Annals of Oncology Advance Access originally published online on July 28, 2008
Annals of Oncology 2008 19(12):2067-2078; doi:10.1093/annonc/mdn418
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oncology practice |
Heterogeneity in cancer guidelines: should we eradicate or tolerate?
1 Department of Medical Oncology, Ioannina University Hospital, Ioannina, Greece
2 Clinic and Polyclinic of Oncology, University Hospital, Zürich, Switzerland
3 The Finsen Centre, Copenhagen University Hospital, Copenhagen, Denmark
* Correspondence to: Dr N. Pavlidis, Professor of Oncology, Department of Medical Oncology, Ioannina University Hospital, Niarxou Avenue, 45500 Ioannina, Greece. Tel/Fax: +30-2651099394; E-mail: npavlid{at}uoi.gr
Background: Heterogeneity in aspects of development, structure and context of oncology guidelines was not evaluated. We analysed and critically examined its implications.
Materials and methods: Nine cancer clinical practice guidelines were selected on the basis of popularity among oncologists. The relevant Web sites and publications on three tumours were examined and characteristics grouped in the data domains: producing organisation, methodology, guideline structure and content, implementation and evaluation and scientific agreement.
Results: ASCO, ESMO, NICE, SIGN, START, NHMRC, NCI, NCCN and CCO guidelines were examined. Development was initiated by stakeholders or authorised bodies, run by task forces with varying degrees of multidisciplinarity, with rare endorsement of external guidelines. Recommendation formulation was on the basis of evidence, shaped via interactive processes of expert review and public consultation-based modifications. Guidelines varied in comprehensiveness per tumour type, number, size, format, grading of evidence, update and legal issues. Orientation for clinic use or as reference document, end-users and binding or elective nature also varied. Standard dissemination strategies were used, though evaluation of adoption and of impact on health outcomes was implemented with considerable heterogeneity.
Conclusions: Heterogeneity in development, structure, user and end points of guidelines is evident, though necessary in order to meet divergent demands. Crucial for their effectiveness are adherence to methodological standards, a clear definition of what the guideline intends to do for whom and a systematic evaluation of their impact on health care.
Key words: cancer, clinical practice, guidelines, oncology
Received for publication February 4, 2008. Revision received May 31, 2008. Accepted for publication June 9, 2008.
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