This research study is on the critical appraisal of the impact of cited research evidence underpinning the development of cancer clinical practice guidelines (CCPGs) by the professional bodies of the European Society for Medical Oncology (ESMO), the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN).
A total of 101 CCPGs were identified from ESMO, NICE and SIGN websites across 13 cancer sites. Their 9,486 cited references were downloaded from the Web of Science© Clarivate Group database and analysed on Excel© (2016) using VBA macros.
ESMO CCPGs mostly cited research from Western Europe while the NICE and SIGN ones from the UK, Canada, Australia and Scandinavian countries. The ESMO CCPGs cited more recent and basic research (e.g. genetics), in comparison to NICE and SIGN CCPGs where older and more clinical research (e.g. drugs treatment) papers were referenced. This chronological difference in the evidence-base is also in line with that ESMO has a shorter gap between the publication of the research and its citation on the CCPGs. It was demonstrated that ESMO CCPGs report more chemotherapy research while the NICE and SIGN more surgery, with the results being statistically significant. Also, breast cancer research was explored individually across the analysed evidence-base, with a similar pattern to overall oncology CCPGs. Additionally, the volume of breast cancer research cited by ESMO was slightly higher than the fraction of the oncology population suffering from breast cancer in Europe; for the NICE and SIGN the citation percentage was twice as much as the UK disease burden, indicating a potential preference on breast cancer among other oncology types.
This study showed that ESMO, NICE & SIGN differ in their evidence-base. Healthcare professionals should be aware of this heterogeneity in effective decision-making of tailored-treatments to patients irrespective of geographic location across Europe. Considering the potential of the United Kingdom exiting the European Union, a closer collaboration between these professional bodies can lead to the use of more evidence-based, relevant and updated clinical practice guidelines.
Clinical trial identification
Legal entity responsible for the study
Elena Pallari, King's College London
All authors have declared no conflicts of interest.