The NIHCE guidelines for the management of colorectal cancer
|
|
- Anis York
- 5 years ago
- Views:
Transcription
1 The NIHCE guidelines for the management of colorectal cancer Graeme Poston Chair Colorectal Cancer Guideline Development Group and Colorectal Cancer Quality Standards Committee National Institute of Health and Clinical Excellence Professor of Surgery Aintree University Hospital, Liverpool UK
2 Overall survival (%) Overall survival for patients with mcrc treated at MD Anderson and Mayo clinics, by year of diagnosis Kopetz S, et al. J Clin Oncol 2009;27: patients from two highly specialized centers Time (months) Over the past decade, OS has improved substantially in patients with mcrc
3 A guideline Is derived by a group of relevant multi-disciplinary experts with patients/carers from a careful synthesis and graded evaluation of the peer reviewed published evidence Addresses areas of clinical uncertainty e.g. which rectal cancer pts should receive pre-operative radiotherapy: - Netherlands 60% - Sweden 40% - Norway 10% - Denmark 5%
4 A guideline The questions of uncertainty are independently agreed by all identified stakeholders prior to guideline production The recommendations are reviewed by stakeholders pre-publication Is independently peer reviewed prior to publication It is NOT: - a consensus statement - financially/politically underpinned by a body with a vested interest in the recommendations
5 Guidelines for the management of colorectal cancer Have been produced in many countries by many organisations over the last two decades Many have been general guidelines about all aspects of diagnosis and management Many have focused on specific issues: - suspicious symptoms - screening - diagnosis - staging - management of the primary tumour - adjuvant treatment - management of advanced disease
6 All very well, but do they improve outcomes? Evidence is limited and dated Grimshaw and Russell, Lancet 1993; 342: systematic review of 59 published evaluations of effect of clinical guidelines - 24 guidelines for specific clinical conditions - 27 studied preventive care - 8 studied prescribing or support services guidelines 55 of 59 (2 oncology) detected significant improvement in the process of care after introduction of guidelines 9 of 11 ( no oncology) studies that assessed the outcome of care reported significant improvements
7 All very well, but do they improve outcomes? Successful introduction of guidelines depends on: - clinical context and relevance of the guideline - methods of guideline development - credibility of guideline development group - methods of guideline dissemination - methods of guideline implementation Successful implementation requires political will by commissioners/payers to utilise guideline Evaluation of effect of guidelines: - requires identification and measurement of meaningful outcome data - internal and external audit/clinical effectiveness data
8 Guideline development Identify and refine subject area of guideline Convene and recruit Guideline Development Group Define members and roles within GDG Required skills: - literature searching and retrieval - epidemiology and biostatistics - health services research and health economics - clinical experts - group process experts - writing and editing - PATIENT AND CARER REPRESENTATION Agree the relevant questions with stakeholders
9 Guideline development Identify and assess the evidence (e.g. Delphi): - what sort of evidence? - where to look for the evidence? - collect all the evidence - assess the evidence for relevance - assess the evidence for susceptibility to bias - extract and summarise the evidence about benefits, costs, and harms Summarise the evidence Categorise and grade the evidence
10 Factors contributing to the process of deriving recommendations Nature of the evidence (e.g. susceptibility to bias) Applicability of the evidence to the population of interest (generalisability) Costs Knowledge and understanding of the healthcare system Beliefs and values of the panel
11 Guideline development: methods of categorising evidence Ia: evidence from meta-analysis of randomised controlled trials Ib: evidence from at least one randomised controlled trail IIa: evidence from at least one controlled study without randomisation IIb: evidence from at least one other type of quasiexperimental study III: evidence from non-experimental descriptive studies, such as comparative studies, correlation studies and case-control studies IV: expert/respected authority opinion (consensus)
12 NIHCE Guideline Methodology Key stakeholders (professional associations, patient groups etc.) invited to submit specific questions relating to uncertainty in current practice Questions then posted on NICE website Stakeholders invited to a one day conference to prioritise the top 20 questions Agreed top 20 questions posted on NICE website If then agreed, the guideline process commences Each key question converted into a PICO [Population, Intervention, Comparator(s), Outcome(s)]
13 NIHCE Guideline Development Group (GDG) Chair, Lead Clinician and members appointed at interview after national advertisement Represent all the professional groups involved directly in the treatment of the guideline disease Three patient/carer representatives Do NOT represent the views of specific associations/organisations Meets bi-monthly for 30 months, addressing two PICO s at each meeting
14 NICE Colorectal Cancer Guideline Development Each specific question developed into a PICO PICO, individual specific question looks at: - Population - Intervention - Comparator(s) - Outcome(s) GRADE methodology: - Grading of Recommendations, Assessment, Development and Evaluation
15 GRADE methodology Quality element Limitations Inconsistency Descriptions of quality elements of GRADE Limitations in the study design and implementation may bias the estimates of the treatment effect. Major limitations in studies decrease the confidence in the estimate of the effect. Inconsistency refers to an unexplained heterogeneity of results. Indirectness Indirectness refers to differences in study population, intervention, comparator or outcomes between the available evidence and the clinical question. Imprecision Results are imprecise when studies include relatively few patients and few events and thus have wide confidence intervals around the estimate of the effect relative to the Publication bias minimal important difference. Publication bias is a systematic underestimate or overestimate of the underlying beneficial or harmful effect due to the selective publication of studies. Each quality element assessed and scored
16 GRADE Methodology Overall quality of outcome evidence in GRADE Quality element D High Moderate Low Very low Further research is very unlikely to change our confidence in the estimate of effect. Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Any estimate of effect is very uncertain.
