ASCO Guidelines: A Collaborative Effort

The ASCO Guidelines Program has worked with other professional societies and guideline development organizations in an effort to expand the ASCO guideline portfolio and harmonize recommended care options across prominent guideline development groups.

For ASCO, this effort began with a systematic and proactive approach in identifying guideline topics for development. ASCO then reached out to partnering organizations to explore the development of joint guidelines where none currently exist, or to consider endorsement or adaptation of recommendations from recently developed evidence-based guidelines.

Guideline Advisory Groups

The recent formation of Guideline Advisory Groups within ASCO is critical to the model. Advisory Groups were created based on a recommendation by the guidelines team of the ASCO Leadership Development Program to the ASCO Board of Directors.

Advisory groups comprise content experts that advise ASCO’s Clinical Practice Guidelines Committee (CPGC) on the highest priority topics to consider for guideline development within a given area. There are currently seven Advisory Groups, with four focusing on specific disease sites—breast, gastrointestinal, genitourinary, and thoracic cancers—and three dedicated to topics within survivorship, supportive care, and resource stratification.

“Guideline advisory groups have been one of the most innovative and productive efforts to come out of the ASCO Guideline Program in the last couple of years,” said Gary H. Lyman, MD, MPH, FASCO, of the Fred Hutchinson Cancer Research Cen- ter and the University of Washington. Dr. Lyman is a member of ASCO’s Board of Directors and the Chair of the Methodology Subcommittee of the CPGC.

Prior to these advisory groups, guideline development typically relied on ad hoc proposals from ASCO members. “While still encouraging member suggestions, this new organization allows for a more systematic and comprehensive approach to guideline development with a broad scope of coverage, and better prioritization,” Dr. Lyman said.

A Collaborative Approach

Providing a list of prioritized guideline topics each year, along with the order in which guidelines will be developed, will facilitate collaborative efforts with other guideline development groups. Such collaborative efforts can include joint guideline development, guideline endorsement, or guideline adaptation.

The prioritized list of topics allows ASCO staff to contact other guideline development groups about possible collaboration in creating new guidelines. Joint guideline development occurs when the topics and scope of effort of two or more guideline development groups align, and there is an agreed-upon process for guideline development. Development of a joint guideline allows for a more efficient use of resources and facilitates increased guideline standardization, credibility, and dissemination.

ASCO collaborates with organizations striving to meet the standards of the Institute of Medicine (IOM) and Council of Medical Specialty Societies (CMSS). This includes managing conflicts of interest among guideline development group members, establishing evidence-based recommendations, and presenting recommendations in a clear and transparent manner.¹

ASCO does not mandate how collaborators should create and present guidelines, as long as they primarily adhere to the IOM and CMSS standards. An organization can contract out its guideline development; produce it in-house; or have a unique development, quality appraisal, and approval process. Documents do not have to contain specific sections, nor must data be summarized in a certain format. Collaborators typically follow the format used to publish their guideline development efforts, and the components are generally consistent across the collaborating guideline development groups.

Collaborations between ASCO and other guideline development groups can take several forms. In the traditional joint collaboration model, organizations typically share the human and/or financial resources equally, with a similar number of representatives on the guideline development panel dividing the writing responsibility.

In a more recent collaborative guideline development, one organization takes the lead, whereas others play more of a supporting role. If ASCO takes the lead, the Society provides the majority of the resources, whereas collaborators send official representatives to sit on the expert panel and approve the final guideline. If both organizations approve of the guideline, it is published as a joint effort and placed on the organizations’ websites. In this manner, guideline productivity can increase. Guidelines can reach a wider audience and have a greater impact with dual publication to their respective memberships.

“ASCO is very flexible in making collaborations work, either from having one representative on the panel to completely coproducing or endorsing other organizations’ guidelines,” said Sharon H. ­Giordano, MD, MPH, of the University of Texas MD Anderson Cancer Center, and Chair of ASCO’s CPGC.

CAP Partnerships

ASCO has created two joint guidelines with the College of American Pathologists (CAP) since the organizations began working together in 2008, and they have followed the traditional model of equal responsibility.

The guideline development process can take longer together than when created by either organization alone. However, the result is a document with more strength, credibility, and reach. “Even if there is additional time, it is incredibly valuable to work with clinicians on the guideline,” said Elizabeth A. Wagar, MD, of The University of Texas MD Anderson Cancer Center, and Chair of CAP’s Pathology and Laboratory Quality Center Committee. Whereas oncologists help CAP members understand the therapeutic options based on biomarker testing, Dr. Wagar said, pathologists help the oncologists understand issues with obtaining high-quality data and clear results.

Expansion and Shortened Production Time

Guideline endorsements and adaptations allow ASCO to rapidly expand its guideline portfolio, an action encouraged by the ASCO membership that will facilitate guideline integration into ASCO’s new CancerLinQ™ initiative. Once Guideline Advisory Groups receive confirmation of prioritized topics from the CPGC, literature is reviewed to see if any guidelines already exist on each topic from other organizations. If the guidelines are evidence-based and up-to-date—and the Guideline Advisory Group agrees with the recommendations—the group considers endorsing the guideline.  If the Guideline Advisory Group agrees with most, but not all, of the recommendations of an existing guideline, it may opt to modify the guideline and produce an adapted version.

ASCO has published several endorsements and adaptations on a variety of topics over the past year, and several more endorsements are currently in press. An independent panel at ASCO adapted a pan-Canadian practice guideline concerning fatigue in adult cancer survivors in 2014.² The adaptation process took a few months, but a de novo guideline likely would have taken at least 1 year, Dr. Lyman said.

With more than 50 completed guidelines, endorsements, and adaptations, and more than 20 topics currently in development, the ASCO Guidelines Program has worked to increase its portfolio of evidence-based clinical practice guidelines to better meet the needs of its membership and the patients they serve. ■

References

1. Institute of Medicine: Standards for developing trustworthy clinical practice guidelines. Available at www. iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust/Standards.aspx. Accessed May 13, 2015.

2. Bower JE, Bak K, Berger A, et al: Screening, assessment, and management of fatigue in adult survivors of cancer: An American Society of Clinical Oncology clinical practice guideline adaptation. J Clin Oncol 32:1840-1850, 2014.