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Evidence in National Comprehensive Cancer Network Harmonized Guidelines for Sub-Saharan Africa: A Meta-Research
Scott J Swartz1, Gwynn Spielman2, Samrawit Agezew3
1Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.
Purpose:
The National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA) have emerged as leading cancer treatment guidelines in SSA. The objective of this study is to examine the evidence cited in support of the NCCN-SSA guidelines, with a focus on population characteristics and generalizability to SSA.
Methods:
This meta-research analysis included all studies cited in support of treatment and/or management recommendations in the NCCN-SSA guidelines for the nine most common cancers in SSA. Studies were identified by two independent reviewers; duplicate studies, those lacking individual-level data, and those unrelated to treatment and/or management were excluded. Data on the study type, participant demographics (age, sex, race/ethnicity), and recruitment geography were abstracted from each full-text article. Descriptive analyses were performed using R to characterize the study type (eg, experimental, observational), demographics (mean age, percent female/male, percent by race/ethnicity), and geographic representation overall and by individual cancer type.
Results:
Overall, 4,589 citations were reviewed and 2,931 (63.9%) studies with individual-level data were included. Of the 2,061 studies reporting geographic information, 50 (2.4%) recruited in SSA; of these, 39 (83.0%) recruited from South Africa. Three studies (0.2%) recruited exclusively in SSA. Most studies (95.3%) recruited exclusively from high- or upper-middle-income countries. Only 29.2% of studies reporting participant race included >10% of Black study participants.
Conclusion:
Most studies cited in the NCCN-SSA guidelines were conducted in high-income countries outside SSA. A small minority of all study participants were Black. These findings underscore potential limitations in the generalizability of the NCCN-SSA guidelines to SSA and highlight a pressing need to generate and incorporate context-specific data to guide care and inform policy.
