Level of Scientific Evidence Underlying Recommendations Arising From the National Comprehensive Cancer Network Clinical Practice Guidelines

2011 ◽  
Vol 29 (2) ◽  
pp. 186-191 ◽  
Author(s):  
Thejaswi K. Poonacha ◽  
Ronald S. Go
Keyword(s):  
National Comprehensive Cancer Network ◽  
Guideline Development ◽  
Scientific Evidence ◽  
Evidence Base ◽  
Professional Organizations ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Therapeutic Recommendations ◽  
High Level ◽  
Cancer Network

Purpose The level of scientific evidence on which the National Comprehensive Cancer Network (NCCN) guidelines are based has not been systematically investigated. We describe the distribution of categories of evidence and consensus (EC) among the 10 most common cancers with regard to recommendations for staging, initial and salvage therapy, and surveillance. Methods NCCN uses a system of guideline development distinct from other major professional organizations. The NCCN definitions for EC are as follows: category I, high level of evidence with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. Results Of the 1,023 recommendations found in the 10 guidelines, the proportions of category I, IIA, IIB, and III EC were 6%, 83%, 10%, and 1%, respectively. Recommendations with category I EC were found in kidney (20%), breast (19%), lung (6%), pancreatic (6%), non-Hodgkin's lymphoma (6%), melanoma (6%), prostate (4%), and colorectal (1%) guidelines. Urinary bladder and uterine guidelines did not have any category I recommendations. Eight percent of all therapeutic recommendations were category I. Guidelines with the highest proportions of category I therapeutic recommendations were for breast (30%) and kidney (28%) cancers. No category I recommendations were found on screening or surveillance. Conclusion Recommendations issued in the NCCN guidelines are largely developed from lower levels of evidence but with uniform expert opinion. This underscores the urgent need and available opportunities to expand evidence base in oncology.

Level of Scientific Evidence Underlying Recommendations from the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Hematologic Malignancies: Are We Moving Forward?

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 32-32
Author(s):  
Aakash Desai ◽  
Harry E Fuentes ◽  
Sri Harsha Tella ◽  
Caleb J Scheckel ◽  
Thejaswi Poonacha ◽  
...  
Keyword(s):  
Clinical Practice ◽  
National Comprehensive Cancer Network ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Scientific Evidence ◽  
Hematologic Malignancies ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Therapeutic Recommendations ◽  
Cancer Network

Background: National Comprehensive Cancer Network (NCCN) guidelines are the most comprehensive and widely used standard for clinical care in malignant hematology by clinicians and payers in the US. The level of scientific evidence in NCCN guidelines for malignant hematological conditions has not been recently investigated. We describe the distribution of categories of evidence and consensus (EC) among the 10 most common hematologic malignancies with regard to recommendations for staging, initial and salvage therapy, and surveillance. Methods: NCCN uses a system of guideline development distinct from other major professional organizations. The NCCN definitions for EC are: category I, high level of evidence such as randomized controlled trials with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. We compared our results with previously published results from 2011 guidelines. Results: Total recommendations increased by 16.6% from 1160 (2011) to 1353 (2020). Of the 1353 recommendations, Category 1, 2A, 2B and 3 EC were 5%, 91%, 4%, 1% while in 2011 they were 3%, 93%, 4% and 0% respectively. Recommendations with category 1 EC were found in all guidelines, except for Burkitt's Lymphoma. 6.3% of therapeutic recommendations were category 1 EC with the majority (56.4%) pertaining to initial therapy. Guidelines with highest proportions of therapeutic recommendations with category 1 EC were Multiple Myeloma (12.4%), CLL/SLL (6.9%) and AML (5.6%). Between 2011 and 2020, the proportion of category I recommendations increased significantly only in Follicular lymphoma and CLL/SLL. No category 1 EC recommendations existed in staging or surveillance. Conclusion: Recommendations issued in the 2020 NCCN guidelines are largely developed from lower levels of evidence but with uniform expert opinion. Despite the major advances in hematology in the past decade, this is largely unchanged. Our study underscores the urgent need and available opportunities to expand the current evidence base in malignant hematological disorders which forms the platform for clinical practice guidelines. Figure Disclosures No relevant conflicts of interest to declare.

