ASCO is at the forefront of helping its members access evidence-based medicine in clinical oncology. Through a rigorous systematic review of published evidence, ASCO produces Clinical Practice Guidelines, upon which summaries and practice tools are based. Recent guideline publications in the Journal of Clinical Oncology (JCO) include “Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer;” “Use of Epoetin and Darbepoetin in Patients with Cancer: 2007 American Society of Oncology/American Society of Hematology Clinical Practice Guideline Update;” “Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non-Small Cell Lung Cancer;” and “Update of Recommendations for the Use of Tumor Markers in Breast Cancer.”
In a 1993 survey, ASCO members rated the development of guidelines as the second most important priority area for the Society, leading to the production of ASCO’s first guideline in 1994. Subsequently, members consistently cite ASCO guidelines among the top three benefits of membership. During the 2008 ASCO Annual Meeting, attendees gave the “Cancer and Thrombosis” venous thromboembolism (VTE) guideline-based categorical courses some of the very highest evaluations from the meeting (2008 Attendee Sessions Evaluations). Users of JCO.org download ASCO guidelines frequently; they are five of the top 10 articles users accessed in 2007 (see list to the right).
Guidelines can help reduce variations in practice, increase the quality of care, provide decision support, and help ensure that providers are delivering evidence-based care. ASCO guidelines review the data from the literature, help interpret the results of clinical trials, and provide expert guidance about new technologies and assays in oncology. Users can know the recommendations are based upon the intensive review ASCO provides for each guideline.
For example, knowledge in the areas of genomics and proteomics has grown exponentially in recent years, affecting oncology particularly. An immense number of cancer biomarker publications appear every year. Translating such a barrage of science into clinically useful information for an oncologist and a person with cancer deciding together whether or not to use a biomarker study is a helpful contribution of guidelines.
New guideline sections on physicianpatient communications can help oncologists explain choices to people with cancer. In addition, ASCO’s Communications Department develops patient guides based on the Clinical Practice Guidelines. Clinicians can provide these guides to patients and their loved ones to help them understand the relevant treatments, assays, and other medical interventions they may receive.
ASCO recently investigated the best way to incorporate guidelines into electronic health records (EHRs). At the 2008 Annual Meeting EHR lab, vendors demonstrated a case scenario that incorporated ASCO guideline recommendations regarding anti-emetics and white blood cell growth factors. As EHRs continue to make inroads into oncology practice, incorporation of guideline recommendations can provide decision support, inform dosing, and contribute to safety.
ASCO convenes Expert Panels, usually from a variety of disciplines, to produce these Clinical Practice Guidelines. All panels include someone personally affected by cancer, such as a survivor or family member. Panels usually meet once to review the body of evidence and make or update recommendations which are supported by the evidence. The literature is systematically collected by panels, ASCO staff, and/ or collaborators. ASCO has collaborated with Cancer Care of Ontario on several guidelines, and has also worked with other professional societies, including the American Society of Hematology (ASH) and the American Society for Therapeutic Radiology and Oncology (ASTRO).
In addition, ASCO has used a relatively new mechanism to endorse guidelines produced by other organizations, such as the “Cancer Care Ontario (CCO) Guideline on Non-Hormonal Therapy for Men with Metastatic Hormone-Refractory Prostate Cancer.” Endorsement of guidelines by other groups requires that the guideline be based on a rigorous, transparent review of the literature, and that it undergoes extensive content and methodology review by ASCO experts.
All guidelines are available on JCO.org; in addition, guidelines with their “toolboxes” of clinical tools and resources are available at www.asco.org/guidelines.
