Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Guideline Quality for Care of Cancer Survivors
JAMA Intern Med; 2017 May; Merkow, et al
There is low specificity and consistency among guidelines addressing the care of cancer survivors, according to a recent study. The retrospective cross-sectional analysis of national cancer guidelines from North America and Europe published since 2010 addressed posttreatment care for survivors of the 9 most common cancers. Individual recommendations were classified into 5 categories: 1) risk-based recommendations, 2) recommendation for surveillance, 3) addressed but no clear recommendation, 4) recommendation against surveillance, or 5) cases in which surveillance was not addressed. Researchers found:
- 41 guidelines were published between January 1, 2010, and March 1, 2016; 85% were from professional organizations.
- Vague recommendations were present in 83% of guidelines, and 44% recommended against at least 1 test.
- European guidelines were more likely than American guidelines to contain ambiguous recommendations.
- Recommendations commonly specified testing frequency but infrequently provided a definitive stop time.
- Imaging recommendations varied among guidelines for each cancer.
Merkow RP, Korenstein D, Yeahia R, Bach PB, Baxi SS. Quality of cancer surveillance clinical practice guidelines. Specificity and consistency of recommendations. JAMA Intern Med. 2017;177(5):701-709. doi:10.1001/jamainternmed.2017.0079.
This Week's Must Reads
Must Reads in Clinical Guidelines
USPSTF: Interventions to Avert Perinatal Depression, JAMA; 2019 Feb 12; US Preventive Services Task Force
ACIP Updates Adult Immunization Schedule, Ann Intern Med; 2019 Feb 5; Kim, Hunter, et al
USPSTF: Interventions to Prevent Child Maltreatment, JAMA; 2018 Nov 27; US Preventive Services Task Force
Cholesterol Guidelines Stress Lifetime Approach, Circulation; ePub 2018 Nov 10; Grundy, et al
USPSTF: Screen Adults for Unhealthy Alcohol Use, JAMA; 2018 Nov 13; Curry, et al
The importance of guidelines for follow-up care of cancer survivors is clear, with 1 of every 20 adults in the US falling into this group. Since this is an area that most primary care physicians do not necessarily know well, it makes guidelines even more important. It is disappointing, but not surprising, to see a lack of clarity in guidelines and inconsistency among guidelines. This is even true in areas we know well like diabetes and the treatment of elevated cholesterol. While it is understandable that different organizations may view data differently and therefore come up with different recommendations, it makes it very difficult for those of us on the front lines to know what to do. This article clarifies the degree of this problem and will hopefully serve as encouragement for guidelines committees to be as clear as possible in their recommendations and where possible, to have harmonized guidelines between different organizations. —Neil Skolnik, MD