E Gabriela Chiorean1, Govind Nandakumar2,3, Temidayo Fadelu4, Sarah Temin5, Ashley Efrain Alarcon-Rozas6, Suyapa Bejarano7, Adina-Emilia Croitoru8, Surbhi Grover9, Pritesh V Lohar10, Andrew Odhiambo11, Se Hoon Park12, Erika Ruiz Garcia13, Catherine Teh14, Azmina Rose15, Bassem Zaki16, Mary D Chamberlin16. 1. University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA. 2. Columbia Asia Hospitals, Bangalore, India. 3. Weill Cornell Medical College, New York, NY. 4. Dana-Farber Cancer Institute, Boston, MA. 5. American Society of Clinical Oncology, Alexandria, VA. 6. Clinica Angloamericana, Lima, Peru. 7. Excelmedica, Liga Contra el Cancer Honduras, San Pedro Sulal, Honduras. 8. Fundeni Clinical Institute, Bucharest, Romania. 9. University of Pennsylvania, Philadelphia, PA. 10. HCG Cancer Center, Vadodara, Gujarat, India. 11. University of Nairobi, College of Health Sciences, Nairobi, Kenya. 12. Samsung Medical Center, Seoul, South Korea. 13. Insituto Nacional De Cancerologia, Mexico City, Mexico. 14. Philippine Association of HPB Surgeons/Makati Medical Center, Makati City, Philippines. 15. Independent Colorectal Patient Representative, London, United Kingdom. 16. Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Abstract
PURPOSE: To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer. METHODS: ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings. RESULTS: Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations. RECOMMENDATIONS: Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with chemotherapy, where chemotherapy is available. If, after a period of chemotherapy, patients become candidates for surgical resection with curative intent of both primary tumor and liver or lung metastatic lesions on the basis of evaluation in multidisciplinary tumor boards, the guidelines recommend patients undergo surgery in centers of expertise if possible. On-treatment surveillance includes a combination of taking medical history, performing physical examinations, blood work, and imaging; specifics, including frequency, depend on resource-based setting.Additional information is available at www.asco.org/resource-stratified-guidelines.
PURPOSE: To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer. METHODS:ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings. RESULTS: Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations. RECOMMENDATIONS: Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with chemotherapy, where chemotherapy is available. If, after a period of chemotherapy, patients become candidates for surgical resection with curative intent of both primary tumor and liver or lung metastatic lesions on the basis of evaluation in multidisciplinary tumor boards, the guidelines recommend patients undergo surgery in centers of expertise if possible. On-treatment surveillance includes a combination of taking medical history, performing physical examinations, blood work, and imaging; specifics, including frequency, depend on resource-based setting.Additional information is available at www.asco.org/resource-stratified-guidelines.
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