17 Guideline recommendations Investigations, diagnosis and staging Management of local disease Management of metastatic disease Ongoing care and support
18 Investigations, diagnosis and staging Diagnostic investigations: - colonoscopy + biopsy - CT colography Staging: - contrast enhanced CT chest, abdomen and pelvis - Rectal cancer: pelvic MRI - Rectal cancer: EUS if MRI suggests amenable to local excision or MRI contraindicated
19 Risk of local recurrence of rectal cancer as predicted by MRI Risk of local recurrence High Moderate Low Characteristics of rectal tumour predicted by MRI Threatened (<1mm)/breached resection margin or low tumour encroaching inter-sphincteric plane or levator involvement T3b or greater with threatened potential surgical margin, or suspicious lymph node not threatening surgical margin, or presence of extra-mural vascular invasion T1, T2 or T3a and no suspicion of lymph node involvement
20 Rectal tumour appears resectable at presentation Do not offer short course pre-operative radiotherapy (SCPRT) or chemoradiotherapy (PCRT) to patients with low risk operable rectal cancer unless as part of a clinical trial Consider SCPRT for patients with moderate risk tumours and PCRT for patients with borderline moderate-high risk tumours Offer PCRT to patients with high risk tumours
21 Patients whose primary Colon or rectal tumours appear unresectable/borderline resectable Do not offer PCRT to patients with rectal cancer solely to facilitate sphincter saving surgery Do not offer neoadjuvant (preoperative) chemotherapy alone to patients with either colon or rectal cancer unless as part of a clinical trial
22 Use of colonic stents in acute large bowel obstruction Only consider for acutely obstructing left side tumours If being considered then CT chest, abdomen, pelvis scan to confirm diagnosis, exclude colonic perforation and stage disease Do NOT use contrast enema studies as only imaging modality Decision to consider stent made in combination by consultant colorectal surgeon with endoscopist experienced in stent placement Do not use for low rectal tumours or evidence of perforation Do not dilate tumour before stent placement Place stent within 24 hours of presentation
23 Stage One colorectal cancer Consider further treatment for patients with locally excised pathologically confirmed stage one cancer, taking into account pathological characteristics, imaging results and previous treatments An early rectal cancer MDT should decide which (if any) treatment to offer
24 Adjuvant chemotherapy Consider for High-risk Stage 2 and all Stage 3 rectal cancer Consider for high-risk Stage 2 colon cancer Recommended for all Stage 3 colon cancers Recommended regimens: - capecitabine monotherapy - oxaliplatin in combination with 5-fluorouracil and folinic acid
25 Patients presenting with stage 4 disease Prioritise treatment to control symptoms if at any time primary tumour is symptomatic If both primary tumour and metastases are considered resectable/potentially resectable, anatomical sitespecific MDTs should consider initial systemic treatment followed by sequenced or simultaneous surgery agreed by all MDTs If the CT scan shows metastatic disease confined to the liver, and there is no contraindication to further treatment, then a specialised Hepatobiliary MDT should determine which further imaging is necessary and what further treatment to be offered
26 Patients presenting with stage 4 disease Offer chest, abdomen, pelvis CT to assess stage If intra-cranial disease is clinically suspected then offer contrast-enhanced MRI of brain Do not routinely image head, neck and limbs unless clinically indicated Review all images by appropriate anatomical sitespecific MDT If CT shows potentially resectable extra-hepatic disease, the appropriate anatomical site-specific MDT should decide if a whole body PET-CT is appropriate If CT is inconclusive then offer repeat imaging at an agreed interval
27 Chemotherapy for advanced colorectal cancer Consider the following sequences of chemotherapy unless contraindicated: - FOLFOX, followed by single agent irinotecan - FOLFOX, followed by FOLFIRI - XELOX, followed by FOLFIRI Consider raltitrexed for patients who are intolerant of 5- FU with folinic acid Capecitabine or tegafur with uracil (+folinic acid) can be considered but only administered by oncologists who specialise in colorectal cancer Cetuximab (together with FOLFOX or FOLFIRI) can be given in 1 st line to patients with inoperable kras wildtype liver limited disease
28 Ongoing care and support Follow-up should commence 4-6 weeks after discharge from hospital and continue until such time that the patient and physician agree that the likely benefits no longer outweigh the risks of further tests, or the patient cannot tolerate further treatment Minimum of 2 chest, abdomen, pelvis CT scans in the first 3 years and regular serum CEA estimations (minimum 6 monthly) during the first 3 years Reinvestigate if there is any clinical, radiological or biochemical suspicion of recurrence Offer full verbal and written information before surgery and thereafter on the impact of treatment on bowel function
29 but do they improve outcomes? And if so, how do we measure it? Guideline development Improving outcomes
30 UK NCIN National Cancer Intelligence Network Collects data from: - cancer registries - hospital episode statistics (HES) based on HRGs and activity (OPCS) - NCRI badged clinical trial data Eight regional cancer registries in England looking at eight common cancers (lung, bladder, colorectal, oesophagogastric, gynaecological, skin, breast, prostate) Northern and Yorkshire registry (NYCRS) tasked with examining colorectal cancer
