Grey areas and evidence gaps in the management of rectal cancer as revealed by comparing recommendations from clinical guidelines.

Evidence-Based Medicine Humans Practice Guidelines as Topic Professional Practice Gaps Rectal Neoplasms / therapy
Australia Clinical guidelines ESMO JSCCR NCCN Ontario Rectal cancer

Journal

Cancer treatment reviews
ISSN: 1532-1967
Titre abrégé: Cancer Treat Rev
Pays: Netherlands
ID NLM: 7502030

Informations de publication

Date de publication:
Jan 2020
Historique:
received: 27 08 2019
revised: 05 11 2019
accepted: 06 11 2019
pubmed: 23 11 2019
medline: 10 1 2020
entrez: 23 11 2019
Statut: ppublish

Résumé

While the management of nonmetastatic and oligometastatic rectal cancer has rapidly evolved over the last few decades, many grey areas and highly debated topics remain that foster significant variation in clinical practice. We aimed to identify controversial points and evidence gaps in this disease setting by systematically comparing recommendations from national and international clinical guidelines. Twenty-six clinical questions reflecting practical challenges in the routine management of nonmetastatic and oligometastatic rectal cancer patients were selected. Recommendations from the ESMO, NCCN, JSCCR, Australian and Ontario guidelines were extrapolated and compared using a 4-tier classification system (i.e., identical/very similar, similar, slightly different, different). Overall agreement between guidelines (i.e., substantial/complete disagreement, partial disagreement, partial agreement, substantial/complete agreement) was assessed for each clinical question and compared against the highest level of available evidence by using the χ Guidelines were in substantial/complete agreement, partial agreement, partial disagreement, and substantial/complete disagreement for 8 (30.8%), 2 (7.7%), 7 (26.9%), and 9 (34.6%) clinical questions, respectively. High level of evidence supported clinical recommendations in 3/10 cases (30%) where guidelines were in agreement and in 10/16 cases (62.5%) where guidelines were in disagreement (χ Substantial variation exists across clinical guidelines in the recommendations for the management of nonmetastatic and oligometastatic rectal cancer. This variation is only partly explained by the lack of supporting, high-level evidence.

Sections du résumé

BACKGROUND BACKGROUND
While the management of nonmetastatic and oligometastatic rectal cancer has rapidly evolved over the last few decades, many grey areas and highly debated topics remain that foster significant variation in clinical practice. We aimed to identify controversial points and evidence gaps in this disease setting by systematically comparing recommendations from national and international clinical guidelines.
METHODS METHODS
Twenty-six clinical questions reflecting practical challenges in the routine management of nonmetastatic and oligometastatic rectal cancer patients were selected. Recommendations from the ESMO, NCCN, JSCCR, Australian and Ontario guidelines were extrapolated and compared using a 4-tier classification system (i.e., identical/very similar, similar, slightly different, different). Overall agreement between guidelines (i.e., substantial/complete disagreement, partial disagreement, partial agreement, substantial/complete agreement) was assessed for each clinical question and compared against the highest level of available evidence by using the χ
RESULTS RESULTS
Guidelines were in substantial/complete agreement, partial agreement, partial disagreement, and substantial/complete disagreement for 8 (30.8%), 2 (7.7%), 7 (26.9%), and 9 (34.6%) clinical questions, respectively. High level of evidence supported clinical recommendations in 3/10 cases (30%) where guidelines were in agreement and in 10/16 cases (62.5%) where guidelines were in disagreement (χ
CONCLUSIONS CONCLUSIONS
Substantial variation exists across clinical guidelines in the recommendations for the management of nonmetastatic and oligometastatic rectal cancer. This variation is only partly explained by the lack of supporting, high-level evidence.

Identifiants

DOI: 10.1016/j.ctrv.2019.101930 PMID: 31756591
pubmed: 31756591
pii: S0305-7372(19)30151-3
doi: 10.1016/j.ctrv.2019.101930
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

101930

Informations de copyright

Copyright © 2019 Elsevier Ltd. All rights reserved.

Auteurs

G Bregni (G)

Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

T Akin Telli (T)

Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

S Camera (S)

Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

C Baratelli (C)

Department of Oncology, University of Turin, Turin, Italy.

L Shaza (L)

Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

A Deleporte (A)

Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

L Moretti (L)

Department of Radiation Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

M A Bali (MA)

Department of Radiology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

G Liberale (G)

Department of Surgical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

A Hendlisz (A)

Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium.

F Sclafani (F)

Gastrointestinal Unit, Department of Medical Oncology, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium. Electronic address: francesco.sclafani@bordet.be.

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Classifications MeSH

questionsmedicales.fr › Professions de santé › Médecine › Médecine clinique › Médecine factuelle › Grey areas and evidence gaps in the management...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Grey areas and evidence gaps in the management...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Recommandations comme sujet › Guides de bonnes pratiques cliniques comme sujet › Grey areas and evidence gaps in the management...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Différences de pratiques professionnelles › Grey areas and evidence gaps in the management...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Tumeurs du rectum › Grey areas and evidence gaps in the management...