TABLE 6.4

Selected Oncology Guidelines, by Sponsoring Group

Group

Guidelines

Comment

National Comprehensive Cancer Network (NCCN)

Path or algorithm guidelines for all common cancers

Evidence-based, with consensus; when no consensus possible, options listed

Intended for mandatory use for all participating cancer centers

No set date for implementation

No set benchmarks for care

Adopted in the community for use outside of NCCN cancer centers No data yet on compliance or outcomes

American Society of Clinical Oncology (ASCO)

Boundary guidelines for new technologies

Hematopoietic growth factors Outcomes important enough to justify treatment

Antiemetics

Surveillance of breast and colorectal cancer patients

Path or algorithm guidelines for specific diseases

Management of non-small-cell lung cancer

Metastatic prostate cancer

Evidence-based with consensus demanded before approval

Adopted by the community but no data available on compliance or outcomes

Likely that all future guidelines will be boundary guidelines for new technologies, with overlap of ASCO and NCCN methods and topics

Society for Surgical Oncology

Path guidelines for management of common surgical problems

Consensus panels

American Urology Association

Path guidelines for common urology problems

Localized prostate cancer

Consensus based on evidence

University of California Cancer Care Consortium (UC and PONA, Inc.)

Path guidelines for most solid tumors

PONA did systematic reviews, consulted with UC faculty for consensus

Organizations Whose Guidelines Are not Available (proprietary)

Kaiser Permanente

Salicknet, Inc.

Value Health Science, Inc.

Multiple others

Path guidelines for management of common oncology problems

Consensus based on evidence; not available outside the corporation

 

SOURCE: Smith and Hillner, 1998.

Variation in practice often reflects uncertainty and points to a need for rigorous clinical research. There are, for example, no randomized clinical trials comparing best supportive care versus second-line chemotherapy for patients with non-small-cell lung cancer. (There are limited Phase II data from single institutions.) An American Society of Clinical Oncology (ASCO)



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