31 NCIN data on colorectal cancer in England Commenced from 1996 Data on 390,000 patients with CRC Identified at individual patient level by - unique NHS registration number - demographics - GMC licence number of consultants responsible for diagnosis and treatment - interventions received - stage of disease at diagnosis - outcome
32 Survival probability Five-year survival of English colorectal cancer patients first diagnosed (n=114,155) Morris EJA, Forman D, Thomas JD, Quirke P, Taylor EF, Fairley L, Cottier B, Poston G. Brit J Surg 2010; 97: All stage 4 resected n=3116 All patients All stage 3 All Stage Years Patients with resected liver metastases All patients without resected metastases Dukes C Dukes D
33 Cumulative Survival Survival of CRC patients after liver resection in England Morris EJA et al. Brit J Surg 2010; 97: Survival stratified by year of surgery ( ) N = censored 1998-censored 2000-censored 2001-censored 2002-censored 2003-censored 2004-censored 2005-censored Survival Time days 4000
34 Percentage of patients receiving a liver resection within three years of resection of their colorectal primary Variation in use of hepatic resection for colorectal cancer metastases across English hospitals Morris EJA et al. Brit J Surg 2010; 97: % difference between best and worst performing hospitals! Trusts
35 Quality Standards A quality standard is a set of specific, concise statements that: act as markers of high-quality, cost-effective patient care across a pathway / clinical area; are derived from the best available evidence such as NICE guidance or other accredited sources are produced collaboratively along with partners, service users and carers
36 What is the purpose of a Quality Standard? To make it clear what high quality care is by providing definitions of clinical and costeffective care To support benchmarking of performance To provide information to patients and the public about the quality of care they can expect To directly measure the benefit of approved guideline introduction
37 Overview of Quality standards development Topic Evidence Source NICE or other NHS evidence accredited source Requires Generates Guidance Recommendations Distilled into Quality Statements Produce Quality Measures
38 How will quality standards be used? At present Are aspirational but achievable Used to drive up the quality of health care For use by: Patients, carers and the public Health and social care professionals plus public health practitioners Commissioners/payers of healthcare Service providers
39 Quality Standards for colorectal cancer People with suspected colorectal cancer without major comorbidity are offered colonoscopy to confirm the diagnosis unless contraindicated* People with colon cancer are offered contrastenhanced CT of the chest, abdomen and pelvis to determine the stage of the disease* People with rectal cancer are offered contrastenhanced CT of the chest, abdomen and pelvis and pelvic MRI to determine the stage of the disease* * Denotes easily measurable metric
40 Quality Standards for colorectal cancer People with rectal cancer are offered a preoperative treatment strategy appropriate to their risk of local disease recurrence* People with locally excised, pathologically confirmed stage I colorectal cancer whose tumour had involved resection margins (less than 1 mm) are offered further active treatment* People with a CT scan suggesting liver metastatic colorectal cancer have their scans reviewed by a surgical member of the hepatobiliary multidisciplinary team [to decide whether further imaging is needed to confirm suitability for surgery or other interventions]* * Denotes easily measurable metric
41 Quality Standards for colorectal cancer People with locally advanced or metastatic colorectal cancer whose disease progresses after first-line systemic anti-cancer therapy are offered second-line systemic anti-cancer therapy if they are able to tolerate it* People free from disease after treatment for colorectal cancer are offered regular surveillance* * Denotes easily measurable metric
42 Conclusions Guidelines are presently aspirational, but in future will be linked to commissioner/purchaser expectations Successful future guidelines identify agreed areas of uncertainty To be of use, guidelines for the management of colorectal cancer need to identify metrics against which their implementation will be judged It is imperative on providers/commissioners of healthcare to: - actively collaborate in/sponsor guideline development - collect measurable outcome data that examine the impact of guideline implementation
43 Conclusions continued Guidelines can be used as a basis of implementing quality standards into healthcare commissioning Purchasers of healthcare (both government and private) can use the metrics of these quality standards to inform contracting of healthcare Failure to achieve these quality standards will lead to the imposition of financial penalties upon the institutions offering such healthcare interventions
The NIHCE guidelines for the management of colorectal cancer
The NIHCE guidelines for the management of colorectal cancer Graeme Poston Chair Colorectal Cancer Guideline Development Group and Colorectal Cancer Quality Standards Committee National Institute of Health
More informationClinical guideline Published: 1 November 2011 nice.org.uk/guidance/cg131
Colorectal cancer: diagnosis and management Clinical guideline Published: 1 November 2011 nice.org.uk/guidance/cg131 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationColorectal cancer: the diagnosis and management of colorectal cancer
Clinical Guideline Colorectal cancer: the diagnosis and management of colorectal cancer Full Guideline Update information Since original publication this guideline has been partially updated: July 2018:
More informationADJUVANT CHEMOTHERAPY...
