Rectal cancer specialist Prof. Axel Grothey from the Mayo Clinic in Rochester, USA, said: “ESMO Clinical Practice Guidelines on Rectal Cancer, and on other cancers, are popular internationally even outside Europe. This is because physicians in practice need guidance and ESMO’s guidelines are much more practice oriented than many other guidelines.”
His comments follow a Cancer article which used the Appraisal of Guidelines Research & Evaluation (AGREE II) instrument to compare several rectal cancer clinical practice guidelines (CPGs).1 The findings were discussed by members of the ESMO Guidelines Committee in a letter to the editor of Cancer.2 They pointed out that “solely the CPG publications were assessed, rather than the whole spectrum of guideline publications from ESMO for Colon and Rectal Cancer”. This limitation was acknowledged in a subsequent letter by the article’s authors.3
Prof. Andrés Cervantes, ESMO Guidelines Committee Chair, Prof. George Pentheroudakis, ESMO Guidelines Committee co-Chair, and Prof. Dirk Arnold, ESMO Guidelines Committee Subject Editor for Gastrointestinal Cancer, also wrote that the methodology for CPG production is “directly linked to the scope of ESMO CPGs to provide information for daily clinical use, in a concise format, for (mainly) the European oncology target audience”.
Grothey said: “The purpose of ESMO guidelines is to provide recommendations for the practical management of patients. The guidelines are developed by experts in a particular type of cancer who are familiar with the current literature and evidence. These experts put the evidence into context for clinical practice with the aim of assisting physicians with everyday scenarios. This is in contrast with other guidelines whose main focus is cost benefit analysis and drug approval.”
Commenting on the value of ESMO guidelines, Grothey said it was important to clearly define what they intend to do. “ESMO guidelines provide practical guidance and make the evidence palatable for clinicians. Rather than scrutinising the individual evidence within the document they package the available literature into a form that is relevant for oncologists. They are user friendly and that’s one of the reasons why they are used by oncologists across the globe.”
Romania officially adopted ESMO Clinical Practice Guidelines in 2008 and recently announced that the guidelines will be translated and distributed on an ongoing basis by the Federation of the Romanian Cancer Societies.
Prof. Tudor-Eliade Ciuleanu, Ion Chiricuta Oncology Institute-IOCN, Cluj Napoca, Romania, said: “The recognition and adoption of ESMO guidelines as official guidelines in Romania is, beyond any doubt, a step forward to improve the quality of care and to approach the European standard. The guidelines are used for orienting clinical practice and for reimbursement.”
Ciuleanu said that the adoption of ESMO Clinical Practice Guidelines as recommended practice in Romania “has been very well received by clinicians”. The latest versions were distributed to participants at the National Congress of the Federation of the Romanian Cancer Societies in October 2014.4,5
Commenting on the choice of ESMO guidelines as best practice for Romania, Ciuleanu said: “ESMO guidelines were adopted as official guidelines for the practice of oncology in Romania on the recommendation of professional societies, which considered ESMO guidelines the most applicable and appropriate model for medical oncologists in the country. The format is aimed at practitioners with concise but explicit, well documented and evidence based recommendations.”
He added: “ESMO guidelines are closer to the clinical practice and reimbursement policies in Romania than other guidelines. For example monoclonal antibodies for metastatic colorectal cancer are reimbursed in Romania according to the ESMO guidelines.”
Romanian guidelines for the main tumour types have been published since the 1990s under the auspices of the Romanian College of Physicians or as an initiative of different groups including surgeons, gynecologists, urologists, pneumologists, gastroenterologists, medical oncologists and radiation oncologists.
But Ciuleanu said: “There was a large heterogeneity among these guidelines depending on the composition of the editorial board. Therefore, since 2008 the oncology professional societies considered that the adoption of ESMO guidelines was the best solution to unify the different versions of the existing guidelines, and to overcome the disparities. We now look forward to receiving translations of all new and updated ESMO guidelines as they are produced.”
Cervantes confirmed that ESMO will continue its commitment to produce high quality guidelines that help physicians take the best decisions in daily practice. “Our ESMO Guidelines are extensively used and downloaded all over the world and we expect that patient outcomes can eventually improve if evidence based guidelines are more universally applied. In consideration of the points addressed in the review article, our aim is to provide high calibre guidelines for optimal cancer care in various possible situations. Some methodological refinements as well as increasing transparency in the process of guidelines production are now underway.”
- Abdelsattar ZM, Reames BN, Regenbogen SE, Hendren S, Wong SL. Critical evaluation of the scientific content in clinical practice guidelines. Cancer. 2014 Nov 6. doi: 10.1002/cncr.29124. [Epub ahead of print]
- Cervantes A, Pentheroudakis G. and Arnold D. (2015), Critical evaluation of the scientific content in clinical practice guidelines. Cancer. doi: 10.1002/cncr.29261
- Abdelsattar ZM and Wong SL (2015), Reply to ESMO guidelines committee comment on ‘Critical evaluation of the scientific content in clinical practice guidelines’. Cancer. doi: 10.1002/cncr.29263
- Volume I – ESMO Guidelines in Solid tumors, Journal of Radiotherapy and Medical Oncology, vol. 20, suppl. 1, 2014, ISSN 1844-0770, 329 pages
- Volume II – ESMO Guidelines in Hematological Malignancies and Supportive Care, Journal of Radiotherapy and Medical Oncology, vol. 20, suppl. 2, 2014, ISSN 1844-0770, 151 pages