This article appears in the following Annals of Oncology issue: ESMO Clinical Recommendations [View the issue table of contents]
ESMO clinical recommendations |
ESMO Clinical Recommendations: using the easier and faster approach to oncology guidelines
1 Department of Medical Oncology, Medical School, University of Ioannina, Greece
2 The Finsen Center, Copenhagen University Hospital, Denmark
3 University Hospital of Zurich, Clinic and Polyclinic for Oncology, Zurich, Switzerland
* Correspondence to: npavlid{at}uoi.gr
the original idea
The European Society for Medical Oncology (ESMO) has developed and disseminated clinical recommendations to all European and non-European oncologists. ESMO's motivation was to establish the clinical recommendations, as it was felt they were important for the future development of medical oncology and for achieving high common standards of medical practice for patients in all European countries.
The principles of the ESMO clinical recommendations were: (i) to create a set of statements for an essential standard of care; (ii) to be disease or topic oriented; (iii) to be evidence based; (iv) to have an emphasis on medical oncology; and (v) to be annually updated.
Each of the ESMO clinical recommendations provides vital, evidence-based information for physicians, including the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans and follow-up.
the history
1998
The original idea for the creation of the ESMO clinical guidelines came from Professor Heine H. Hansen via the Central European Task Force in 1998. In particular, he visualized the need for clinical recommendations that might be more practical in daily use. This was supported at a meeting of the ESMO national representatives, who felt that the development of guidelines would contribute to the standing of medical oncology in Europe.
1999
Thus, in 1999 the ESMO Guidelines Task Force was constituted. Initially, the group began with a chairman (Rolf Stahel, Switzerland), a central coordinator (Lorez Jost, Switzerland), an ESMO officer (Maria Cristina Reinhart) and five members (Jørn Herrstedt, Denmark; Otto Kloke, Germany; Nicholas Pavlidis, Greece; Gunta Purkalne, Latvia; and Svetislav Jelic, Yugoslavia). During the next 5 years more members joined the task force (Jonas Bergh, Sweden; Richard Greil, Austria; Vesa Kataja, Finland; and João Oliveira, Portugal).
2006
Since 1 January 2006 the Guidelines Task Force has been an independent group—the ESMO Guidelines Working Group—under the new ESMO Education Committee structure. It consists of: (i) an editorial board with a chairman (Nicholas Pavlidis, Greece), three members (Rolf Stahel, Switzerland; Heine Hansen, Denmark; and Svetislav Jelic, Serbia), an Annals of Oncology executive (Lewis Rowett, UK) and an ESMO Coordinator (Paola Minotti, Switzerland), (ii) the seven subject editors responsible for the topics, the authors, the revision of the manuscripts and the presentation and discussion of final drafts with the editorial board (M. Castiglione, Switzerland; J. Oliveira, Portugal; E. Felip, Spain; V. Kataja, Finland; M. Dreyling, Germany; L. Jost, Switzerland; and F. Roila, Italy), (iii) the assigned authors and (iv) the five preselected reviewers per topic who have all been ESMO Faculty members.
2008
In 2008 the Guidelines Working Group made some changes and now consists of: (i) an editorial board with a chairman (Nicholas Pavlidis, Greece), two members (Rolf Stahel, Switzerland and Heine Hansen, Denmark), an Annals of Oncology executive (Lewis Rowett, UK), an external medical oncologist coordinator (George Pentheroudakis, Greece) and an ESMO Coordinator (Roberta Vecchi, Switzerland); (ii) nine subject editors: Monica Castiglione—Switzerland for breast and gynaecological cancer, Martin Dreyling—Germany for haematological malignancies, Enriqueta Felip—Spain for lung and head/neck cancer, Paolo Casali—Italy for sarcomas, Vesa Kataja—Finland for genito-urinary cancer, Andres Cervantes—Spain for gastrointestinal cancer, Fausto Roila—Italy for supportive care, Svetislav Jelic—Serbia for liver, pancreatic cancer and neuroendocrine tumours and George Pentheroudakis—Greece for rare tumours; (iii) the assigned authors and (iv) the five preselected reviewers per topic on a multidisciplinary platform (Figure 1).
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Figure 2 demonstrates the functioning network of the ESMO Guidelines Working Group
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Nearly 9 years after the inception of the ESMO Guidelines Task Force and up to 2009, 54 clinical recommendations were freely available on the ESMO website and in Annals of Oncology.
the evaluation of dissemination of ESMO Clinical Recommendations
During the last several years ESMO Clinical Recommendations have been disseminated and implemented through different methodological tools.
We continuously evaluate the results of these tools in order to access the diffusion of ESMO Clinical Recommendations to the oncological community.
These tools are: (i) the data from the annual downloads of Oxford Journals usage statistics through the supplementary issues of Annals of Oncology, (ii) the evaluation scoring from the interactive ESMO Guidelines sessions conducting during the ESMO Congresses and (iii) the results from a questionnaire (with 10 questions related to ESMO Guidelines evaluation) distributed to ESMO Congresses and ECLU participants.
downloads
The extracted data from the downloads for the last 2 years were the following:
(i) May 2007–May 2008: 45 066 and (ii) May 2008–October 2008: 60 330 downloads (Table 1). The three most commonly downloaded tumours were ‘primary breast cancer’, ‘metastatic breast cancer’ and ‘non-small-cell lung cancer’.
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interactive ESMO sessions
The evaluation scoring (average score) of the five interactive sessions during the last five ESMO Congresses were as follow: Hamburg (2000): 3.78, Nice (2002): 4.05, Vienna (2004): 4.07, Istanbul (2006): 4.24 and Stockholm (2008): 4.48 (Table 2).
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the questionnaire
Analysis of the questionnaire data from the 31st and 32nd ESMO Congresses and the2007 and 2008 ECLU conferences showed that the majority of the European and non-European oncologists favor ESMO Clinical Recommendations (Table 3).
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the perspectives
The ESMO Guidelines Working Group feels that the ESMO Clinical Recommendations have been widely accepted by the oncological community.
It should also be emphasized that ESMO Clinical Recommendations have already been translated into nine languages (French, German, Italian, Spanish, Portuguese, Russian, Japanese, Chinese and Greek).
Since last year the ESMO Guideline Task Force decided to include a number of clinical recommendations as a product of International Consensus Conferences. These recommendations will be larger in context and more detailed than the previously existing ESMO Guidelines.
In addition, the ESMO Guidelines Working Group intends in the near future to increase the size of several clinical recommendations, especially those of the most common tumours (the big killers), due to a continuous huge amount of new information.
references
1. Pavlidis N, Hansen H, Stahel R. ESMO Clinical Recommendations: a practical guide for medical oncologists. Ann Oncol (2007) 18:1759–1763.
2. Pavlidis N. Towards a convenient way to practice medical oncology. Ann Oncol (2007) 18(Suppl 2). ii3–ii4.
3. Pentheroudakis G, Stahel R, Hansen H, Pavlidis N. Heterogeneity in cancer guidelines: should we eradicate or tolerate? Ann Oncol (2008) 19:2067–2078.
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