The quality of care received by patients often differs based on numerous factors, including but not limited to, treatment protocols that are being used in practice, health care setting, geographic location, access to medications, and insurance coverage. Recently, the issue of whether standardized treatment protocols, also known as pathways, can reduce costs without reducing the quality of care has been the subject of much debate, as has been their ability to reduce variance of care. As pathways are increasingly deployed in practice, they have a growing impact on how treatment is delivered and ultimately on health outcomes for patients.
In the spring of 2012, NCCN will host an invitation-only NCCN Policy Summit: Equity in Cancer Care: Pathways, Protocols, and Guidelines. This policy summit will be a forum to discuss the implementation of pathways, including but not limited to, how much flexibility pathways should allow in care, how pathways impact public and private health insurance benefit design, what impact pathways may have on variation in care, and how data are used to determine pathways.
The collection and subsequent use of data for clinical, regulatory, and coverage decision-making in oncology are of great interest to many stakeholders, including providers, payors, patients, and regulators. Rising health care costs and continued concerns about safety and quality have resulted in the demand for more data and evidence by payors and providers alike. A common foundation of high-quality data that are available in real time can simultaneously be used to improve clinical care and yield quality measurements, both of which are high priorities for stakeholders.
In the summer of 2012, NCCN will host an invitation-only NCCN Policy Summit to discuss concepts, including but not limited to, databases, cohort studies, surrogate end points, clinical trial design, pharmacovigilance, and coverage with evidence development. Before the Policy Summit, NCCN will convene a multidisciplinary diverse Work Group to identify challenges and provide recommendations on these topics, among other key challenges. Ultimately, the focus of this initiative is to advance the evidence base for cancer treatment and to examine the way evidence is generated, aggregated, and applied to decision-making.
Setting the Guidelines for Cancer Treatment in the Middle East & North Africa
Last month, more than 250 oncology professionals from across the Middle East & North Africa (MENA) region gathered in Doha, Qatar, for 3 days of intensive education and discussion surrounding the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) and their application in MENA practices. Dr. Hamdy Azim of Cairo University opened the program on January 26 by describing the history of NCCN’s work in the region and the goal of continued, annual collaborations in which NCCN experts contribute their time and expertise to the betterment of the lives of patients with cancer in the Middle East. Dr. Azim remarked that, in MENA, the “NCCN Guidelines have emerged as a very useful tool for improving the quality of decision-making for oncology professionals.” This sentiment was reiterated throughout the event and was fundamental to the overarching theme stressing the importance of minimizing practice variation by implementing evidence-derived, region-appropriate standards.
Dr. Nagi El Saghir of American University of Beirut Medical Center emphasized that using guidelines makes physicians better than they would be if they relied entirely on their individual background and experience in making complex decisions regarding patient care. He expressed his belief that deviation from guidelines recommendations should only occur with justification based on patient-specific characteristics or preferences, rather than on a discretionary basis.
As part of a particularly inspiring lecture, Dr. Abdul Rahman Jazieh of National Guard Hospital of Riyadh made an impassioned plea to the audience to improve their service to patients and themselves through recognizing the room for improvement, the need for clinical trials, and the importance of guidelines in the treatment of patients with cancer. He referred to the discussions with NCCN experts as a “huge reality check,” and one that must be acknowledged for new skills to be learned.
Joan McClure represented NCCN and provided a detailed review of the NCCN Guidelines components, development process, derivative products, and their use by payors and in informatics systems. Ms. McClure described how the NCCN Guidelines represent the continuum of care, comprising 15,000 collective hours of development effort each year by NCCN’s 900 panel members. She stressed NCCN’s position on encouraging clinical trials.
Dr. Mohammad Jahanzeb of University of Miami and University of Tennessee spoke about the challenges in adapting treatment recommendations for regional use, including cultural and language barriers, and application in community practice. He also discussed the value of working through these challenges and illustrated examples of successful NCCN global collaborations and their resultant resources.
Dr. Robert Carlson of Stanford Cancer Institute and Dr. David Ettinger of The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins represented the NCCN Breast Cancer Guidelines and NCCN Lung Cancer Guidelines Panels, respectively. They educated participants on the latest updates to the NCCN Guidelines and participated in tumor board panel discussions in which they evaluated patient cases alongside the MENA experts on those tumors.
In conjunction with the congress, tumor-specific MENA committees met to review updates and proposed adaptations to the NCCN Guidelines for Breast, Colon, Prostate, and Lung Cancers, and for Lymphomas and Hepatobiliary Carcinoma.
For more information about NCCN international initiatives, please visit NCCN. org/international.
