Guiding the guidelines : The Lancet

...Clinical Practice Guidelines We Can Trust is the tandem document from the IOM—tandem in the sense that one of these standards states that a systematic review must precede guideline formulation. The IOM points out that the database of the Guidelines International Network includes more than 3700 guidelines from 39 countries. The standards were formulated to overcome common deficiencies—particularly in bias and how bias is handled—in existing guidelines. These deficiencies include the variable quality of evidence, poorly done systematic reviews, methodology that is not transparent, a development group that does not reflect all stakeholders, and unmanaged conflicts of interest. The IOM recommends that before the development group is formed, conflicts of interest need to be fully disclosed—and their definition includes financial, intellectual, and institutional interests. The prospective panel members should also explain how any conflicts they might have could influence the guideline process. The IOM is clear in some specific areas: members of the group need to divest relevant financial investments they or family members hold, and not take part in advisory boards or marketing activities with relevant companies. Additionally, the chair and co-chairs should have no conflicts of interest, members with conflicts should form a minority, and funders should have no role in guideline development. Overall, tough talk from the IOM—but much needed talk. Apart from expert members in the group, the standards include involvement of patients or their representatives.

abstract: Revised Bethesda Guidelines: compliance in identifying HNPCC affected families (Lynch Syndrome)

Conclusion
Based on these results, there is a marked incompliance with revised Bethesda guidelines when assessing patients with colorectal cancer. This has a significant impact on clinical pathways for the management of HNPCC  (Lynch Syndrome) families.

ESMO: Community Oncology: Ensuring the Best Standards of Care

“The important thing is that community oncologists should not work alone. They should be part of a network and participate in a common reflection and also work with others in clinical research. In France, community oncologists work closely with university hospitals or big cancer centers and are in contact with larger teams. National and international guidelines are followed and ensure that patients receive quality treatment.”

Advance Directive Language and Laws May Interfere With Patient Wishes - RWJF

The guidelines created to protect patients making end-of-life decisions may have the opposite effect. A Robert Wood Johnson Foundation Physician Faculty Scholar identifies problems and offers solutions

NCCN Guidelines for Patients™ - Ovarian Cancer

Ovarian Cancer

National Guideline Clearinghouse | New This Week focus on breast cancer (New Zealand)

New Zealand Guidelines Group

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General principles of care. In: Management of early breast cancer.

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Staging. In: Management of early breast cancer.

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Surgery for early invasive breast cancer. In: Management of early breast cancer.

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Radiotherapy. In: Management of early breast cancer.

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Systemic therapy: chemotherapy regimens. In: Management of early breast cancer.

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Systemic therapy: endocrine therapies. In: Management of early breast cancer.

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Ductal carcinoma in situ. In: Management of early breast cancer.

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Follow-up. In: Management of early breast cancer.

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Special issues. In: Management of early breast cancer.

2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours

National Guideline Clearinghouse | ACR Appropriateness Criteria acute pelvic pain in the reproductive age group (current as at 2008)

NGC - Compare - NATIONAL GUIDELINE CLEARINGHOUSE™ (NGC) GUIDELINE SYNTHESIS SCREENING FOR OVARIAN CANCER

"This synthesis was prepared by ECRI Institute on October 2, 2007. It was reviewed by SIGN on October 10, 2007, UMHS on October 25, 2007, and ACR on November 2, 2007. The synthesis was updated in April 2010 to remove UMHS and USPSTF recommendations and to update ACR recommendations. The information was verified by ACR on June 2, 2010."

Updated Guidelines for Human Pluripotent Stem Cell Research - CIHR (Canadian Institute for Health Research)

definition: Capable of differentiating into many cell types. For example, a cell capable of turning into bone, fat, tendon, cartilage and ligament cells, but not into brain cells or liver cells, might be considered Pluripotent.
www.stem-cell-treatment-now.com/glossary.html

free full text: Non-epithelial ovarian cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up

Note: the papers from ESMO (ovarian cancer) requires registration/access is free 1) Classification of germ cell ovarian tumors 2) Classification of sex cord stromal ovarian tumors "This set of recommendations applies to invasive epithelial ovarian carcinoma; the management of tumors of low malignant potential (‘borderline’) is not covered here."

full free access: Newly and relapsed epithelial ovarian carcinoma: ESMO Clinical Recommendations

Approved by the ESMO Guidelines Working Group: April 2002, last update October 2008. This publication supercedes the previously published version—Ann Oncol 2008; 19 (Suppl 2): ii14–ii16.

