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Omar Shamieh and Abdul-Rahman Jazieh

Palliative care is an important component of cancer treatment. Advancing palliative care in the developing countries is essential to improving patient care. The issues limiting its practice must be addressed, especially in light of the initiative to adapt the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) to the Middle East and North Africa (MENA) region. Palliative care is in its early stage of evolution in the MENA region, and its practice encounters many challenges and barriers. Adaptation of guidelines should take into consideration the situation and conditions in the targeted region to improve the standard of care to an internationally acceptable level. A group of experts in the MENA region reviewed the literature and collaborated to assess the current status of palliative care and recommend modifications to the NCCN Guidelines based on the unique needs of the region.

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Abdul Rahman Jazieh, Joan S. McClure and Robert W. Carlson

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Hamdy A. Azim, Abdul-Rahman Jazieh and Mohammad Jahanzeb

Over the past decade, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) have emerged as a very useful tool for supporting and improving the quality of decision-making for oncologists worldwide. Considering that approximately 12 million cancer patients were registered by the WHO during 2008 and that the NCCN Web site ( attracts more than 150,000 visitors per month, one can conclude that the NCCN Guidelines program has potentially influenced the management of approximately 15% of all cancer patients worldwide. Although this example shows its far-reaching benefit, it also shows that there is plenty of room for expanding its application. A real need exists within the oncology community to have a reliable evidence-based tool to translate the rapidly accumulating scientific research into practical medical decisions that may offer a better and more consistent treatment outcome for patients. The NCCN recently launched the NCCN–Middle East and North Africa (NCCN–MENA) Guidelines Congress in an attempt to provide versions of the original NCCN Guidelines tailored for cancer management in this region. However, one may ask whether it is really important to have a revised set of Guidelines specifically dedicated to a certain geographical region, when the original NCCN guidelines are satisfactory and comprehensive. We believe the answer is “YES” for 3 main reasons: differences in race, genetic, and environmental factors; differences in presenting features and stage; and differences in access to technology and drugs. Differences in Racial, Genetic, and Environmental Factors The NCCN Guidelines have been generated based on high-level evidence provided by...
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Abdul-Rahman Jazieh, Hamdy A. Azim, Joan McClure and Mohammad Jahanzeb

The NCCN developed clinical practice guidelines for oncology that set the standard of cancer care in the United States. Because of wide acceptance of, need for, and interest in standardized treatment practices across the world, NCCN launched initiatives to help international groups adapt these guidelines. This article describes the initiative in the Middle East and North Africa (MENA) region. A group of oncology experts and key opinion leaders were assembled into 7 specific committees to develop treatment guidelines for breast cancer, lung cancer, colon cancer, prostate cancer, hepatobiliary cancer, lymphoma, and palliative care. The committees reviewed the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) to identify any modifications required for them to be more applicable to the MENA region based on available evidence and regional experience. These modifications were discussed with NCCN experts and summarized for each specific area. The development of these guidelines generated a strong interest in the region to develop more evidence-based practice and create further networking and collaboration.

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Abdul-Rahman Jazieh, Hanaa Bamefleh, Ahmet Demirkazik, Rabab Mohamed Gaafar, Fady B. Geara, Mansur Javaid, Jamal Khader, Kian Khodadad, Walid Omar, Ahmed Saadeddin, Hassan Al Sabe, Mohammad Behgam Shadmehr, Amgad El Sherif, Najam Uddin, Mohammad Jahanzeb and David Ettinger

A lung cancer committee from the Middle East and North Africa (MENA) region was established to modify the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Non–Small Cell Lung Cancer to create a platform for standard care in the region. The committee comprised different experts in thoracic oncology from the region, including the disciplines of medical and clinical oncology, radiation oncology, thoracic surgery, pulmonary medicine, radiology, and pathology. The committee reviewed version 2 of the 2009 NCCN Guidelines on Non–Small Cell Lung Cancer and identified recommendations requiring modification for the region using published evidence and relevant experience. These suggested modifications were discussed among the group and with a United States–based NCCN expert for approval. The recommended modifications, with justification and references, were categorized based on the NCCN Guidelines flow. This article describes these recommended modifications. The process of adapting the first NCCN-based guidelines in the region is a step toward helping to improve lung cancer care in the region and encouraging networking and collaboration.