Colorectal Pathway Board: Non-Surgical Oncology Guidelines October 2015 Organization» Table of Contents ADJUVANT CHEMOTHERAPY... 2 DUKES C/ TNM STAGE 3... 2 DUKES B/ TNM STAGE 2... 3 LOCALLY ADVANCED
More informationManchester Cancer Colorectal Pathway Board: Guidelines for management of colorectal hepatic metastases
Manchester Cancer Colorectal Pathway Board: Guidelines for management of colorectal hepatic metastases Date: April 2015 Date for review: April 2018 1. Principles The recognised specialist HPB MDT for Greater
More informationNational Breast Cancer Audit next steps. Martin Lee
National Breast Cancer Audit next steps Martin Lee National Cancer Audits Current Bowel Cancer Head & Neck Cancer Lung cancer Oesophagogastric cancer New Prostate Cancer - undergoing procurement Breast
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Colorectal cancer: diagnosis and management of colorectal cancer 1.1 Short title Colorectal cancer 2 The remit The Department
More informationColorectal cancer. The diagnosis and management of colorectal cancer. Issued: December NICE clinical guideline 131. guidance.nice.org.
Colorectal cancer The diagnosis management of colorectal cancer Issued: December 2014 NICE clinical guideline 131 guidance.nice.org.uk/cg131 NICE has accredited the process used by the Centre for Clinical
More informationCOLORECTAL CANCER CASES
COLORECTAL CANCER CASES Case #1 Case #2 Colorectal Cancer Case 1 A 52 year-old female attends her family physician for her yearly complete physical examination. Her past medical history is significant
More informationNICE BULLETIN Diagnosis & treatment of prostate cancer
Diagnosis & treatment of prostate cancer NICE provided the content for this booklet which is independent of any company or product advertised Diagnosis and treatment of prostate cancer Introduction In
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GASTROINTESTINAL RECTAL CANCER GI Site Group Rectal Cancer Authors: Dr. Jennifer Knox, Dr. Mairead McNamara 1. INTRODUCTION 3 2. SCREENING AND
More informationBladder Cancer Guidelines
Bladder Cancer Guidelines Agreed by Urology CSG: October 2011 Review Date: September 2013 Bladder Cancer 1. Referral Guidelines The following patients should be considered as potentially having bladder
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Health Technology Appraisal Nivolumab for previously treated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency
More informationIMAGING GUIDELINES - COLORECTAL CANCER
IMAGING GUIDELINES - COLORECTAL CANCER DIAGNOSIS The majority of colorectal cancers are diagnosed on colonoscopy, with some being diagnosed on Ba enema, ultrasound or CT. STAGING CT chest, abdomen and
More informationNICE guideline Published: 24 January 2018 nice.org.uk/guidance/ng83
Oesophago-gastric cancer: assessment and management in adults NICE guideline Published: 24 January 18 nice.org.uk/guidance/ng83 NICE 18. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationHorizon Scanning Technology Briefing. Cetuximab (Erbitux) for metastatic colorectal cancer. National Horizon Scanning Centre.
Horizon Scanning Technology Briefing National Horizon Scanning Centre Cetuximab (Erbitux) for metastatic colorectal cancer December 2006 This technology summary is based on information available at the
More informationAppendix E - Summary form Oxaliplatin and capecitabine for the adjuvant treatment of colon cancer table of consultee comments
Oxaliplatin and capecitabine for the adjuvant treatment of colon cancer table of consultee comments Section Consultees Comments Action Objective Roche RCP RCP As far as capecitabine is concerned, the objective
More informationCancer of Unknown Primary Service
Cancer of Unknown Primary Service Dr Maurice Fernando Consultant In Specialist Palliative Care and CUP lead Doncaster and Bassetlaw Hospitals NHS FT Wakefield meeting -14-07-2016 CUP service CUP MDT
More informationNational Optimal Lung Cancer Pathways. Dr Sadia Anwar Nottingham University Hospitals NHS Trust Clinical Lead for Lung Cancer
National Optimal Lung Cancer Pathways Dr Sadia Anwar ttingham University Hospitals NHS Trust Clinical Lead for Lung Cancer Overview How NOLCP evolved How it relates to national guidance Pathways Implementation
More informationRECTAL CANCER CLINICAL CASE PRESENTATION
RECTAL CANCER CLINICAL CASE PRESENTATION Francesco Sclafani Medical Oncologist, Clinical Research Fellow The Royal Marsden NHS Foundation Trust, London, UK esmo.org Disclosure I have nothing to declare
More informationCarcinoma del retto: Highlights
Carcinoma del retto: Highlights Stefano Cordio Struttura Complessa di Oncologia Medica ARNAS Garibaldi Catania Roma 17 Febbraio 2018 Disclosures Advisory Committee, research funding and speakers bureau
More informationGuideline for the Management of Vulval Cancer
Version History Guideline for the Management of Vulval Cancer Version Date Brief Summary of Change Issued 2.0 20.02.08 Endorsed by the Governance Committee 2.1 19.11.10 Circulated at NSSG meeting 2.2 13.04.11
More informationCOLORECTAL CARCINOMA
QUICK REFERENCE FOR HEALTHCARE PROVIDERS MANAGEMENT OF COLORECTAL CARCINOMA Ministry of Health Malaysia Malaysian Society of Colorectal Surgeons Malaysian Society of Gastroenterology & Hepatology Malaysian
More informationAudit Report. Colorectal Cancer Quality Performance Indicators. Patients diagnosed April 2014 March Published: July 2016
NORTH OF SCOTLAND PLANNING GROUP Colorectal Cancer Managed Clinical Network Audit Report Colorectal Cancer Quality Performance Indicators Patients diagnosed April 2014 March 2015 Published: July 2016 Mr
More informationCase Conference. Craig Morgenthal Department of Surgery Long Island College Hospital
Case Conference Craig Morgenthal Department of Surgery Long Island College Hospital Neoadjuvant versus Adjuvant Radiation Therapy in Rectal Carcinoma Epidemiology American Cancer Society statistics for
More informationCetuximab for the first-line treatment of metastatic colorectal cancer
Cetuximab for the first-line treatment of metastatic colorectal cancer Issued: August 2009 guidance.nice.org.uk/ta176 NICE has accredited the process used by the Centre for Health Technology Evaluation
More informationCREATE Trial Proposal: Survey of current practice and potential trial participation
CREATE Trial Proposal: Survey of current practice and potential trial participation Approximately a quarter of newly diagnosed rectal cancer patients have features on pre-treatment pelvic MRI indicating
More information!"#$ Oncology Outcomes Report
!"#$ Oncology Outcomes Report The Cleveland Clinic Florida Cancer Institute is dedicated to the comprehensive care of patients with cancer. Oncologists collaborate with a variety of physicians across multiple
More informationColorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015
Colorectal Pathway Board (Clinical Subgroup): Imaging Guidelines September 2015 1 Contents Page No. 1. Objective 3 2. Imaging Techniques 3 3. Staging of Colorectal Cancer 5 4. Radiological Reporting 6
More informationNICE guidelines development Low back pain and sciatica: Management of non-specific low back pain and sciatica
NICE guidelines development Low back pain and sciatica: Management of non-specific low back pain and sciatica Steven Vogel Vice Principal (Research), The British School of Osteopathy Editor-in-Chief, The
More informationCASE STUDIES IN COLORECTAL CANCER: A ROUNDTABLE DISCUSSION
CASE STUDIES IN COLORECTAL CANCER: A ROUNDTABLE DISCUSSION PROVIDED AS AN EDUCATIONAL SERVICE BY THE INSTITUTE FOR CONTINUING HEALTHCARE EDUCATION SUPPORTED BY AN EDUCATIONAL GRANT FROM GENENTECH LEARNING
More informationGastric and Colon Cancer. Dr. Andres Wiernik 2017
Gastric and Colon Cancer Dr. Andres Wiernik 2017 GASTRIC CANCER Gastric Cancer Classification Epidemiology General principles of Management 25% GE Junction Gastric Cancer 75% Gastric Cancer Epidemiology
More informationCancer of Unknown Primary (CUP) Protocol
1 Department of Oncology. Cancer of Unknown Primary (CUP) Protocol Version: Document type: Document sponsor Designation Document author [ s] Designation[s] Approving committee / Group Ratified by: Date
