PHILADELPHIAWith the completion of nine new oncology practice
guidelines, to be presented at the fourth annual conference of the
National Comprehensive Cancer Network (NCCN), the coalitions
guidelines now cover approximately 95% of cancer patients treated in
the United States, William T. McGivney, PhD, chief executive officer
of the NCCN, told Oncology News International in an inverview.
The NCCN is a consortium of 17 major US cancer centers.
In a separate interview, Rodger Winn, MD, of M.D. Anderson Cancer
Center and chair of the NCCNs guidelines committee, said that
the guidelines will continue to expand to cover minor
variants of the disease-specific guidelines already in place,
as well as ancillary cancer-related issues.
For example, Dr. Winn commented, a task force will convene this month
to consider the possibility of developing practice guidelines on
supportive care and terminal care.
One guideline dealing with an ancillary issuedistress
managementintroduced last year, has become one of the
networks most requested guidelines. This guideline is a
breakthrough, Dr. Winn said. It conceptualizes the whole
domain of distress and provides a structure for approaching
psychological problems. The distress guideline is divided into
three componentspsychological, social, and spiritualand,
at the 1999 meeting, algorithms will be presented for specific
psychological disorders such as anxiety and depression.
The 1999 meeting will include a roundtable on how the media handles
cancer advances, which Dr. McGivney expects will be just as lively as
last years roundtable on who should pay for clinical trials.
Tentatively scheduled to participate are representatives from
television, the print media, a major cancer journal, patient groups,
the pharmaceutical industry, the Oncology Nursing Society, and the
Food and Drug Administration, as well as an ethicist and physicians
involved in basic and clinical oncology research.
Another interesting session, Dr. McGivney said, will be a discussion
of a model partnership between an academic oncology center and
managed care, namely, Ohio State Universitys James Cancer
Hospital and Anthem Blue Cross Blue Shield ). I think its
the model for continuing quality improvement in cancer, Dr.
The NCCNs outcomes database project will be updated at the
meeting. We expect to report on about 1,750 patients, which is
far and above the 350 or so we had last year in the database,
Dr. McGivney said. I think there will be data presented that
specifically address the patterns of care in NCCN facilities and the
appropriateness of different forms of interventions.
The conference is also scheduled to include a panel discussion about
the NCCNs efforts, in collaboration with a major cancer
organization, to bring the information in its practice guidelines to
patients. As the NCCN guidelines increasingly become the
standard for oncology practice, Dr. McGivney said,
its important to communicate to patients in an
understandable way the information upon which their treatment is based.
Another much anticipated session will be the presentation of the
NCCNs model for global pricing in breast cancer.
Weve delineated the units of resources consumed in
managing breast cancer at different stages of the diagnosis up to one
year postdiagnosis and estimated the probability of certain patients
going one direction vs another direction, Dr. McGivney said.
NCCN institutions can use the model to determine an appropriate
global price for management of breast cancer patients for a year
postdiagnosis. The model has been beta tested in two of our
institutions and received excellent reviews in terms of its
comprehensiveness, accuracy, and user friendliness, he said.
Dr. Winn noted that the networks practice guidelines panels try
to accommodate controversial issues within their recommendations. He
said that one of the more heated discussions among guidelines panels
concerned the treatment of one of the least serious
malignanciesnonmelanoma skin cancer.
The discussions were intense, he said, I think because there
are several approaches to treatmentMohs surgery, radiation
therapy. The way medicine is practiced, surgeons, and radiation
oncol-ogists each travel down their own path. When you bring them
together to develop guidelines, as the NCCN does, they may, at first,
find it difficult to integrate.
The NCCN has updated its prostate cancer guideline and, new this
year, will be a practice guideline for early detection of prostate
cancer. Its an algorithm that looks at early diagnosis of
prostate cancer rather than screening, Dr. Winn said. If
the patient and physician opt for PSA screening, then there is a
specific algorithm of what to do with the results.