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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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Ali Bazarbachi, Hamdy A. Azim, Hussain Alizadeh, Mahmoud Aljurf, Ibrahim Barista, Naeem A. Chaudhri, Zahira Fahed, Omar A. Fahmy, Ardeshir Ghavamzadeh, Mohamed H. Khalaf, Sami Khatib, Aghiad Kutoubi, Semra Paydas, Hanadi Rafii Elayoubi, Ghazi Zaatari, Hamdy M. Zawam and Andrew D. Zelenetz

In the Middle East and North Africa (MENA) region, cancer has many epidemiologic and clinical features that are different from those in the rest of the world. Additionally, the region has a relatively young population and large disparities in the availability of resources at diagnostic and treatment levels. A critical need exists for regional guidelines on cancer care, including those for lymphoid malignancies. A panel of lymphoma experts from MENA reviewed the 2009 version of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Non-Hodgkin's Lymphoma and Hodgkin Lymphoma and suggested modifications for the region that were discussed with the United States NCCN Lymphoma Panels. This article presents the consensus recommendations.