Level of Scientific Evidence Underlying Recommendations Arising From the National Comprehensive Cancer Network Clinical Practice Guidelines for Hematologic Malignancies

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 509-509
Author(s):  
Benny Kusuma ◽  
Ronald S. Go
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Scientific Evidence ◽  
B Cell Lymphoma ◽  
Hematologic Malignancies ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Large B Cell Lymphoma ◽  
Therapeutic Recommendations ◽  
Cancer Network

Abstract Abstract 509 Purpose: The level of scientific evidence on which the National Comprehensive Cancer Network (NCCN) guidelines are based has not been systematically investigated. We describe the distribution of categories of evidence and consensus (EC) among the 10 most common hematologic malignancies with regard to recommendations for staging, initial and salvage therapy, and surveillance. Methods: NCCN uses a system of guideline development distinct from other major professional organizations. The NCCN definitions for EC are as follows: category I, high level of evidence with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. Results: Of the 1160 recommendations found in the 10 guidelines, the proportions of category I, IIA, IIB, and III EC were 3%, 93%, 4%, and 0%, respectively. Recommendations with category I were found in acute myeloid leukemia (4%), multiple myeloma (7%), Hodgkin's lymphoma (1%), diffuse large B-cell lymphoma (4%), follicular lymphoma (11%). Chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle cell lymphoma, marginal zone lymphoma, AIDS-related B-cell lymphoma, and Burkitt lymphoma did not have any category I recommendations. Three percent of all therapeutic recommendations were category I. Guideline with the highest proportion of category I therapeutic recommendations was for diffuse large B-cell lymphoma (46%). No category I recommendations were found on staging or surveillance. Conclusion: Recommendations issued in the NCCN guidelines are largely developed from lower levels of evidence but with uniform expert opinion. This underscores the urgent need and available opportunities to expand evidence base in oncology. Disclosures: No relevant conflicts of interest to declare.

Level of scientific evidence underlying palliative care recommendations arising from the National Comprehensive Cancer Network (NCCN) clinical practice guidelines.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19537-e19537
Author(s):  
Felipe Melo Cruz ◽  
Fernando Mauro Lima Prearo ◽  
Daniel Iracema Cubero ◽  
Auro Del Giglio
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Supportive Care ◽  
Scientific Evidence ◽  
Relative Content ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Care Guidelines ◽  
High Level ◽  
Cancer Network

e19537 Background: The palliative care NCCN recommendations are classified according to the level of scientific evidence in four groups: category I, high level of evidence with uniform consensus; category IIA, lower level of evidence with uniform consensus; category IIB, lower level of evidence without a uniform consensus but with no major disagreement; and category III, any level of evidence but with major disagreement. Palliative care guidelines have not yet been judged as to the relative content of each of the aforementioned types of recommendations. Methods: We analyzed the distribution of categories of evidence cited in the 10 supportive care NCCN guidelines, version 2.2011. Results: Of the 2,537 recommendations found in the 10 guidelines, the proportion of category I, IIA and IIB recommendations were 2.9%, 95.7%, 1.4%, respectively. There wasn’t any category III recommendation (table 1). The fields with a higher rate of category I recommendations were fatigue (14.3%) and chemotherapy induced nausea and vomiting (12.7%). No category I recommendations were found on Senior Adult Oncology, Cancer and Chemotherapy induced Anemia and Adult Cancer Pain. Conclusions: : Palliative care NCCN recommendations are largely based on lower level of evidence, but with uniform expert opinion. This data show the urgent need to expand palliative care research in oncology. [Table: see text]

Level of scientific evidence supporting NCCN guidelines: Is there evidence of progress?

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 14-14
Author(s):  
Aakash Desai ◽  
Ronald S. Go ◽  
Thejaswi Poonacha
Keyword(s):  
Scientific Evidence ◽  
Clinical Care ◽  
Uterine Cancer ◽  
Evidence Base ◽  
Current Evidence ◽  
Level Of Evidence ◽  
Nccn Guidelines ◽  
Current Evidence Base ◽  
The Us ◽  
Therapeutic Recommendations

14 Background: National Comprehensive Cancer Network (NCCN) guidelines are the most comprehensive and widely used standard for clinical care in oncology by clinicians and payors in the US. The level of scientific evidence in NCCN guidelines has not been studied since it’s last review in 2010. We describe the categories of evidence and consensus (EC) among the 10 most common cancers in the US as of 2019 and compare them with 2010 guidelines. Methods: We obtained the 2019 version of NCCN guidelines. The definitions for various categories of EC used were: Category 1 (high level evidence such as randomized controlled trials with uniform consensus), 2A (lower level of evidence with uniform consensus), 2B (lower level of evidence without a uniform consensus but with no major disagreement) and 3 (any level of evidence but with major disagreement). We compared our results with previously published results from 2010 guidelines. Results: Total recommendations increased by 77% from 1023 (2010) to 1818 (2019). Of the 1818 recommendations, Category 1, 2A, 2B and 3 EC were 7%, 87%, 6% and 0% while in 2010 they were 5%, 85%, 9% and 1% respectively. Recommendations with category 1 EC were found in lung (13%), prostate (11%), melanoma (8%), breast (7%), NHL (5%), kidney (2%), bladder (2%) and colorectal (2%) guidelines. Pancreatic and uterine cancer guidelines had no recommendations with category 1 EC. 19% of therapeutic recommendations were category 1 EC with the majority (65%) pertaining to initial therapy. Guidelines with highest proportions of therapeutic recommendations with category 1 EC were breast (30%), lung (10%), and kidney (10%) cancers. No category 1 EC recommendations existed in screening or surveillance. Although we found an increase in the total number of recommendations, the distribution of different types of categories of EC are largely similar to 2010. Conclusions: Recommendations in 2019 NCCN guidelines are largely derived from lower levels of evidence with uniform expert opinion. Despite the major advances in oncology in the past decade, this is largely unchanged. Our study underscores the urgent need and available opportunities to expand the current evidence base in oncology which forms the platform for clinical practice guidelines.

