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Clinical practice guidelines in breast cancer.
N Kumar Tyagi1, S Dhesy-Thind1
1Division of Medical Oncology, Department of Oncology, McMaster University, Hamilton, ON.
Current Oncology (Toronto, Ont.)
|June 19, 2018
Summary
Clinical practice guidelines (CPGs) for breast cancer (BCA) vary in quality and applicability. Improving CPG implementation is crucial for better patient outcomes and closing the knowledge-to-practice gap.
Area of Science:
- Oncology
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Numerous clinical practice guidelines (CPGs) exist for breast cancer (BCA) screening and management.
- This review assesses the strengths and weaknesses of available BCA CPGs.
Purpose of the Study:
- To evaluate the methodologic quality, recommendations, and implementability of CPGs from major professional organizations.
- To compare guidelines for specific BCA scenarios: ovarian function suppression (OFS) and sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC).
Main Methods:
- Reviewed guidelines from ASCO, CCO's PEBC, NCCN, and St. Gallen using the AGREE II tool.
- Two independent assessors evaluated guideline methodology and applicability for two clinical scenarios.
Main Results:
- ASCO and CCO's PEBC guidelines demonstrated the highest methodologic quality.
- NCCN and St. Gallen guidelines had lower methodologic rigor; all guidelines scored poorly on applicability.
- Recommendations for OFS were consistent across most guidelines, while SLNB recommendations after NAC were contradictory.
Conclusions:
- CPGs exhibit heterogeneity in methodologic quality and applicability.
- Low-quality implementation strategies hinder CPG uptake and adherence.
- Further research is needed to address barriers to CPG implementation and improve patient outcomes.
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