More informationPancreatic Adenocarcinoma
Pancreatic Adenocarcinoma AProf Lara Lipton 28 April 2018 Percentage alive 5 years after diagnosis for men and women Epidemiology 6% of cancer related deaths worldwide 4 th highest cause of cancer death
More informationTreatment strategy of metastatic rectal cancer
35.Schweizerische Koloproktologie-Tagung Treatment strategy of metastatic rectal cancer Gilles Mentha University hospital of Geneva Bern, January 18th, 2014 Colorectal cancer is the third most frequent
More informationChemotherapy for resectable liver mets: Options and Issues. Herbert Hurwitz Duke University Medical Center Durham, North Carolina, USA
Chemotherapy for resectable liver mets: Options and Issues Herbert Hurwitz Duke University Medical Center Durham, North Carolina, USA Chemotherapy regimens in 1 st line mcrc Standard FOLFOX-Bev FOLFIRI-Bev
More informationAdjuvant and neoadjuvant chemotherapy for rectal cancer: Expensive but little gain
Adjuvant and neoadjuvant chemotherapy for rectal cancer: Expensive but little gain Outline The problem Adjuvant therapy Neoadjuvant therapy Options Conclusion The problem 30 years ago: Local recurrence
More informationRECTAL CANCER APPARENT COMPLETE RESPONSE (acr) AFTER LONG COURSE CHEMORADIOTHERAPY
COLORECTAL CLINICAL SUBGROUP RECTAL CANCER APPARENT COMPLETE RESPONSE (acr) AFTER LONG COURSE CHEMORADIOTHERAPY Finalised by: Dr Simon Gollins Mr Andrew Renehan Dr Mark Saunders Mr Nigel Scott Dr Shabbir
More informationAintree University Hospital
Aintree University Hospital Liverpool, UK Evolving role of DEBIRI with DC Bead - TACE in mcrc Hassan Z Malik MD FRCS Consultant Hepatobiliary Surgeon Hassan Z Malik is a consultant to Biocompatibles UK
More informationTechnology appraisal guidance Published: 25 January 2012 nice.org.uk/guidance/ta242
Cetuximab, bevacizumab and panitumumab for the treatment of metastatic colorectal cancer after first- line chemotherapy: Cetuximab (monotherapy or combination chemotherapy), bevacizumab (in combination
More informationOncological Treatment of Colorectal & Anal Cancer
Oncological Treatment of Colorectal & Anal Cancer Pathway of Care Kent & Medway Cancer Collaborative Publication date July 2018 Expected review date July 2019 Version number 10.0 Version status Final Table
More informationClinical guideline Published: 23 February 2009 nice.org.uk/guidance/cg81
Advanced breast cancer: diagnosis and treatment Clinical guideline Published: 23 February 2009 nice.org.uk/guidance/cg81 NICE 20. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Technology Appraisals. Patient Access Scheme Submission Template
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Technology Appraisals Patient Access Scheme Submission Template Bevacizumab in combination with fluoropyrimidine-based chemotherapy for the first-line
More informationCancer of Unknown Primary (CUP)
Cancer of Unknown Primary (CUP) Pathways and Guidelines V1.0 London Cancer September 2013 The following pathways and guidelines document has been compiled by the London Cancer CUP technical subgroup and
More informationCT PET SCANNING for GIT Malignancies A clinician s perspective
CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset
More informationUpper GI Cancer Quality Performance Indicators
Publication Report Upper GI Cancer Quality Performance Indicators Patients diagnosed during January 2013 to December 2015 Publication date 28 th March 2017 An Official Statistics Publication for Scotland
More informationState of the Art: Colorectal Cancer Liver Metastasis Dr. Iain Tan
State of the Art: Colorectal Cancer Liver Metastasis Dr. Iain Tan Consultant GI Medical Oncologist National Cancer Centre Singapore Clinician Scientist, Genome Institute of Singapore OS (%) Overall survival
More informationIntended for use by Clinicians and Health Care Providers involved in the Management or Referral of adult patients with pancreatic
Intended for use by Clinicians and Health Care Providers involved in the Management or Referral of adult patients with pancreatic cancer Section AA Cancer Centre Referrals In the absence of metastatic
More informationCancer and Data in the New NHS May Di Riley, Director Clinical Outcomes
Cancer and Data in the New NHS May 2011 Di Riley, Director Clinical Outcomes Overarching NHS context Financial constraints White Paper GP Commissioning/Commissioning Board Public Health England National
More informationDiagnostics consultation document KRAS mutation testing of tumours in adults with metastatic colorectal cancer
National Institute for Health and Care Excellence Diagnostics consultation document KRAS mutation testing of tumours in adults with The National Institute for Health and Care Excellence (NICE) is producing
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Abdominal drainage, after hepatic resection, 159 160 Ablation, radiofrequency, for hepatocellular carcinoma, 160 161 Adenocarcinoma, pancreatic.