Specialty representation on national comprehensive cancer network guideline committees.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11041-11041
Author(s):  
Bismarck Odei ◽  
Temitope Agabalogun ◽  
Erika Bello-Pardo ◽  
Christina C. Huang ◽  
Daniel Vanderbilt ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Guideline Development ◽  
Committee Member ◽  
Univariate Analysis ◽  
Academic Rank ◽  
Head Neck Cancer ◽  
H Index ◽  
Nccn Guidelines ◽  
Cancer Management ◽  
Cancer Network

11041 Background: Among the National Comprehensive Cancer Network (NCCN) guidelines, the existence of Category 1 evidence for cancer management decisions remains low, resulting in the reliance on multispecialty perspective to determine optimal treatment approach. Multiple studies suggest that the specialty composition of oncological teams is important in the trajectory of decision-making. Consequently, we sought to determine if there was adequate representation of radiation oncologists (ROs) on NCCN committees (NCMs). Methods: NCMs with Category 1 or 2A recommendations for radiotherapy use were identified. Committee members were documented including specialty, academic rank, and committee role. H-index and gender was assessed for each member. A minimum arbitrary threshold of < 10% was used to define underrepresentation of ROs. Univariate and multivariate (MVA) logistic regression identified factors predictive of underrepresentation. Results: Of 57 assessed guidelines, 38 (66.7%) NCMs recommended radiation as Category 1 or 2A from which a total of 1284 committee members were identified. Median committee size was 33 (range 29-38). Overall, 42.2% were Medical Oncologists (MOs), 23.9% were Surgical Oncologists (SOs), and 11.5% were ROs [22.4% were a mix of Radiologists, Pathologists, other specialty physicians, and non-physician members like Patient Advocates]. ROs constituted 4.4% of NCM Chairs (MOs: 68.9%, SOs: 13.3%, Other: 13.3%); 29% of Vice Chairs (MOs: 35.5%, SOs: 35.5%); and 5.9% of the discussion writing committee (MOs: 70.6%, SOs: 23.5%). The representation of ROs was highest for Head/ Neck Cancer NCM (38.8%) and Prostate Cancer NCM (25.8%). 42% of the NCMs recommending radiation had < 10% representation of ROs; 17% of guidelines recommending radiation had 1 or less RO including 4 NCMs which did not have a single RO committee member. On univariate analysis, factors predictive of RO underrepresentation were low SO representation (p = 0.038) and low median H-index of the NCM (p = 0.013); low proportion of full professors trended towards significance (p = 0.060). On MVA, median H-index had a negative association with RO underrepresentation (p = 0.038) —no association was found to rank, gender or specialty. Conclusions: Our study shows alarmingly low representation of ROs among NCCN committees which include radiation as a Category 1 or 2A recommendation. This can both limit the discussion during guideline development and negatively impact the diversity of perspectives in management recommendations. Efforts to ensure more proportional representation of ROs on NCCN guideline committees are warranted including exploring potential barriers to committee leadership.

The experience of conducting a Cochrane systematic review of the impact of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs

2009 ◽  
Vol 13 (2) ◽  
pp. 62-66 ◽  
Author(s):  
Thomas Rotter ◽  
Leigh Kinsman ◽  
Erica James ◽  
Andreas Machotta ◽  
Holger Gothe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Pathways ◽  
Hospital Costs ◽  
Evidence Base ◽  
Care Group ◽  
Level Of Evidence ◽  
Organisation Of Care ◽  
High Level ◽  
Meta Analyses ◽  
The Impact

Despite the high prevalence of clinical pathways (CPWs), the results from published studies are inconsistent and contradictory. The plethora of study designs, settings and lack of an agreed definition of a CPW make the relevance of individual studies difficult to apply to clinical settings. It was timely to catalogue and analyse the existing evidence base for CPWs via a rigorous systematic review. Systematic reviews and meta-analyses provide a high level of evidence for the effectiveness of interventions and are commonly employed reviewing strategies for addressing scientific questions in health-related research. This method is especially useful when research results are known to be inconsistent. Instead of conducting another primary evaluation, a detailed review is needed that reflects a summation of available research. This paper reports and discusses methodological and technical issues of a systematic review of the effectiveness of CPWs in hospitals, based on our experience with the Cochrane Effective Practice and Organisation of Care Group.

