Background: Colorectal cancer (CRC) survivors are at increased risk of developing the disease again. Surveillance guidelines are aimed at maximising the early detection of recurring or new cancers and pre-cancerous polyps. The frequency and type of surveillance recommended depends on the type of treatment for the initial CRC, the extent of colonoscopic investigation prior to treatment and the results of previous surveillance tests. This paper aimed to test the effect of a paper–based educational intervention to improve adherence to colonoscopy following treatment for colorectal cancer.
Conclusions: Results indicate the paper-based educational intervention is not effective in improving adherence to colorectal cancer surveillance guidelines for colonoscopy.
The Scottish Intercollegiate Guidelines Network (SIGN) has revised SIGN 146 – Cutaneous melanoma guideline 146. This guideline takes into account new evidence in diagnostic and prognostic indicators, imaging techniques and laboratory investigation and systemic therapy.
Heins, M.J. et al. European Journal of Public Health. Published online December 2016
Background: Guideline adherence remains a challenge in clinical practice, despite guidelines’ ascribed potential to improve patient outcomes. We studied the level of adherence to recommendations from Dutch national cancer treatment guidelines, and the influence of general and cancer-specific guideline characteristics on adherence.
Conclusion: We found significant variation in adherence between different cancer treatment guidelines. While some guideline characteristics that seem to explain this variation may be considered difficult to modify, the potential for variance across cancer types and treatment modalities suggests that adherence could be further improved. At the same time, these results warrant tailored strategies for the improvement of adherence to clinical practice guidelines.
Herst, J. et al. Clinical Oncology. Published online: September 30 2016
A clinical practice guideline for early stage Hodgkin lymphoma is proposed.
The recommendations, based on a systematic review, have been reviewed by an external panel.
Evidence quality was evaluated with the Cochrane Risk of Bias tool and we used GRADE.
Combined modality therapy or chemotherapy alone are options for early-stage Hodgkin lymphoma.
PET scanning was not considered a good tool to identify patients for whom IFRT could be omitted.
In the past, treatment for patients with early-stage Hodgkin lymphoma consisted mainly of radiotherapy. Now, chemotherapy alone and chemoradiotherapy are treatment options. These guidelines aim to provide recommendations on the optimal management of early-stage Hodgkin lymphoma.
We conducted a systematic review searching MEDLINE, EMBASE, the Cochrane Library and other literature sources from 2003 to 2015, and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Two authors independently reviewed and selected studies, and appraised the evidence quality. The document underwent internal and external review by content, methodology experts, a patient representative and clinicians in Ontario.
We have issued recommendations for patients with classical Hodgkin lymphoma and with nodular lymphocyte predominant Hodgkin lymphoma; with favourable and unfavourable prognosis; and for the use of positron emission tomography to direct treatment. We have provided our interpretation of the evidence and considerations for implementation. Examples of recommendations are: ‘Patients with early-stage classical Hodgkin lymphoma should not be treated with radiotherapy alone’; ‘chemotherapy plus radiotherapy or chemotherapy alone are recommended treatment options for patients with early-stage non-bulky Hodgkin lymphoma’; ‘The Working Group does not recommend the use of a negative interim positron emission tomography scan alone to identify patients with early-stage Hodgkin lymphoma for whom radiotherapy can be omitted without a reduction in progression-free survival’.
Through the use of GRADE, recommendations were geared towards patient important outcomes and their strength reflected the available evidence and its interpretation from the patients’ point of view.
NHS England has published guidance to support commissioners and strategic clinical networks to ensure every person affected by cancer will have access to a recovery package and follow-up pathways by 2020, as set out in the cancer strategy.
The guidance includes checklists for developing service specifications, practical examples and templates to use and adapt locally.
Margaret McCartney wrote a relevant viewpoint in the British Medical Journal back in 2014. She immortalised the words of David Haslam (then Chair of the guideline developers NICE) at the NICE conference. From the horse’s mouth, he said- they are “guidelines not tramlines”. You could feel the collective sigh of relief from all the GPs (including me) who had deviated (even slightly) from the NICE guidelines (once or twice).
You might, then, find it strange that in Oxford that we’ve been redeveloping the 2-week-wait (urgent referral) cancer pathways with the Oxfordshire Clinical Commissioning Group so that they match up with the suspected cancer guidelinesreleased by NICE in July 2015. This has been no mean feat! (and is not exclusive to Oxford). There were over 200 recommendations and each form requires sign-off from our hospital colleagues before being used by the 632 GPs working in the 72 practices across Oxfordshire. Hospital specialists have reservations about NICE, expressing concerns that tests being recommended inappropriately and too many patients being referred without cancer will further overwhelm their already overstretched clinics. So, if this is true, why bother at all?- specialists dislike the new guidelines and GPs don’t take any notice of them.
The 2015 guideline includes three major leaps forwards to overcome the fact their 10 year-old predecessor led to thedetection of under 50% of cancers: 1) they lower the risk of cancer at which GPs should refer or test their patients, meaning patients can be investigated earlier- something patients want; 2) they are based on research conducted on General Practice patients, as relying only on traditional “red flag” or “alarm” late symptoms seen in specialist clinics means that cancers may be caught too late or present as an emergency; 3) they are based on symptoms and not just cancer types, as some symptoms like weight loss and fatigue are common to many cancers and are missed by cancer based guidelines. So referrals may go up, but the previous system was not working.