Dario Trapani1, Jean Yves Douillard2, Eric P Winer3, Harold Burstein4, Lisa Anne Carey5, Javier Cortes6, Gilberto Lopes7, Julie R Gralow8, William J Gradishar9, Nicola Magrini10, Giuseppe Curigliano11, Andrè M Ilbawi12. 1. Division of Early Drug Development for Innovative Therapies, European Institute of Oncology (IEO) IRCCS, Milan, Italy. 2. Medical Oncology, University of Nantes Medical School, France. 3. Dana-Farber/Partners CancerCare, Boston, MA, USA. 4. Dana-Farber/Partners CancerCare, Boston, MA, USA. 5. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA. 6. IOB, Institute of Oncology, Quironsalud Group, Madrid & Barcelona, Medica Scientia Innovation Research (MedSIR), Vall d'Hebron University Hospital (VHIO), Barcelona. 7. Divisions of Hematology and Medical Oncology, Departments of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA. 8. University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 9. Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA. 10. Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland. 11. University of Milan, Department of Oncology and Hemato-Oncology, Milan, Italy. 12. Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland.
Abstract
BACKGROUND: Breast cancer (BC) is a leading cause of morbidity, mortality, and disability for women worldwide. There is substantial variation in treatment outcomes, which is function of multiple variables, including access to treatment. Treatment standards can promote quality and improve survival; thus, their development should be a priority for the cancer-control planning. METHODS: We extracted the guidelines for the treatment of BC from a systematic review of the literature. We evaluated the development process, the methodology, and the recommendations formulated and surveyed the country resource stratification. Metrics of health-system capacity were selected to study the guidelines context appropriateness. RESULTS: We analyzed 49 distinct guidelines for BC, mostly in English language (n = 23), developed in upper-middle and high-income countries of the European and American regions (n = 39). A resource-stratified approach was identified in a quarter of the guidelines (n = 11), mostly from resource-constrained settings. Only one-half of the guidelines reached a gender balance of the authorship, and 10.2% were based on a multidisciplinary steering committee. A number of efforts and solutions of resource adaptations were recognized, mostly in low- and middle-income countries. Overall, the national guidelines appeared not sensitive enough of the local health-system capacity in formulating recommendations, with possible exception for the radiation therapy availability. CONCLUSION: This global landscape of treatment standards for BC demonstrates that the majority is not context appropriate. Research on the formulation of cancer treatment standards is highly warranted, along with novel platforms for developing and disseminating resource-appropriate guidance.
BACKGROUND: Breast cancer (BC) is a leading cause of morbidity, mortality, and disability for women worldwide. There is substantial variation in treatment outcomes, which is function of multiple variables, including access to treatment. Treatment standards can promote quality and improve survival; thus, their development should be a priority for the cancer-control planning. METHODS: We extracted the guidelines for the treatment of BC from a systematic review of the literature. We evaluated the development process, the methodology, and the recommendations formulated and surveyed the country resource stratification. Metrics of health-system capacity were selected to study the guidelines context appropriateness. RESULTS: We analyzed 49 distinct guidelines for BC, mostly in English language (n = 23), developed in upper-middle and high-income countries of the European and American regions (n = 39). A resource-stratified approach was identified in a quarter of the guidelines (n = 11), mostly from resource-constrained settings. Only one-half of the guidelines reached a gender balance of the authorship, and 10.2% were based on a multidisciplinary steering committee. A number of efforts and solutions of resource adaptations were recognized, mostly in low- and middle-income countries. Overall, the national guidelines appeared not sensitive enough of the local health-system capacity in formulating recommendations, with possible exception for the radiation therapy availability. CONCLUSION: This global landscape of treatment standards for BC demonstrates that the majority is not context appropriate. Research on the formulation of cancer treatment standards is highly warranted, along with novel platforms for developing and disseminating resource-appropriate guidance.
Authors: Paolo Tarantino; Chiara Corti; Peter Schmid; Javier Cortes; Elizabeth A Mittendorf; Hope Rugo; Sara M Tolaney; Giampaolo Bianchini; Fabrice Andrè; Giuseppe Curigliano Journal: NPJ Breast Cancer Date: 2022-02-18