Adaptation of NCCN Guidelines to the Middle East and North Africa Region

Since its inception in April 2009, the NCCN/Middle East and North Africa (MENA) Guideline Initiative has reached important milestones in the adaptation and implementation of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) in the MENA region. The initiative was launched with an introductory meeting and committee formation among regional experts who convened to adapt NCCN Guidelines to the region. During these 5 years, the teams achieved many remarkable tasks, including:

  • Completing the adaptation and publication of NCCN/MENA Guidelines in 6 disease sites (non-small cell lung, breast, colon, hepatobiliary, and prostate cancers; and lymphoma) in 2010, published as a supplement to JNCCN1

  • Establishing a MENA Regional Center for NCCN Collaboration at National Guard Health Affairs in Riyadh, Kingdom of Saudi Arabia, to coordinate regional activities2

  • Holding 3 regional meetings in Abu Dhabi and Dubai, United Arab Emirates, and in Doha, Qatar

  • Completing the adaptation and publication of guidelines in NCCN format in 2014, to be available at NCCN.org

  • Gaining experience in the process of adapting guidelines, which is probably the most important accomplishment, because it will propagate the concept of evidence-based medicine in the region; the development of an easy tool for adaptation helped streamline the discussion and make the process easier and more practical2

  • Increasing the number of unique visitors from the region to the NCCN Web site (NCCN.org) 5-fold over the past 5 years, and noticeably doubling this number the year the initiative was launched (2009; Figure 1)

  • Raising awareness about the need for cross-border collaborative activities to answer important questions regarding cancer epidemiology and disease management, which resulted in some regional projects that came to fruition3

  • Fostering intellectual and educational interaction between regional experts and those in the United States. The regional experts learned about the function and process of NCCN as an organization with monumental experience in the field with its own culture and style, whereas the NCCN experts had the opportunity to see their guidelines through the eyes of external reviewers (the regional experts) who reviewed these guidelines with a different perspective and examined them in close detail, which sometimes resulted in NCCN adopting some of the new ideas generated from the region, such as the addition of treatment of some types of lymphomas (T-cell lymphomas)4

Figure 1
Figure 1

Unique visitors to NCCN.org from the Middle East and North Africa region, 2008-2013.

Citation: Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw 12, 7; 10.6004/jnccn.2014.0091

Expectedly, challenges exist for such projects because of the heterogeneity in socioeconomic status and available resources among countries in the region. Therefore, it was critical to agree to keep the guidelines at the highest possible standards and avoid defaulting to the creation of “convenience” guidelines. The guidelines were adapted to meet the needs of countries with the best access to resources to encourage others to improve care and raise their standards, keeping in mind that each country, or even each institution, may need to perform further adaptation or create their own pathways according to their settings and resources.

The dispersion of committee membership across wide geographic regions presented logistical challenges that the groups tried to overcome through electronic communication and holding committee meetings concurrent with other medical meetings or events for member convenience.

In summary, the NCCN/MENA Guidelines Initiative is contributing to the MENA region's awareness of oncology guidelines and enhancing collaborative activities across borders. The future direction of the initiative involves including more disease sites, expanding membership, and focusing on implementation and adherence issues.

References

  • 1.

    The Abu Dhabi Declaration: Adapted Application of NCCN Clinical Practice Guidelines in Oncology in the Middle East and North Africa Region. J Natl Compr Canc Netw2010;8(Suppl 3):S147.

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  • 2.

    JaziehARAzimHAMcClureJJahanzebM. The process of NCCN Guidelines adaptation to the Middle East and North Africa Region. J Natl Compr Canc Netw2010;8(Suppl 3):S57.

    • Search Google Scholar
    • Export Citation
  • 3.

    JaziehARJaafarHNMustafaR. Epidermal growth factor receptor mutation (EGFRMUT) in non-small cell lung cancer (NSCLC) in the Middle East [abstract]. J Clin Oncol2013;31(Suppl):Abstract e19035.

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  • 4.

    BazarbachiAAzimHAAlizadehH. Modification and implementation of NCCN Guidelines on lymphomas in the Middle East and North Africa Region. J Natl Compr Canc Netw2010;8(Suppl3):S2935.

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    • Export Citation

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Abdul Rahman Jazieh, MD, MPH, is the Chairman, Department of Oncology, King Abdulaziz Medical City and a Professor at King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. He is also the founding Director of the MENA/NCCN Coordinating Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.

He obtained his MD from Damascus University, Syria, and his Masters in Public Health from Tulane University, New Orleans. He completed his Fellowship in Hematology and Medical Oncology at the University of Arkansas for Medical Sciences. He obtained American Boards of Internal Medicine, Hematology, and Medical Oncology.

He was a Professor of Medicine and Chief of Hematology/Oncology Division at the University of Cincinnati. Dr. Jazieh is a member of multiple US professional societies and was a member of the International Affair Committee of ASCO.

Dr. Jazieh has won multiple honors and awards, including proclamation to the City of Cincinnati naming the day of January 5, 2006, as Dr. Abdul Rahman Jazieh Day.

Dr. Jazieh has numerous publications and many presentations in various meetings.

The ideas and viewpoints expressed in this commentary are those of the author and do not necessarily represent any policy, position, or program of NCCN.

Figures

References

  • 1.

    The Abu Dhabi Declaration: Adapted Application of NCCN Clinical Practice Guidelines in Oncology in the Middle East and North Africa Region. J Natl Compr Canc Netw2010;8(Suppl 3):S147.

    • Search Google Scholar
    • Export Citation
  • 2.

    JaziehARAzimHAMcClureJJahanzebM. The process of NCCN Guidelines adaptation to the Middle East and North Africa Region. J Natl Compr Canc Netw2010;8(Suppl 3):S57.

    • Search Google Scholar
    • Export Citation
  • 3.

    JaziehARJaafarHNMustafaR. Epidermal growth factor receptor mutation (EGFRMUT) in non-small cell lung cancer (NSCLC) in the Middle East [abstract]. J Clin Oncol2013;31(Suppl):Abstract e19035.

    • Search Google Scholar
    • Export Citation
  • 4.

    BazarbachiAAzimHAAlizadehH. Modification and implementation of NCCN Guidelines on lymphomas in the Middle East and North Africa Region. J Natl Compr Canc Netw2010;8(Suppl3):S2935.

    • Search Google Scholar
    • Export Citation

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