainable for longer periods and could encourage exercise to be continued over an individual's lifetime. It is important that a pre-screening assessment be conducted to evaluate the effects of disease, treatments, and comorbidities.

Exercise for people with cancer: a clinical practice guideline.

Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario's Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer, focusing on the benefits of specific types of exercise, recommendations about screening requirements for new referrals, and safety concerns. Consistent with the pebc's standardized approach, a systematic search was conducted for existing guidelines, and systematic literature searches were performed in medline and embase for both systematic reviews and primary literature. Content and methodology experts performed an internal review, which was followed by an external review by targeted experts and intended users. The search identified three guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present guideline provides recommendations for the duration, frequency, and intensity of exercise appropriate for people living with cancer. It also provides recommendations for pre-exercise assessment, safety concerns, and delivery models. There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment, and that it does not cause harm. The present guideline is intended to support the Canadian Society for Exercise Physiology's Canadian physical activity guidelines. The recommendations are intended for clinicians and institutions treating cancer patients in Ontario, and for policymakers and program planners involved in the delivery of exercise programs for cancer patients.

Use of heparins in patients with cancer: individual participant data meta-analysis of randomised trials study protocol

IntroductionParenteral anticoagulants may improve outcomes in patients with cancer by reducing risk of venous thromboembolic disease and through a direct antitumour effect. Study-level systematic reviews indicate a reduction in venous...

Why I became a cancer surgeon

Graeme Poston speaks to Roshaine Gunawardana, Managing Commissioning Editor: Graeme Poston (DSc MB BS, MS, FRCS[Eng], FRCS[Ed]) is a consultant hepatobiliary surgeon at the University Hospital Aintree, Liverpool, UK and Professor of Surgery at the University of Liverpool. He enjoys an international reputation in hepatobiliary surgery. To date, he has personally performed over 900 major hepatobiliary resections. His unit at University Hospital Aintree is one of the largest tertiary resectional hepatobiliary practices in the UK, having performed over 2000 liver resections over the last 20 years. He gained his undergraduate medical training at St Georges Hospital Medical School, London, and postgraduate training at The Hammersmith Hospital and St Mary's Hospital, London and University of Texas Medical Branch, Galveston, TX, USA. He is a past President of the European Society of Surgical Oncology, the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, and the British Association of Surgical Oncology. He is Chair of National Health Service England, Hepato Pancreato Biliary Specialized Commissioning, Chair of the NICE Colorectal Cancer Guideline Development Group and Quality Standards Committee, and past Chair of the Cancer Services Committee of the Royal College of Surgeons of England. He is a principal investigator of a number of ongoing national and international clinical trials in hepatobiliary surgery, and co-author of numerous national and international guidelines for the management of hepatobiliary cancers, nine textbooks of surgery, and over 230 papers. Honors and distinctions include a Doctorate of Science honoris causa of King George V University, Lucknow; Ernest Miles Medal of the Royal Marsden Surgical Society; Olaf ac Acrel Medal of the Swedish Surgical Association; Stanford Cade Medal of the Royal College of Surgeons of England; Kilroe Medal of the Christie Hospital, Manchester; N K Misra Medal of the Indian Association of Surgical Oncology; Honorary Fellow of the Association of Surgeons of India and the College of Surgeons of Sri Lanka; Hunterian Professor of the Royal College of Surgeons of England; and numerous international visiting professorships. In what little spare time he has, he enjoys trekking in high places (climbed Kilimanjaro, trekked to Everest and Annapurna Base Camps, and crossed the Lakya La).

