Clinical Practice Guidelines: Highlights
Clinical Practice Guidelines
Clinical Practice Guidelines are systematically developed statements used to direct the decision making for patient care. The basis for these guidelines ranges from evidence supported by research findings (considered the strongest or most valid evidence), to nonresearch findings, such as case studies and opinions or practice experience (considered weaker evidence).
Guidelines are not limited to directing care relative to specific diseases but can also address decision making for different modalities, supportive care, technology, screening, genetics, and practice and professional development, to name a few. The selection of a guideline for development usually arises from issues of high incidence and cost, discrepancies in practice and in outcomes, and the availability and strength of the supporting evidence.
New guidelines are developed by an expert panel from professional, government, management, or independent groups, or in collaboration. Panel members have expertise in the specific area addressed. Panels may be multidisciplinary, and some groups use an independent consultant to direct the process, to increase objectivity and reduce bias. Generally, the established guidelines are reviewed annually by the original panel or an independent group.
Because colorectal cancer (CRC) is a high volume and high-cost disease, several oncology groups have specific CRC guidelines. Links to these guidelines are provided below and do not require membership for access.
American Society of Clinical Oncology (ASCO)
As the world's leading professional organization representing physicians who treat people with cancer, ASCO has developed 4 CRC guidelines.
Colorectal Cancer Surveillance: 2005 Update of an American Society of Clinical Oncology Practice Guideline, available at: http://www.jco.org/cgi/reprint/23/33/8512.pdf
2005 Update on ASCO Practice Guideline Recommendations for Colorectal Cancer Surveillance: Guideline Summary, available at:
http://www.asco.org/asco/downloads/CRC_G-line_Summary.pdf
American Society of Clinical Oncology Recommendations on Adjuvant Chemotherapy for Stage II Colon Cancer, available at: http://www.jco.org/cgi/content/full/22/16/3408
American Society of Clinical Oncology Recommendations for the Use of Tumor Markers in Gastrointestinal Cancer, 2006 Update, available full text at http://www.jco.org/cgi/reprint/JCO.2006.08.2644v1.pdf A summary of the recommendations can be downloaded from the November 2006 issue of Journal of Oncology Practice at http://jop.stateaffiliates-asco.org/November06Issue/314.pdf.pdf
Consensus Guidelines from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology
Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008. Screening tests are grouped: those that primarily detect cancer early and those that can detect cancer early and also detect adenomatous polyps, allowing for prevention of CRC through polypectomy. The 3 organizations share the opinion that colon cancer prevention should be the primary goal of screening. The full guideline can be viewed at http://caonline.amcancersoc.org/
National Cancer Institute (NCI), a division of the National Institutes of Health(NIH)
The PDQ (Physician Data Query) is NCI's comprehensive cancer database. It contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, and supportive care, and complementary and alternative medicine; a registry of approximately 2,600 open and 14,000 closed cancer clinical trials from around the world. The PDQ cancer information summaries are peer reviewed and updated monthly. The PDQ adult treatment summaries are also available in patient versions, and written in easy-to-understand, nontechnical language.
Colon cancer guidelines are available at:
http://www.cancer.gov/cancertopics/pdq/treatment/colon/healthprofessional
Rectal cancer guidelines are available at:
http://www.cancer.gov/cancertopics/pdq/treatment/rectal/healthprofessional
The National Guideline Clearinghouse (NGC) http://www.guideline.gov/ is a valuable public resource for evidence-based clinical practice guidelines. It is an initiative of the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services.
National Oncology Alliance (NOA)
NOA is a management group with treatment guidelines providing practical information for patients cared for in community-based oncology practices. NOA treatment guidelines serve as the framework for all NOAís clinical and business tools and for oncology treatment regimens. There is an annual update of all guidelines.
The Colon Cancer guideline is available at:
http://guidelines.noainc.com/documents/Guidelines/colon_2005_FINAL.pdf
National Comprehensive Cancer Network (NCCN)
NCCN has issued updated the clinical guidelines (versions 1.2008) for the management of colon cancer, rectal cancer and anal carcinoma.
Colon cancer guidelines can be accessed at http://www.nccn.org/professionals/physician_gls/PDF/colon.pdf
Rectal cancer guidelines can be accessed at http://www.nccn.org/professionals/physician_gls/PDF/rectal.pdf
Anal cancer guidelines can be accessed at http://www.nccn.org/professionals/physician_gls/PDF/anal.pdf
Page 4 of each updated set of guidelines contains a summary of changes for the new version.
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