NCCN clinical practice guidelines

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					    An Update on Oncology Topics for the
         Primary Care Practitioner
              5/5/07 SCMA Annual Meeting
• Introduction to session/ S.C. Cancer Alliance- Dr Monitto
• Benefits and use of National Comprehensive Cancer
  Network (NCCN) guidelines for primary care
  physicians- Dr Monitto
• Medical issues primary care physicians may face caring
  for their patients with cancer- Dr Montero
• Update on lung cancer- Dr Silvestri
• Update on breast cancer- Dr Montero/Dr Baker
• Update on colorectal cancer- Dr O’Brien
• Update on head and neck cancer- Dr Sharma
• Questions
         S.C. Cancer Alliance

• Founded in 2003, the SCCA is a statewide
  non-profit organization that is dedicated to
  reducing the impact of cancer on ALL
  people in South Carolina.
• The SCCA is currently comprised of over
  900 members.
American Cancer Society
Blue Cross/Blue Shield of SC
Medical University of S.C. (MUSC)
National Black Leadership Initiative on Cancer (NBLIC),
SC Chapter
SC Congressional Nursing Network
SC Dept. of Health & Environmental Control
SC Dept. of Health & Human Services
SC Hospital Association
SC House of Representatives
SC Medical Association
SC Oncology Society
SC Press Association
SC Senate
SC Women's Cancer Coalition
State Hospice Organization
       S.C. Cancer Alliance

• Charged with implementing the state's first
  comprehensive cancer control plan
• Task forces and project teams have been
  formed to address each cancer plan
1.   Advocacy and Policy
2.   Early Detection
3.   Prevention
4.   Research
5.   Survivor and Family Issues
6.   Patient Care
6. Patient Care

 Goal: Reduce barriers to state of the art
 cancer care in South Carolina through
          educational efforts
 National Comprehensive
 Cancer Network (NCCN)
A useful tool for primary care
About the National Comprehensive
    Cancer Network (NCCN)

• A not-for-profit alliance of 20 of the
  world’s leading cancer centers
• The primary goal of all NCCN
  initiatives is to improve the quality of
  oncology practice
 The NCCN member institutions
• City of Hope Cancer Center,      • Arthur G. James Cancer
  Los Angeles, CA                    Hospital and Richard J. Solove
• Dana-Farber/Partners               Research Institute at
  CancerCare, Boston, MA             The Ohio State University,
• Duke Comprehensive Cancer          Columbus, OH
  Center, Durham, NC               • The Sidney Kimmel
• Fox Chase Cancer Center,           Comprehensive Cancer Center
  Philadelphia, PA                   at Johns Hopkins, Baltimore,
• Huntsman Cancer Institute at
  the University of Utah, Salt     • Robert H. Lurie
  Lake City, UT                      Comprehensive Cancer Center
                                     of Northwestern University,
• Fred Hutchinson Cancer             Chicago, IL
  Research Center/Seattle
  Cancer Care Alliance, Seattle,   • Memorial Sloan-Kettering
  WA                                 Cancer Center, New York, NY
 The NCCN member institutions
• H. Lee Moffitt Cancer Center &   • University of Alabama at
  Research Institute at the          Birmingham Comprehensive
  University of South Florida,       Cancer Center, Birmingham,
  Tampa, FL                          AL
• Roswell Park Cancer Institute,   • UCSF Comprehensive Cancer
  Buffalo, NY                        Center, San Francisco, CA
• Siteman Cancer Center at         • University of Michigan
  Barnes Jewish Hospital and         Comprehensive Cancer
  Washington University School       Center, Ann Arbor, MI
  of Medicine, St. Louis, MO       • UNMC Eppley Cancer Center
• St. Jude Children's Research       at The Nebraska Medical
  Hospital/University of             Center, Omaha, NE
  Tennessee Cancer Institute,      • The University of Texas M. D.
  Memphis, TN                        Anderson Cancer Center,
• Stanford Hospital & Clinics,       Houston, TX
  Stanford, CA
NCCN Clinical Practice Guidelines
          in Oncology
• Recognized standard for clinical guidelines
  in the oncology community
• The most widely used in oncology practice
• Updated at least annually in a consensus-
  driven process with explicit review of the
  evidence by multidisciplinary panels
• Now covers more than 95% of all cancers
  NCCN Treatment Guidelines for
• The NCCN translates Treatment
  Guidelines for all of the major cancers and
  supportive care issues into patient
• Available in both English and Spanish in
  booklet form at or
    NCCN guideline panels address:

•   Treatment
•   Cancer detection
•   Risk assessment and reduction
•   Supportive care /symptom management
  Primary care physicians play a
      crucial role in oncology
• Example: Breast cancer
  – Initial diagnosis
     • Making sure that diagnosis is prompt and therapy
       is instituted quickly
  – Identifying high risk patients for prevention
  – Counseling patients regarding treatment
  – Following breast cancer survivors
Gail model for risk assessment
   Other guidelines that may be
 helpful to primary care physicians
Guidelines for Detection, Prevention, & Risk
  Reduction of Cancer
• Breast Cancer Screening and Diagnosis
• Cervical Cancer Screening
• Colorectal Cancer Screening
• Prostate Cancer Early Detection
• Breast Cancer Risk Reduction
• Genetic/Familial High-Risk Assessment: Breast
  and Ovarian
   Other guidelines that may be
 helpful to primary care physicians
Guidelines for Supportive Care e.g.
• Adult Cancer Pain
• Nausea
• Prevention/treatment of cancer related
• Venous Thromboembolic Disease
   Other guidelines that may be
 helpful to primary care physicians
• Treatment Guidelines for 95% of all
  cancers can be accessed

• Helpful for counseling patients who
  may look to primary MD for advice
  when treatment options are
NCCN Clinical Practice Guidelines
          in Oncology
      Can be accessed at
• Contact
  Drew Monitto, MD
  Department of Radiation Oncology
  Gibbs Regional Cancer Center
  Spartanburg Regional Healthcare System
  864 560-6917
• Introduction to session /Benefits and use of NCCN
  guidelines for primary care physicians Dr Monitto (10
• Medical issues primary care physicians may face caring
  for their patients with cancer Dr Montero (20 minutes)
• Update on lung cancer Dr Silvestri (20 minutes)
• Update on breast cancer Dr Megan Baker/ Dr. Montero
  (20 minutes)
• Update on colorectal cancer Dr Esnaola (20 minutes)
• Update on head and neck cancer Dr Sharma (20
• Questions (10 minutes)
   NCCN’s complete spectrum of
       programs include:
• NCCN Clinical Practice Guidelines in
• Treatment Guidelines for Patients
• Clinical Trials Network
• Educational Conferences and Symposia
  for Clinicians
• The Journal of the National
  Comprehensive Cancer Network
• Other Educational Materials

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