New Guidelines Emphasize the Need for Cancer Patients to Exercise

Note: "some gynecologic cancers"/talks briefly about "changes in neuropathy"/treatments etc

" Research Gaps Remain

The panel found that there is consistent evidence that exercise training can lead to improvements in aerobic fitness, muscular strength, quality of life, and fatigue in breast, prostate, and hematologic cancer patients and survivors, but that the data for colon and gynecologic cancers are still too limited to lead to conclusions.

Multiple research gaps remain in this field, the panel notes. These include a need for greater specificity with regard to the dose-response effects of specific modes of exercise training on specific end points and within a broader range of populations, such as survivors of colon and gynecologic cancers.

They also urge fitness trainers who work with cancer survivors to learn as much as possible about the specifics of the cancer diagnosis and treatment to make informed safe choices with regard to exercise testing and prescription.

Cancer diagnosis and treatment effects numerous body systems that are required for and affected by exercise training, they conclude, and "because cancer treatments are increasingly customized according to specific tumor characteristics, fitness professionals may benefit from contacting the medical treatment team for more precise information regarding the treatments received.""

ASCO And The CAP Issue Joint Guideline To Improve Hormone Receptor Testing For Patients With Breast Cancer

""There is clearly a need to accurately identify breast cancer subtypes as ER and/or PgR-positive to help us identify those patients most likely to benefit from endocrine therapy and minimize the risk of potentially denying effective and life-saving therapy to patients incorrectly labeled as having ER/PgR-negative invasive disease, while allowing patients with true ER/PgR-negative disease to be considered for other therapies." said Antonio C. Wolff, MD, FACP, co-chair of the ASCO/CAP Hormone Receptor Testing in Breast Cancer Panel and associate professor of oncology at the Johns Hopkins Kimmel Comprehensive Cancer Center. The guideline recommends the following:" (see article for further information)

Methods of consumer involvement in developing healthcare policy and research, clinical practice guidelines and patient information material.

Authors’ conclusions There is little evidence from randomised controlled trials of the effects of consumer involvement in healthcare decisions at the population level. The trials included in this review demonstrate that randomised controlled trials are feasible for providing evidence about the effects of involving consumers in these decisions.
   Comment 1:This paper is an issue for public health policy-makers not clinicians. Consumer involvement has a great risk of being tokenistic.  Comment 2:As a community health professional, the results will serve as an evidence to involve health care consumers in the process of policy and guideline formulation.  Comment 3:
The evidence presented that face-to-face interactions with consumers is the most effective type of involvement for developing patient educational materials is helpful for clinicians.

New supportive care assessment guideline available | Canadian Partnership Against Cancer

Note: search results show there is no reference either in the body of the paper nor in the references section to ovarian cancer

"Conclusion
Despite limitations in the research, there is reasonable evidence that psychosocial
and supportive care needs are under-addressed, that assessment improves patient
outcomes, and that some screening for distress and psychosocial assessment tools
have effective psychometric properties that help to “red flag” patients and support
comprehensive assessment. The recommendations in this guideline have been
designed to explain, ignite, and support the need for quality psychosocial health care
needs assessment and screening for distress in persons living with cancer. Using an
evidence base that is grounded in research and clinical practice, they stress the
importance of assessment as a first step in the explication of need and the
implementation of appropriate interventions. At the same time, this document has
suggested a range of important considerations as the field moves forward – from
needs assessment, clinical service provision, resource allocation, intervention, followup,
and outcome evaluation, to related research, and more. We believe the adoption
of these recommendations into cancer practice will bring us one step closer to a
person-focused cancer system that can improve patient and family experience of
living with cancer."

updated (annual) February 2010: NCCN Clinical Practice Guidelines in Oncology

Note: the NCCN website requires registration/password but is free. It is an excellent resource for ovarian cancer(s) as well as genetic syndrome guidelines.

Page 4 indicates changes over prior guidelines.

New Joint Outpatient Chemotherapy Administration Standards - Cancer Journal for Clinicians

The guidelines were created largely in response to recent studies that have examined reports of chemotherapy administration errors among outpatients, and to reports of an increased risk of errors with the administration of new oral chemotherapeutics.

IGRT, SBRT Guidelines Issued By ASTRO, ACR

"The American Society for Radiation Oncology (ASTRO) and the American College of Radiology (ACR) have released practice guidelines for image guided radiation therapy (IGRT) and stereotactic body radiation therapy (SBRT) in the February issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of ASTRO."

full free access: How to integrate individual patient values and preferences in clinical practice guidelines? A research protocols

Background: