Resource constraints in low- and middle- income countries (LMICs) often impede critical medical care. 65% of new cases of lip and oral cancer, and 76% of related deaths occur in LMICs, where patients lack access to standard diagnostic tests and/or treatment approaches. The development of resource-stratified clinical guidelines promotes access to critical diagnostic and treatment pathways in LMICs.
To address the unmet need in LMICs, a multi-disciplinary committee of NCCN Member Institution experts developed the NCCN Framework™ for Head and Neck Cancers: Lip and Oral. In the evidence-based, resource-stratified Guidelines, recommendations from the NCCN Guidelines for Head and Neck Cancers were assigned to specific resource levels, based on access to various interventions and importance in achieving clinical outcomes. International experts reviewed the resource-stratified Guidelines to assess utility in LMICs and NCCN approved and published the finalized guidelines.
The NCCN Framework for Head and Neck Cancers: Lip and Oral has four resource levels: Basic, Core, Enhanced, and Parent guideline. The Framework for Basic Resources identifies essential services required for minimal standard of care for improvement in outcome; the Core Resources lead to improved outcomes but are not cost prohibitive; the Enhanced Resources recommend additional services that may improve outcomes, but may be cost prohibitive in certain settings. For initial treatment of early stage cancer of the oral cavity (T1-2, N0) as an example, the Enhanced Framework recommends surgical resection and radiation therapy (RT), but not sentinel lymph node (SLN) biopsy, which is recommended in the NCCN parent Guidelines and requires more advanced resources. The Basic Framework recommends surgical resection as the only primary treatment option, since RT may not be available at this resource level.
The NCCN Framework for Head and Neck Cancers: Lip and Oral provide LMICs with a system to optimize care in limited resource settings, and a map to improve cancer care incrementally as resources become available. Use of this framework facilitates improved patient care in resource-constrained settings.
Clinical trial identification
Legal entity responsible for the study
National Comprehensive Cancer Network
All authors have declared no conflicts of interest.