The Costs of Drugs Used to Treat Myelodysplastic Syndromes Following National Comprehensive Cancer Network Guidelines

2008 ◽  
Vol 6 (9) ◽  
pp. 942-953 ◽  
Author(s):  
Peter L. Greenberg ◽  
Leon E. Cosler ◽  
Salvatore A. Ferro ◽  
Gary H. Lyman
Keyword(s):  
National Comprehensive Cancer Network ◽  
Myelodysplastic Syndromes ◽  
Iron Chelation ◽  
International Prognostic Scoring System ◽  
Limited Attention ◽  
Recombinant Erythropoietin ◽  
Nccn Guidelines ◽  
Transfusion Requirements ◽  
Average Annual Cost ◽  
Cancer Network

Guidelines for management of patients with myelodysplastic syndromes (MDS) have been generated by the National Comprehensive Cancer Network (NCCN) Myelodysplastic Syndromes Panel. Because MDS is a heterogeneous spectrum of disorders, these patients have been categorized into prognostic subgroups, predominantly using the International Prognostic Scoring System (IPSS). Several drugs have been used to treat these patients, and their selection and sequential recommended use by the panel depend on disease characteristics and responses to treatment. Recombinant erythropoietin alfa and darbepoetin alfa have been the mainstay of therapy for treating anemia associated with MDS. The FDA has recently approved several other drugs for treating MDS, including azacytidine and decitabine for all stages of disease, lenalidomide for low-risk anemic patients with del(5q) chromosomal abnormality, and deferasirox for treating iron overload. For iron chelation, deferoxamine is also used occasionally. Treatment with immunosuppressive therapy (antithymocyte globulin and cyclosporin) has been therapeutically beneficial for a subset of younger patients with MDS. Because the financial cost of these therapies are substantial and have received only limited attention, this article evaluates the costs of specific drugs and their sequential use in the lower-risk IPSS (low and intermediate-1) subgroups based on the NCCN guidelines. Results estimate an average annual cost for potentially anemia-altering drugs of $63,577 per patient, ranging from $26,000 to $95,000, depending on the specific therapies. In patients for whom the therapies fail, annual costs for iron chelation plus red blood cell transfusions are estimated to average $41,412. The economic impact of drug therapy should be weighed against the patient's potential for improvement in clinical outcomes, quality of life, and transfusion requirements.

Compliance with National Comprehensive Cancer Network guidelines for antiemesis in cisplatin regimens.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 280-280
Author(s):  
Terri P. Wolf ◽  
Dana Ann Little
Keyword(s):  
National Comprehensive Cancer Network ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
Adherence Rate ◽  
Cancer Centers ◽  
Nccn Guidelines ◽  
Guideline Compliance ◽  
Cancer Network ◽  
The Impact

280 Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans. To determine guideline compliance rates, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting. Methods: Prior to a chart audit, medical oncologists were surveyed on their knowledge of NCCN antiemesis guidelines, frequency of prescribing based on guidelines, and reasons for not using guidelines. Auditors identified patient charts through billing records and reviewed cycle 1 day 1 orders of cisplatin regimens. Secondary data was collected on hydration orders and home medications for antiemesis. Results: Guideline adherence varied from 0% to 76% with overall adherence at 28%. Dexamethasone doses ranged from 2-20 mg (guideline 12 mg) as did serotonin antagonists (5HT3) ordered at higher IV doses of 24-32 mg (guideline 8-16 mg). Conclusions: Although cancer centers report following the guidelines, this study did not find consistent adherence. The cancer center with the highest adherence rate works closely with a pharmacist and has built order sets with the guidelines. One cancer center had wide variances among practitioners. The variances increase the potential for error. The cancer center with lowest adherence rate used 10 mg doses of dexamethasone because the drug is delivered in 10 mg vials. This study identified multiple systems issues impacting guideline compliance. Managing nausea and vomiting is important for patient QOL and to manage costs by decreasing hospitalizations, treatment delays, and nutritional deficits. Understanding prescribing habits relative to guidelines provides an opportunity to change practice and reduce variability.

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