NCCN to Present New Guidelines, Outcomes Database

PHILADELPHIA—With the completion of nine new oncology practice guidelines, to be presented at the fourth annual conference of the National Comprehensive Cancer Network (NCCN), the coalition’s 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 NCCN’s 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 issue—distress management—introduced last year, has become one of the network’s 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 components—psychological, social, and spiritual—and, 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 year’s 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 University’s James Cancer Hospital and Anthem Blue Cross Blue Shield ). “I think it’s the model for continuing quality improvement in cancer,” Dr. McGivney said.

The NCCN’s 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 NCCN’s 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, “it’s 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 NCCN’s model for global pricing in breast cancer. “We’ve 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 network’s 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 malignancies—nonmelanoma skin cancer.

The discussions were intense, he said, “I think because there are several approaches to treatment—Mohs 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. “It’s 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.”