New NCCN Guidelines for Children With Cancer Meet Growing Needs of Pediatric Oncology Community Worldwide

NCCN recently released the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pediatric Acute Lymphoblastic Leukemia (ALL)—the most comprehensive and up-to-date evidence-based, consensus-driven guidelines for treating children with cancer outside of a clinical trial setting. These new NCCN Guidelines are the first of several planned to address pediatric cancers.

“We are publishing the NCCN Guidelines for Pediatric ALL in response to a growing global need for protocols that ensure children with cancer receive the best care possible, no matter where they’re treated,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “Thankfully, in recent years pediatric ALL has reached a very high cure rate, with almost all low-risk patients achieving long-term survival. However, that means fewer patients are being treated within the context of a clinical trial, which creates the need for treatment guidelines that set sufficient and appropriate standards for care. NCCN’s evidence- and expert-consensus–based approach, proven track record for improving outcomes, and ability to provide rapid updates, allows us to fill this void.”

ALL is a blood cancer that impacts about 2,900 people aged ≤21 years in the United States every year. It is the most common children’s cancer, accounting for 35% of all cancers in that age group.1 Treatment typically involves multiagent chemotherapy regimens, lasts for 2 to 3 years, and comprises 4 components: remission induction, consolidation, maintenance, and central nervous system-directed therapy.2 Pediatric ALL is also at the forefront for innovative new approaches such as targeted therapy and immunotherapy, including the first FDA approval for CAR T-cell therapy.3

“The cure rate for pediatric ALL in the U.S. has risen from 0% in the 1960s to nearly 90% today,” said Patrick Brown, MD, Associate Professor of Oncology and Pediatrics, Director, Pediatric Leukemia Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Chair, NCCN Guidelines for Adult and Pediatric ALL. “This is among the most profound medical success stories in history. The NCCN Guidelines assemble today’s ‘best practices’ into one comprehensive, consensus document, based on input from experts across medical disciplines, including pediatric oncologists, radiation oncologists, bone marrow transplant physicians, infectious disease experts, and molecular pathologists.”

“These guidelines ensure that every child gets the highest quality treatment, even outside of a clinical trial,” said Hiroto Inaba, MD, PhD, Member, St. Jude Children's Research Hospital, Vice Chair, NCCN Guidelines for Pediatric ALL. “Our recommendations include a strong focus on supportive care, so hopefully patients will not experience severe side effects. Pediatric ALL survivors live a long time; we have to consider long-term effects as well.”

The NCCN Guidelines for Pediatric ALL span birth through adolescence and into young adulthood. They were designed to overlap with the NCCN Guidelines for Adult ALL, and harmonize treatment approaches for patients in the overlapping age rage. The recommendations are categorized by risk level, which can also be age-related; with the highest risk associated with those diagnosed within the first 12 months of life or between age 10 and 21 years.

“One unique and useful component of these guidelines is the identification of vulnerable populations, and assembling the best supportive care advice for them,” explained Dr. Brown. “Patients with Down syndrome and very young infants, for example, face particular challenges that we address.”

NCCN plans to continue growing the library of NCCN Guidelines for pediatric cancers, until they address at least 90% of all incident childhood cancers. Up next will be NCCN Guidelines for Pediatric Burkitt Lymphoma, which will be published before the end of 2019.

There are also plans to adapt the NCCN Guidelines for Pediatric ALL into NCCN Harmonized Guidelines and NCCN Framework for Resource Stratification of NCCN Guidelines (NCCN Framework) for low- and middle-income countries to provide direction for effective management even when resources are limited. In these settings, having established care standards can make the difference between life and death.

“We know that many, many children can be cured with inexpensive and widely-available therapies,” said Dr. Brown. “With the increasing global reach of the NCCN Guidelines, we can really pave the way for increasing the cure rates throughout the world.”

“In places where resources are limited, oncologists need to know they are using the available options optimally. Our plans for resource-stratified versions of the NCCN Guidelines for Pediatric ALL will provide the information they need to make the right call,” said Dr. Carlson. “Experts from among the best children’s hospitals in the world are represented on our panels. Families can be reassured that children who are treated according to the NCCN Guidelines are getting the very best care available.”

References

  • 1.

    Acute lymphoblastic leukemia (ALL). Children’s Oncology Group website. Available at: https://www.childrensoncologygroup.org/index.php/acute-lymphoblastic-leukemia. Accessed May 20 2019.

  • 2.

    Cooper SLBrown PA. Treatment of pediatric acute lymphoblastic leukemia. Pediatr Clin North Am 2015;62:6173.

  • 3.

    FDA approval brings first gene therapy to the United States. U.S. Food & Drug website. Available at: https://www.fda.gov/news-events/press-announcements/fda-approval-brings-first-gene-therapy-united-states. Accessed May 20 2019.

CureMD Oncology Integrates NCCN Templates

NCCN is collaborating with CureMD to integrate the NCCN Chemotherapy Order Templates (NCCN Templates) into the CureMD Oncology EHR to allow for point-of-care access to treatment recommendations and order templates derived from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines).

“The collaboration with CureMD advances NCCN’s commitment to supporting evidence-based clinical decision support to improve quality, safety, and ultimately outcomes in cancer care,” said C. Lyn Fitzgerald, MJ, Senior Vice President, U.S. & Global Development, NCCN. “We’re enthusiastic about the inclusion of the NCCN Guidelines and NCCN Templates in the CureMD Oncology EHR platform as it will make it easier for clinicians to provide the best evidence- and expert-consensus–based decisions for their patients.”

CureMD is a leading provider of innovative health information systems and services that transform the administrative and clinical operations of healthcare organizations. Their oncology EHR automates providers’ workflows and includes key features that ensure oncology practices and their patients have access to evidence-based treatment information developed by leading experts.