More informationTechnology appraisal guidance Published: 24 August 2016 nice.org.uk/guidance/ta405
Trifluridine tipirracil for previously treated metastatic colorectal cancer Technology appraisal guidance Published: 24 August 2016 nice.org.uk/guidance/ta405 NICE 2018. All rights reserved. Subject to
More informationAddendum to clinical guideline 131, Colorectal cancer
: National Institute for Health Care Excellence Final Addendum to clinical guideline 131, Colorectal cancer Clinical guideline addendum 131.1 Methods, evidence recommendations December 2014 Final version
More informationOptimal Treatment Strategies for Localized Ewing s Sarcoma of Bone after Neoadjuvant Chemotherapy
A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Optimal Treatment Strategies for Localized Ewing s Sarcoma of Bone after Neoadjuvant Chemotherapy J. Werier,
More informationOutcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study
Original Article Outcome of rectal cancer after radiotherapy with a long or short waiting period before surgery, a descriptive clinical study Elmer E. van Eeghen 1, Frank den Boer 2, Sandra D. Bakker 1,
More informationUpper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012
Upper GI Malignancies Imaging Guidelines for the Management of Gastric, Oesophageal & Pancreatic Cancers 2012 Version Control This is a controlled document please destroy all previous versions on receipt
More informationCOLON CANCER CARE GUIDELINES NON-METASTATIC DISEASE
COLON CANCER CARE GUIDELINES NON-METASTATIC DISEASE Guideline Authors: Todd S. Crocenzi, M.D.; Mark Whiteford, M.D.; Matthew Solhjem, M.D.; Carlo Bifulco, M.D.; Melissa Li, M.D.; Christopher Cai, M.D.;
More informationreviews Staging, and in the Diagnosis, Managed Care Considerations therapy
reviews therapy Managed Care Considerations in the Diagnosis, Staging, and Treatment of Colorectal Cancer by Johanna Bendell, MD, Director, GI Oncology Research; Associate Director, Drug Development Unit,
More informationGuidelines for the Management of Bladder Cancer West Midlands Expert Advisory Group for Urological Cancer
Guidelines for the Management of Bladder Cancer West Midlands Expert Advisory Group for Urological Cancer West Midlands Clinical Networks and Clinical Senate Coversheet for Network Expert Advisory Group
More informationOVERALL CLINICAL BENEFIT
cetuximab plus FOLFIRI to convert unresectable liver metastatses to resectable, perc confirmed that neither the FIRE-3 study nor the CRYSTAL study were designed to assess resectability and, in the absence
More informationRectal cancer management: a team sport The role of radiology and the multidisciplinary conference
Rectal cancer management: a team sport The role of radiology and the multidisciplinary conference W. Donald Buie MD MSc FRCSC Professor of Surgery and Oncology Department of Surgery University of Calgary
More informationAn Integrated National Strategy for Breast Cancer Audit. Martin Lee Gill Lawrence
An Integrated National Strategy for Breast Cancer Audit Martin Lee Gill Lawrence National Audit Funding DH (NCAPOP* budget) Oversight National Clinical Audit Advisory Group (NCAAG) Commissioning and Monitoring
More informationSCREENING FOR BOWEL CANCER USING FLEXIBLE SIGMOIDOSCOPY REVIEW APPRAISAL CRITERIA FOR THE UK NATIONAL SCREENING COMMITTEE
SCREENING FOR BOWEL CANCER USING FLEXIBLE SIGMOIDOSCOPY REVIEW APPRAISAL CRITERIA FOR THE UK NATIONAL SCREENING COMMITTEE The Condition 1. The condition should be an important health problem Colorectal
More informationRadiotherapy for Rectal Cancer. Kevin Palumbo Adelaide Radiotherapy Centre
Radiotherapy for Rectal Cancer Kevin Palumbo Adelaide Radiotherapy Centre Overview CRC are common (3 rd commonest cancer) rectal Ca approx 25-30% of all CRC. Presentation PR bleeding: beware attributing
More informationGhosts in the Machine: Jonathan B. Koea MD; FRACS. Department of Surgery Auckland Hospital Auckland New Zealand
Ghosts in the Machine: Patient Journeys Through Cancer Treatment Jonathan B. Koea MD; FRACS. Department of Surgery Auckland Hospital Auckland New Zealand Age-Standardised Cancer Incidence (100,000 population)
More informationColorectal Cancer Comparative Audit Report
SOUTH EAST SCOTLAND CANCER NETWORK (SCAN) PROSPECTIVE CANCER AUDIT Colorectal Cancer 2014 2015 Comparative Audit Report Mr B.J. Mander, NHS Lothian, Lead Colorectal Cancer Clinician, SCAN Group Chair Mr
More informationRectal Cancer. GI Practice Guideline
Rectal Cancer GI Practice Guideline Dr. Brian Dingle MSc, MD, FRCPC Dr. Francisco Perera MD, FRCPC (Radiation Oncologist) Dr. Jay Engel MD, FRCPC (Surgical Oncologist) Approval Date: 2006 This guideline
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Endometrial Cancer
THIS DOCUMENT North of Scotland Cancer Network Clinical Management Guideline for Endometrial Cancer Based on WOSCAN CMG with further extensive consultation within NOSCAN UNCONTROLLED WHEN PRINTED DOCUMENT
More informationCOLORECTAL CANCER 44
COLORECTAL CANCER 44 Colorectal Cancer Highlights from the 2009 Annual Meeting of the American Society of Clinical Oncology Edited by Stuart M. Lichtman, MD Memorial Sloan-Kettering Cancer Center Commack,