Clifford Goodman to Moderate March NCCN Academy
Next month, Clifford Goodman, PhD, of The Lewin Group will moderate the NCCN Academy for Excellence & Leadership in Oncology School of Pharmaceutical & Biotech Business (NCCN Academy) program, which will be held in Hollywood, Florida on March 14, 2012. This interactive, 1-day NCCN Academy will commence the day before the NCCN Annual Conference general session begins. NCCN Academy is a program series structured as a forum for pharmaceutical and biotech professionals to learn from key stakeholders about the most pressing issues in oncology today, with the goal that those insights will aid them in creating mutually successful working relationships.
To open this installment in the NCCN Academy series, issues affecting decision-making will be evaluated from both the academic and community perspectives. Panelists to discuss this hot topic include Al B. Benson III, MD, of The Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Tim Boozan of Florida Cancer Specialists Foundation; Kirby J. Eng, RPh, of CVS Caremark; James N. Frame, MD, of David Lee Cancer Center; and Raymond J. Muller, MS, RPh, of Memorial Sloan-Kettering Cancer Center.
Representing McKesson Health Solutions, Laura Coughlin, RN, MBA, will discuss guidelines, pathways, and decision-assist tools alongside copanelists Kirby J. Eng, RPh; C. Lyn Fitzgerald, MJ, of NCCN; Daniel McCrone, MD, of New Century Health; and Mark S. Rubin, MD, of Florida Cancer Specialists & Research Institute.
Afternoon sessions include Patricia J. Goldsmith of NCCN presenting on the business side of oncology. This popular module provides clarification and insight into this increasingly pertinent subject. For the closing session, a panel of NCCN experts will be assembled to give attendees the unique opportunity to “Ask the Experts.” Ramaswamy Govindan, MD, of Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Robert J. Morgan, Jr., MD, of City of Hope Comprehensive Cancer Center; and John A. Thompson, MD, of Seattle Cancer Care Alliance will be available to address participants’ questions about the development of NCCN treatment recommendations, the decision-making process that results in the recommendations included in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), and other areas of interest as expressed by the audience.
In addition to live NCCN Academy programs, NCCN offers select NCCN Academy modules for limited licensing in video format for a period of 12 months that may be used by companies for internal training purposes. If you are interested in customizing an NCCN Academy to meet your companies’ specific needs, please visit NCCN.org to submit your inquiry.
New Release of NCCN Guidelines for Patients: Colon Cancer; Updated NCCN Guidelines for Patients: Prostate Cancer
To provide people with cancer and their caregivers with state-of-the-art treatment information in patient-friendly language, NCCN has developed two new publications: a new release of the NCCN Guidelines for Patients: Colon Cancer and an update to the NCCN Guidelines for Patients: Prostate Cancer. The guidelines provide a framework to help people with cancer talk with their physician about the best treatment options.
According to the 2012 annual report from the the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries, colon cancer is the fourth most common cancer in the United States. The newly released NCCN Guidelines for Patients: Colon Cancer include a treatment guide covering the different stages of colon cancer from early detection and diagnosis, throughout treatment, and across the entire continuum of care. The guidelines describe tests and treatment options for colon cancer, along with treatment side effects. A thorough glossary is included to aid patients with medical terminology. These guidelines suggest the best practice for colon cancer care and support enrollment into clinical trials when appropriate.
Prostate cancer is a complex disease; fortunately there is a dearth of sound data to support treatment recommendations. NCCN’s Guidelines for Patients: Prostate Cancer cover several variables (including life expectancy, disease characteristics, predicted outcomes, and patient preferences) that should be considered by the patient and the physician in tailoring prostate cancer therapy to the individual patient. The guidelines provide information that will help people with prostate cancer and their friends and family understand the cancer and help them talk with their cancer care team about the best treatment options. In particular, the guidelines give treatment recommendations based on the characteristics of the cancer, possible side effects of treatments, and a side-by-side comparison of the main benefits and disadvantages of the treatments for prostate cancer.
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) are the most widely used guidelines in oncology practice; physicians around the globe use the NCCN Guidelines when determining appropriate cancer treatment for their patients. The NCCN Guidelines for Patients present the same information that physicians use when making treatment decisions for people with cancer, and provide it in an easy-to-understand format.
The NCCN Guidelines for Patients on colon cancer and prostate cancer, as well as those on breast, ovarian, and non–small cell lung cancers, and chronic myelogenous leukemia, malignant pleural mesothelioma, melanoma, and multiple myeloma, are available free of charge at NCCN.com and NCCN.org. The updated NCCN Guidelines for Patients: Prostate Cancer, as well as others, is also available in print booklet format. To request hard copies, e-mail email@example.com.
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