“At CureMD Oncology, we are dedicated to elevating the level of care oncology practices provide cancer patients. Collaborating with NCCN and providing oncology practices with industry-leading clinical guidelines and treatment regimens through our award-winning Oncology EHR is a resounding example of our dedication to improving care quality,” said Bill Hashmat, CEO, CureMD.

The NCCN Guidelines are the recognized standard for clinical policy in cancer care and are the most thorough and most frequently updated clinical practice guidelines available in any area of medicine. Derived directly from the NCCN Guidelines, the NCCN Templates include chemotherapy and immunotherapy regimens with literature support, supportive care agents, monitoring parameters and safety instructions. The goal of the NCCN Templates is to enhance patient safety by empowering health care providers to standardize patient care, reduce medical errors, and anticipate and manage adverse events.

NCCN continues to add to the library of chemotherapy order templates to improve the safe use of drugs and biologics in cancer care.

For more information about the use of NCCN Content in Health Information Technology, visit NCCN.org/HIT.

New PatientPoint Campaign Brings NCCN Resources to Oncology Practices Nationwide

PatientPoint and the NCCN today announced a new collaboration to integrate the NCCN Guidelines for Patients: Nausea and Vomiting into the PatientPoint Interact Exam Room Program. PatientPoint is also promoting NCCN programs and evidence-based NCCN resources to patients, caregivers and oncology specialists. The collaboration, projected to reach more than 4,000 oncologists nationwide, leverages PatientPoint technology at critical touchpoints throughout the patient journey to share information about NCCN Guidelines for Patients, webinars, professional education, events, apps and other tools.

NCCN is a not-for-profit alliance of 28 leading cancer centers devoted to patient care, research and education. NCCN is dedicated to improving and facilitating quality, effective, efficient and accessible cancer care so patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. The NCCN Guidelines for Patients are supported by charitable donations given to the NCCN Foundation.

As part of the new campaign, PatientPoint will deliver information about NCCN resources in oncology waiting rooms, exam rooms and physician back office areas via its PatientPoint Communicate, PatientPoint Interact and PatientPoint Access engagement programs.

“This collaboration with PatientPoint provides a new way for us to let people with cancer and their loved ones know about the NCCN Guidelines for Patients we offer to help them understand their options and take part in informed, shared decision-making,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “Spreading the word about our resources at the point of care, when patients and providers are most primed to act, will enable us to connect our resources with more people who will benefit from them.”

In waiting and exam rooms, content encourages patients and caregivers to access NCCN Guidelines for Patients: Nausea and Vomiting and “Know What Your Doctors Know” live webinars and videos. Back-office content encourages physicians and staff to access a host of clinical tools, including the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), mobile apps, NCCN Virtual Reimbursement Resource Room and upcoming educational events.

“We know that a cancer diagnosis is overwhelming for patients and families and that healthcare professionals must stay up to date on constantly changing guidelines and treatment recommendations,” said PatientPoint Founder and CEO Mike Collette. “Through this new collaboration with NCCN, we will be able to help deliver trusted, timely, evidence-based information and education that will help improve care and contribute to better outcomes.”

NCCN and AstraZeneca Seek Opportunities to Improve Outcomes in Advanced Ovarian Cancer

The NCCN Oncology Research Program (ORP) is collaborating with AstraZeneca, a global, science-led biopharmaceutical company, to further quality in cancer care for people with advanced ovarian cancer. This follows a recently announced and still active request for proposals, also in collaboration with AstraZeneca, on innovative approaches for improving care in unresectable stage III and IV non-small cell lung cancer. Letters of intent are due Monday, July 22, 2019, for this new opportunity, which is available to researchers at any of the 28 NCCN Member Institutions.

“Advanced and recurrent ovarian cancer remains a treatment challenge,” explained Wui-Jin Koh, MD, Chief Medical Officer, NCCN. “It’s currently the deadliest gynecologic cancer, and requires a coordinated, multi-disciplinary approach. With this project, we’re looking for research that focuses on how to optimize multiple facets of management effectiveness by harnessing innovative technologies or addressing knowledge gaps.”

Some areas of particular interest for proposals include:

  • Adhering to standard of care management

  • Delivering care through innovative methods (eg, telemedicine)

  • Improving adoption of appropriate genetic testing

  • Discovering new strategies for sharing and implementing novel findings expeditiously

  • Creating shared decision-making models

  • Improving the use of supportive services

  • Utilizing technology to enhance quality of life in patients

Proposals that are reproducible, scalable, rapidly implementable, and provide quantifiable outcome measures are preferred. NCCN ORP is also interested in discovering concepts to reduce financial toxicity, manage care across multiple facilities, increase clinical trial enrollment, and enhance shared decision-making and patient information.

The NCCN ORP fosters innovation and knowledge discovery that improve the lives of patients with cancer. Collaboration between NCCN Member Institutions is strongly encouraged to cultivate interactive sharing of knowledge and expertise, and to use members' combined strengths. For more information and to read the entire Request for Proposals, visit NCCN.org/ORP.

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References

  • 1.

    Acute lymphoblastic leukemia (ALL). Children’s Oncology Group website. Available at: https://www.childrensoncologygroup.org/index.php/acute-lymphoblastic-leukemia. Accessed May 20 2019.

  • 2.

    Cooper SLBrown PA. Treatment of pediatric acute lymphoblastic leukemia. Pediatr Clin North Am 2015;62:6173.

  • 3.

    FDA approval brings first gene therapy to the United States. U.S. Food & Drug website. Available at: https://www.fda.gov/news-events/press-announcements/fda-approval-brings-first-gene-therapy-united-states. Accessed May 20 2019.

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