At this year's annual NCCN conference, the organization presented updates in 13 areas, including specific disease states and general screening methods.
When seeking guidance in the application of best clinical practice standards, those in oncology healthcare routinely turn to the National Comprehensive Cancer Network (NCCN). The NCCN develops thorough, widely recognized Clinical Practice Guidelines in Oncology, and updates those guidelines each year in accordance with new insights and therapies within the field.
At this year’s annual NCCN conference, the organization presented updates in 13 areas, including specific disease states and general screening methods. Three of the guidelines, in the areas of acute lymphoblastic leukemia, adolescent and young adult oncology, and lung cancer screening, were newly introduced this year.
Renowned physicians presented the updates during the conference, which was attended by more than 1500 doctors, nurses, pharmacists, and business leaders. The meeting also focused on quality issues; business challenges; new treatments, therapies, and trends; and their application in patient care.
A roundtable discussion on the provision of cancer care to corporate employees was led by longtime NCCN moderator, ABC news reporter and cancer survivor Sam Donaldson; another roundtable, focused on balancing patient care against cost concerns, was moderated by Clifford Goodman, PhD, of the Lewin Group.
An overview of the 2012 guideline updates is provided below
Dr Alvarnas: "Unlike other specialty areas, most of which were announcing updates to long-existing guidelines, the ones we announced this year were our first. It has taken many years and many trials to create anything resembling a standard of care, not only because the disease is rare, but also because there has long been controversy over what treatments work best."
Dr Carlson: "There was no comment previously in terms of how often staging or restaging studies should be done in patients with metastatic disease receiving systemic therapy. It was added because performing restaging studies is quite expensive, and interpretation of those studies is often difficult. We also wanted to emphasize the importance of looking not only at radiographic studies, but at symptoms, physical exams, blood tests—a series of aspects of a patient and that patient's care—to determine whether or not a therapy is helping."
Dr Vrionis: "There's a lot of excitement, long term, about the potential of targeted therapies, but difficulties like crossing the blood-brain barrier mean that such treatments are not developed and tested to the point of becoming part of the guidelines yet. The main theme of our presentation this year wasn't about any changes to the guidelines, but to emphasize how best to use those treatments that are in the guidelines."
Dr Benson: "This year's updates are what I would call fine-tuning based on the evidence that we have. Hopefully, as more clinical trials are designed and as new therapies become available, those will be reflected in future guidelines."
Dr Gordon: "In some ways, the changes made this year were made in a 'cost-savings' way as we learn which methods are more effective and when more or less treatment is needed."
Dr Reid: "This is the first time the NCCN, or any American organization, has ever published recommendations for lung cancer screening. In 2010, the NCI's randomized National Lung Screening Trial demonstrated that using spiral (helical) low-dose computed tomography (LDCT) of the chest on people with a high risk of lung cancer—in comparison to chest x-ray—improved their survival by 20%. This screening will change mortality by allowing us to diagnose lung cancer at earlier stages."
Dr Coit: "The major changes affect oncologists and are the recognition of targeted and immunotherapies for patients with metastatic melanoma."
Dr Zelenetz: "Historically, we followed the 5% rule, in that we didn't include guidelines for diseases that impacted less than 5% of the total population of non-Hodgkin lymphoma patients. The reality is that in these rare diseases, guidelines are even more necessary because many treating oncologists don't have a lot of experience with these diseases."
Dr Anderson: "What the guidelines are wonderful for is establishing a framework for treatment options at different stages of disease. They offer the opportunity for enrolling patients in clinical trials, especially when there are no accepted treatments."
Dr Morgan: "There were no major changes to the actual guidelines this year, but we did unveil a number of small but important tweaks, along with some major changes to the guideline wording designed to make them clearer and easier for clinicians to use."
Dr Govindan: "Crizotinib (Xalkori) for patients with advanced or metastasized non—small cell lung cancer (NSCLC) who are ALKpositive is the ultimate story of personalized therapy. It works in 60% to 65% of these patients, even those who have cancer in their brains, to cause dramatic shrinkage of tumors. This produces results two to three times better than chemotherapy. It's one of the big breakthroughs in cancer treatment."
Dr Srinivas: "We made very few changes to guidelines over the past year, so we used our presentation to highlight guideline changes that physicians will need to watch for and potential guideline changes related to new drugs—or existing drugs being used in new ways—that may well be adopted before the end of the year."
This article is based on writing and reporting by Anna Azvolinsky, PhD, Beth Fand Incollingo, Ben Leach, and Andrew D. Smith.