NCCN has developed a comprehensive set of clinical practice guidelines across the continuum of cancer care to assist health care professionals and patients in making clinical decisions. The current set of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) cover the malignancies that affect more than 97% of all patients with cancer in the United States and a variety of supportive care issues. The NCCN Guidelines are widely recognized as the standard for clinical policy in oncology in the United States and are used in the academic and community settings. The NCCN Guidelines are available in multiple formats and derivatives, and are used at the point of care for decision-making, in making payment decisions by third-party payers, as standards for quality of care assessment, and as educational tools.
The NCCN Guidelines are developed by multidisciplinary panels of disease experts and patient advocates from the 25 NCCN Member Institutions. The panels use an evidence-based consensus process of guideline development, wherein recommendations are based on high-level evidence when available, and on expert consensus when high-level evidence does not exist. Currently, 47 NCCN Guidelines Panels are established, comprising more than 950 expert clinicians/investigators from NCCN Member Institutions and patient advocates who are responsible for developing the guidelines and assuring that they are current and represent state-of-the-art cancer care. 1
The complete library of the NCCN Guidelines is available free of charge on the NCCN Web site (NCCN.org), and many guidelines are also available through print publication in JNCCN—Journal of the National Comprehensive Cancer Network. More than 4 million copies of the NCCN Guidelines are down-loaded each year by more than 500,000 registered users of the NCCN Web site. Approximately 36% of the NCCN Guidelines downloads are by users who report that they live outside the United States.
The process for updating the NCCN Guidelines begins with the identification of new scientific evidence, which is then evaluated by the appropriate NCCN Guidelines Panel. The NCCN Guidelines are reviewed annually by panel members and other experts at each of the 25 member institutions to identify potential changes for discussion at the panel meeting. Submissions from entities or individuals outside NCCN are also accepted for review by the appropriate guidelines panel. The panels consider potential modifications to the NCCN Guidelines through a discussion of the quality, consistency, and quantity of the evidence, and a formal vote is taken on all recommended changes. A category of evidence is assigned to each recommendation, which evaluates the level of evidence supporting the recommendation and the extent of agreement among panel members (available at NCCN.org and in the NCCN Guidelines for Prostate Cancer, in this issue). After the modifications are identified, the NCCN Guidelines are changed to reflect those decisions, and the algorithms and a manuscript describing the rationale for the recommendations are published on NCCN.org.
A formal conflict of interest policy and procedures are in place to minimize the potential for intentional or unintentional bias in the NCCN Guideline development and modification process. Funding for the NCCN Guidelines development process comes exclusively from NCCN Member Institution dues. The conflict of interest policy requires that all panel members disclose their financial conflicts of interest verbally at the panel meetings and in written documents that are publically available on NCCN.org. Panel members with meaningful financial conflicts of interest are excluded from participating in guideline development. Potential panel members with substantial financial conflicts of interest are excluded from participating in any NCCN Guidelines Panel.
NCCN Guidelines and Derivative Information Products: User Guide. NCCN Web site. Available at: http://www.nccn.org/professionals/. Accessed April 7, 2014.
Goss PE, Lee BL, Badovinac-Crnjevic T et al. . Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013;14:391–436.
International Adaptations & Translations of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Available at: http://www.nccn.org/international/international_adaptations.aspx. Accessed April 7, 2014.
Benson AB III, Belkall-Saab T, Chan E et al. . NCCN Clinical Practice Guidelines in Oncology: Colon Cancer: Latin American Edition. Version 3.2013. Available at: www.nccn.org/international/international_adaptations.aspx.
Anderson BO, Yip CH, Smith RA et al. . Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer 2008 113:2221–2243.
Eniu A, Carlson RW, El Saghir NS et al. . Guideline implementation for breast healthcare in low- and middle-income countries: treatment resource allocation. Cancer 2008;113:2269–2281.
Anderson BO, Cazap E, El Saghir NS et al. . Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010. Lancet Oncol 2011;12:387–398.