Optimisation of Preoperative Assessment in Patients Diagnosed with Rectal Cancer

AimsTreatment decision making for patients with rectal cancer is complex and optimal preoperative assessment is important to ensure patients receive appropriate and high-quality care. Therefore, our objective was to develop an evidence-based, multidisciplinary guideline to assist physicians treating rectal cancer to ensure that preoperative assessment is optimal. Materials and methodsA multidisciplinary expert panel of physicians who treat rectal cancer was selected as members of the Cancer Care Ontario Preoperative Assessment for Rectal Cancer Guideline Development Group (GDG). This group initially met to identify important clinical questions with respect to optimisation of preoperative assessment in patients diagnosed with rectal cancer. A systematic review, specific to each of these clinical questions, was then conducted using MEDLINE, EMBASE and the Cochrane Library databases. The GDG met at regular intervals to review the evidence and to develop guidelines to address each of the clinical questions. ResultsThe GDG identified seven important clinical questions with respect to the optimisation of preoperative assessment in patients diagnosed with rectal cancer. The clinical questions pertained to: (i) investigations required to assess distant metastasis (one question); (ii) imaging for local staging of rectal cancer (five questions); (iii) multidisciplinary cancer conference (MCC) (one question); (iv) restaging-magnetic resonance imaging (one question). The systematic reviews related to these clinical questions yielded 31 articles that were abstracted and reviewed by the GDG. Based on the systematic reviews, a guideline was developed containing seven recommendations that were either adapted from existing guidelines, based on review of the evidence or by consensus when evidence was limited. ConclusionsA set of seven recommendations have been developed in order to optimise pretreatment assessment in patients with rectal cancer by promoting evidence-based practice. These guidelines are based on the best available evidence and have been peer reviewed by two independent multidisciplinary expert panels for relevance and validity.

Interview: Data acquisition, tumor heterogeneity and precision medicine: future challenges for oncologic comparative effectiveness research

Al B Benson 3rd, MD, FACP, is a Professor of Medicine in the Division of Hematology/Oncology at Northwestern University’s Feinberg School of Medicine in Chicago (IL, USA). He is also the Associate Director for Clinical Investigations for the Robert H Lurie Comprehensive Cancer Center. Benson earned his medical degree at the State University of New York at Buffalo, following which he completed an Internal Medicine Residency at the University of Wisconsin Hospitals in Madison (WI, USA). He was an Assistant Professor of Medicine at the University of Illinois and Co-Medical Director for the National Public Health Service in Champaign (IL, USA). He then served as a Clinical Oncology Fellow at the University of Wisconsin Clinical Cancer Center. Benson is a recipient of the American Society of Clinical Oncology (ASCO) Statesman Award (Fellow of ASCO). He has been a member of the ASCO Task Force on Quality of Cancer Care, the Co-Chair of ASCO’s Stage II Colon Cancer Guidelines Panel and the Guidelines Panel for use of Radiofrequency Ablation for Colorectal Cancer Hepatic Metastases. He also is the Chair of both the Eastern Cooperative Oncology Group Gastrointestinal and Data Monitoring Committees. In addition, he is a past President of the Illinois Medical Oncology Society, past President for the Association of Community Cancer Centers, and a member of the Executive Committee and immediate past-chair of the Board of Directors of the National Comprehensive Cancer Network (NCCN). He is a member of the Board of the NCCN Foundation and ECOG Research and Education Foundation. He is the past President of the International Society of GI Oncology. Benson is a member of the Scientific Board of Directors of the Patient Advocate Foundation, the National Patient Advocate Foundation, Fight Colorectal Cancer and Friends of Cancer Research. Benson’s research is primarily in the areas of gastrointestinal cancer clinical trials and cancer guideline development. Benson is an associate editor of the Journal of Comparative Effectiveness Research .

NICE guidance on the diagnosis and treatment of colorectal cancer

Graeme Poston is a consultant hepatobiliary surgeon at University Hospital Aintree (Liverpool, UK) and Professor of Surgery at University of Liverpool, enjoying an international reputation in hepatobiliary surgery. He has personally performed over 800 major liver and biliary resections (mainly for metastatic colorectal cancer) and heads one of the largest resectional hepatobiliary practices in the UK. He qualified at St George’s Hospital Medical School (London, UK), in 1979, subsequently training at Hammersmith Hospital and St Mary’s Hospital (London, UK) and the University of Texas Medical Branch, Galveston, (TX, USA). Graeme Poston is President of the European Society of Surgical Oncology and Past-President of the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, and the British Association of Surgical Oncology. He is Chair of the NICE Colorectal Cancer Guideline Development Group, Colorectal Cancer Quality Standards Development Committee and National Health Service Specialized Commissioning Clinical Reference Group for HPB Services. He is a past Chair of the Cancer Services Committee of the Royal College of Surgeons of England. In addition to membership of UK and European clinical trial committees, Poston is a principal investigator of several ongoing national and international clinical trials in hepatobiliary oncology. He is chair/co-author of numerous national and international guideline development groups for the management of colorectal cancer, neuroendocrine tumors and hepatocellular carcinoma.

