UK behind on cancer guidelines

Cancer patients in the UK are less likely to receive innovative drug treatments according to guideline recommendations, compared to those in other parts of Europe, a new study from King’s has found.

Researchers evaluated clinical practice guidelines issued by different national bodies, finding that UK examples were more likely to focus on surgery, and slower to pick up on new research. They also found that recommendations in continental Europe tended to focus on the use of new chemotherapy agents or targeted treatment, while UK guidelines tended to focus on surgery, screening or radiotherapy.

The team analysed 101 clinical practice guidelines developed for oncologists from the European Society of Medical Oncology (ESMO) which is made up of multi-disciplinary specialists from 130 countries. Both the UK guidelines issued by the National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) were weighted towards surgical modalities rather than new chemotherapy agents.

A major reason for the different treatment approaches was that while the ESMO guidelines cited more recent research, which included targeted drug treatment, NICE and SIGN highlighted research from the UK, Canada, Australia and Scandinavian countries that were older and more clinically research based. This older research tended to recommend surgical interventions, rather than drug treatments.

The time it took for new research to progress from peer review to being included in treatment guidelines was also investigated. In countries following ESMO guidelines, there was a gap of a year between the publication of research and its recommendation for clinical use. In the UK the gap was four times as long. This contributes to the idea that UK patients may be missing out on potentially beneficial treatments that their European peers are receiving.

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Lead researcher Elena Pallari said: ‘Clinical guidelines are meant to be based on the best available evidence. By demonstrating how that evidence-base differs for different authoritative bodies for oncology, the study not only indicates an information bias, but also the potential for biased impact on treatment recommendations and patient outcomes.’

Co-author, Professor  Tony Fox, from the  Institute of Pharmaceutical Sciences added: ‘It is by no means certain that prescribers realise that international guidelines differ. Not only that, but prescribers probably do not realise that one reason they differ is because of the selective ways in which expert committees approach the whole evidence base.’

Researchers also found that while there was a research emphasis on high-profile cancers, such as breast cancer, other less fashionable cancers were neglected. This emphasis was often at odds with the actual impact of the disease on the general population.

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The paper ‘Differential research impact in cancer practice guidelines’ evidence base: lessons from ESMO, NICE and SIGN’ was published in  ESMO Open on 6 January 2018.