Where Are We Headed: The Value of Updating Guidelines

Several years ago Shekelle et al.1 subtitled their report examining the AHRQ guidelines, “How quickly do guidelines become outdated?” This review asked the developers of 17 guidelines whether those that had been available for several years and not updated were still valid. The findings were somewhat startling: 7 required major update and 6 needed minor revision. Only 3 were considered still valid as written. Half the guidelines were invalid at 5.6 years, and the authors recommended that clinical practice guidelines undergo review at least every 3 years.The NCCN guidelines are updated annually. Of course, no one is surprised that the tremendous advances in oncology drug development lead to major new recommendations in the management of many cancers each year. Thanks to the dedication of the NCCN panels, major new advances may be inserted into the guidelines almost immediately. The goal is ensuring that new interventions that benefit patients, especially those that impact survival, are incorporated into the corpus of oncologic knowledge with no delay. The rapid revision of the breast cancer guidelines to incorporate trastuzumab after the ASCO presentations is a prime example of this nimbleness.The myelodysplastic syndromes (MDS) guidelines in this issue illustrate an even more profound example of the need to update guidelines regularly and frequently. As stated in the manuscript, MDS represent “myeloid clonal hemopathies with relative heterogeneous spectrums of [clinical] presentation.” Several years ago, as this guideline was being developed, the heterogeneity represented by the FAB variants was categorized into groups according to the...

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Rodger J. Winn is the Editor-in-Chief of JNCCN. He is Clinical Consultant at the National Quality Forum, and his past positions include Associate Professor of Clinical Medicine at The University of Texas M. D. Anderson Cancer Center. Dr. Winn received his medical degree from Jefferson Medical College of Philadelphia. His postgraduate training includes an internship and residency at Jefferson Medical College, and he also completed a medical oncology fellowship at Memorial Sloan-Kettering Cancer Center in New York. He is board certified in internal medicine and holds subspecialty certification in oncology.

References

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    ShekellePGOrtizERhodesS. Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: How quickly do guidelines become outdated?JAMA2001;286:1461-1467.

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    SilvermanLRDemakosEPPetersonBL. Randomized controlled trial of azacytidine in patients with myelodysplastic syndrome: A study of the CALGB. J Clin Oncol2002;20:2429-2440.

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