NCCN and NCCN Clinical Practice Guidelines in Oncology.ppt by tongxiamy


									              NCCN and
        NCCN Clinical Practice
       Guidelines in Oncology™

Joan S. McClure, MS
Senior Vice President of Clinical Information and Publications
National Comprehensive Cancer Network (NCCN)
         What is the NCCN?
An Alliance of 21 Academic Cancer Centers in the
  United States
A National Developer and Communicator of:
  – Programs to support member institution missions in
    education, research, and patient care
  – Scientific/evaluative information to inform and
    improve the decision-making between patients and
    physicians to improve quality and effectiveness of
  – Developer of benchmarking data regarding quality of
    cancer care
• Complex group of about 200 different
• Managed by multidisciplinary teams
• Rapidly evolving standard of care based
  on large volume of research
• Share-care models across disparate
  settings of care
• Coordination of care a significant
   Two Types of Evidence-Based
• Process map of integrated interventions
  over time
• Exhaustive review of single decision point
          NCCN Guidelines
• Comprehensive across all stages, modalities
  and continuum of care
  – 44 multidisciplinary expert panels
  – Cancer screening, diagnosis, treatment and
    supportive care
• Updated at least annually and up to 4 times per
  year since 1995
• Category of evidence and consensus
  designated for each recommendation
• Transparent processes
• Centerpiece of suite of tools to support quality
  oncology care
  NCCN Clinical
Practice Guidelines
   in Oncology™
 Components of NCCN Guidelines
• Title
• Panel List
   – Names, affiliations, specialties
• Algorithm
   – Step by step clinical decision making map
• Staging
   – Identification of patient subsets
• Discussion
   – Data supporting recommendations and
   – Issues identified by panel
• References
• Disclosures
   – Individual
   – Organizational
Evidence-based Consensus Allows
    Comprehensive Guideline
                Evidence-based guideline

           Continuum of disease and patient care

          Evidence-based consensus guideline

   High-level evidence exists
   Gaps in evidence filled with expert consensus
   NCCN Levels of Evidence
• Category 1: Based upon high-level evidence and
  uniform NCCN consensus that intervention is
• Category 2A: Based on lower-level evidence
  and uniform NCCN consensus that it constitutes
  appropriate care
• Category 2B: Based upon lower-level evidence
  and NCCN consensus that it constitutes
  appropriate care
• Category 3: Any level of evidence but major
  NCCN disagreement that the recommendation is
Selecting Recommendations
                              • The amount of data available
                                differs across disease sites
                                and across clinical decisions
                                within a disease site
        Data from multiple
                              • Major change in standard of
                                care supported by consistent,
                                convincing studies which have
                                major impact on outcomes –
                                e.g., Adjuvant trastuzumab in
        Expert evaluation       breast cancer
                              • Less dramatic, but significant
                                change in standard of care
        Distill appropriate     supported by lower level
        recommendations         evidence – e.g., bevacizumab
                                in Glioblastoma
                              • New studies WILL change the
                                standard of care over time
Examples from Breast Cancer
• No industry or any other interest group funds are
  used to support panel meetings
• No industry representatives allowed at meetings
• Individual panel members disclose conflicts of
  interest at each panel meeting and in writing
• Potential conflicts of interest published
• Members are excused from deliberations when
  degree of conflict warrants
• Most panel members have some conflict(s)
  Implementation of Guidelines

• Measure concordance with guidelines
  – evaluate the quality of care
  – examine patterns and outcomes of care
  – evaluate treatments and other interventions
  – provide feedback to providers
  – provide feedback to guidelines developers
           NCCN Oncology Outcomes
           Database Project Update*
            Project                        Start          Patients   Institutions
                                                                      18 NCCN
Breast Cancer                             7/1997            54,820
                                                                     18 community
                                          7/2000             4,344        7
Colon/Rectal Cancer                       9/2005             5,419        8
Non-Small Cell Lung
                                          1/2007             2,528        8
Ovarian Cancer                            1/2004               558        6

* Number of patients abstracted as of October 29, 2009.
        Standards for Guidelines
• Provide latitude for both types of guideline
• Permit both evidence and consensus as criteria
  for inclusion
• Accommodate rapid update cycles
• Foster transparency and consistency of process
• Disclosure of developers potential conflicts
• Encourage assessment of implementation

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