Cancer guideline development in Europe: A survey among ECCO members

A survey was conducted among European Cancer Organisations by the European CanCer Organisation (ECCO) to evaluate initiatives on cancer guideline development.An electronic questionnaire based on the ‘Appraisal of Guidelines Research and Evaluation’ (AGREE) instrument was sent to different ECCO members and other Scientific European Organisations involved in cancer care.Between April 2010 and July 2010, 30 European Cancer Organisations (ECOs) were contacted and 21 responded to the questionnaire. Of these, 13 were involved in the production of clinical practice guidelines.The majority of the cancer guidelines were treatment or disease-management related (84.6%). The objectives were appropriate clinical care (76.9%), cost containment (7.7%) or both (23.1%). Almost all organisations developed guidelines for their members but more than half were also aimed at policy makers (53.9%).In 69% of cases, the guidelines were developed according to specific instructions by searches in an electronic data base while in 46.2% there was a manual evaluation of the original articles.Disciplines almost always involved in guideline development groups were the medical and nursing specialities, while in some groups, communication specialists were always involved. Patients, as key stakeholders of the guidelines were involved by eight organisations in their development.The median costs for the development of a cancer guideline were between 25000 and 50,000euro.This survey shows that many European cancer organisations are producing cancer guidelines. Since their development is both costly and time consuming, a coordinated approach should be encouraged.

CoCanCPG. Coordination of Cancer Clinical Practice in Europe

All European countries are facing common challenges for delivering appropriate, evidence-based care to patients with cancer. Despite tangible improvements in diagnosis and treatment, marked differences in cancer survival exist throughout Europe. The reliable translation of new research evidence into consistent patient-oriented strategies is a key endeavour to overcome inequalities in healthcare. Clinical-practice guidelines are important tools for improving quality of care by informing professionals and patients about the most appropriate clinical practice. Guideline programmes in different countries use similar strategies to achieve similar goals. This results in unnecessary duplication of effort and inefficient use of resources. While different initiatives at the international level have attempted to improve the quality of guidelines, less investment has been made to overcome existing fragmentation and duplication of effort in cancer guideline development and research. To provide added value to existing initiatives and foster equitable access to evidence-based cancer care in Europe, CoCanCPG will establish cooperation between cancer guideline programmes. CoCanCPG is an ERA-Net coordinated by the French National Cancer Institute with 17 partners from 11 countries. The CoCanCPG partners will achieve their goal through an ambitious, stepwise approach with a long-term perspective, involving: 1. implementing a common framework for sharing knowledge and skills; 2. developing shared activities for guideline development; 3. assembling a critical mass for pertinent research into guideline methods; 4. implementing an appropriate framework for cooperation. Successful development of joint activities involves learning how to adopt common quality standards and how to share responsibilities, while taking into account the cultural and organisational diversity of the participating organisations. Languages barriers and different organisational settings add a level of complexity to setting up transnational collaboration. Through its activities, CoCanCPG will make an important contribution towards better access to evidence-based cancer practices and thus contribute to reducing inequalities and improving care for patients with cancer across Europe.

A for Effort: Learning From the Application of the GRADE Approach to Cancer Guideline Development

Few would argue against a methodology that facilitates more explicit and transparent judgments about health care research evidence and the link to practice and policy decisions. In this issue of the JournalofClinicalOncology,DePalmaetal 1 describetheapplicationof one such method, the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach, for the development of clinical practice guidelines for breast, colorectal, and lung cancer treatment. The GRADE approach has emerged in response to concerns about the glut of competing grading systems, their limitations, and the confusion resulting from lack of a common rubric. GRADE (http://www.gradeworkinggroup.org/) provides an explicit method for arriving at recommendations classified according to the quality of supporting evidence. 2-8

P1-248: Lung cancer guideline development in ontario: impact on policy and practice

P1-248: Lung cancer guideline development in ontario: impact on policy and practice