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Developing clinical recommendations for breast, colorectal, and lung cancer adjuvant treatments using the GRADE

Rossana De Palma1, Alessandro Liberati, Giovannino Ciccone

  • 1PRI-ER Oncology Research Group, Agenzia Sanitaria Regionale, Viale Aldo Moro 21, Bologna, Italy. rdepalma@regione.emilia-romagna.it

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|March 4, 2008
PubMed
Abstract

Insights

The GRADE system effectively guides recommendations for anticancer drugs by separating evidence quality from recommendation strength. This approach ensures rigorous, interdisciplinary decision-making for cancer treatment policies.

Area of Science:

  • Oncology
  • Clinical Pharmacology
  • Evidence-Based Medicine

Background:

  • Accelerated approval of anticancer drugs can compromise benefit-risk assessment.
  • Developing robust drug-specific recommendations is crucial for effective cancer treatment.

Purpose of the Study:

  • To create drug-specific recommendations for anticancer therapies using an explicit framework.
  • To differentiate judgments on evidence quality from the strength of recommendations.

Main Methods:

  • Utilized the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system.
  • Assessed 12 clinical questions on adjuvant treatment for breast, colorectal, and lung cancer via multidisciplinary panels.
  • Supported by methodologists to ensure rigorous evaluation.

Main Results:

  • Recommendations were generated for 9 out of 12 questions, including strong and weak recommendations for or against treatments.
  • The perceived benefit-risk balance was the primary predictor of panel recommendations and their strength (P < .01).
  • No specific course of action was recommended for the remaining 3 questions.

Conclusions:

  • The GRADE system facilitates explicit decision-making by evaluating evidence quality and benefit-risk profiles.
  • This methodology proved effective in integrating methodologic rigor with interdisciplinary input for evidence-based clinical policies.
  • The approach supports the development of clear clinical policies for anticancer drug use.

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