More informationColorectal Cancer Quality Performance Indicators
Publication Report Colorectal Cancer Quality Performance Indicators Patients diagnosed between April 2013 and March 2016 Publication date 27th June 2017 An Official Statistics Publication for Scotland
More informationState of the art management of Colorectal Liver Metastasis: an interplay of Chemotherapy and Surgical options
State of the art management of Colorectal Liver Metastasis: an interplay of Chemotherapy and Surgical options Ioannis S. Hatzaras, MD, MPH, FACS Assistant Professor of Surgery Division of Surgical Oncology
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Carcinoma of the Uterine Cervix
THIS DOCUMENT North of Scotland Cancer Network Carcinoma of the Uterine Cervix UNCONTROLLED WHEN PRINTED DOCUMENT CONTROL Prepared by A Kennedy/AG Macdonald/Others Approved by NOT APPROVED Issue date April
More informationClinical guideline Published: 27 April 2011 nice.org.uk/guidance/cg122
Ovarian cancer: recognition and initial management Clinical guideline Published: 27 April 2011 nice.org.uk/guidance/cg122 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE GUIDANCE EXECUTIVE (GE) Consideration of consultation responses on review proposal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE GUIDANCE EXECUTIVE (GE) Consideration of consultation responses on review proposal Review of TA 118 Colorectal cancer (metastatic) - bevacizumab &
More informationSurveillance report Published: 17 March 2016 nice.org.uk
Surveillance report 2016 Ovarian Cancer (2011) NICE guideline CG122 Surveillance report Published: 17 March 2016 nice.org.uk NICE 2016. All rights reserved. Contents Surveillance decision... 3 Reason for
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Malignant melanoma: assessment and management of malignant melanoma 1.1 Short title Malignant Melanoma 2 The remit The Department
More informationClinical indications for positron emission tomography
Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will
More informationAudit Report. Colorectal Cancer Quality Performance Indicators. Patients diagnosed April 2016 March Published: March 2018
Colorectal Cancer Managed Clinical Network Audit Report Colorectal Cancer Quality Performance Indicators Patients diagnosed April 2016 March 2017 Published: March 2018 Mr Michael Walker NOSCAN MCN Clinical
More informationChemotherapy of colon cancers
Chemotherapy of colon cancers Stage distribution Stage I : 15% T 1,2 NO Stage IV: 20 25% M+ Stage II : 20 30% T3,4 NO Stage III N+: 30 40% clinical stages I, II, or III colon cancer are at risk for having
More informationShared Care Pathway for Soft Tissue Sarcomas Presenting to Site Specialised MDTs. Gynaecological sarcomas Version 1
Shared Care Pathway for Soft Tissue Sarcomas Presenting to Site Specialised MDTs Gynaecological sarcomas Version 1 Background This guidance is to provide direction for the management of patients with sarcomas
More informationCETUXIMAB FOR THE FIRST LINE TREATMENT OF METASTATIC COLORECTAL CANCER (MCRC)
CETUXIMAB FOR THE FIRST LINE TREATMENT OF METASTATIC COLORECTAL CANCER (MCRC) 1. BACKGROUND submitted evidence to NICE on the 2 nd cetuximab in the treatment of mcrc. May 2008 for the appraisal of The
More informationClinical Policy: Panitumumab (Vectibix) Reference Number: CP.PHAR.321
Clinical Policy: (Vectibix) Reference Number: CP.PHAR.321 Effective Date: 03/17 Last Review Date: 03/17 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory
More informationCosting report: Bladder cancer
Putting NICE guidance into practice Costing report: Bladder cancer Implementing the NICE guideline on bladder cancer (NG2) Published: February 2015 Updated September 2015 to update the unit cost of transurethral
More informationClinical Commissioning Policy: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages)
Clinical Commissioning Policy: Gemcitabine and capecitabine following surgery for pancreatic cancer (all ages) NHS England Reference: 1711P 1 NHS England INFORMATION READER BOX Directorate Medical Operations
More informationOn-going and planned colorectal cancer clinical outcome analyses
On-going and planned colorectal cancer clinical outcome analyses Eva Morris Cancer Research UK Bobby Moore Career Development Fellow National Cancer Data Repository Numerous routine health data sources
More informationPrimary brain tumours and cerebral metastases workshop
Primary brain tumours and cerebral workshop 22.4.16 Summary of workshop group discussions on the content of the scope Scope section Title: Primary brain tumours and cerebral Who the guideline is for People
More informationPhysician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer
Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Gabriela M. Vargas, MD Kristin M. Sheffield, PhD, Abhishek Parmar, MD, Yimei Han, MS, Kimberly M. Brown,
More informationThe Surgical Management of Colorectal Metastases
11th July 2017 Bowel Cancer UK The Surgical Management of Colorectal Metastases Ben Cresswell MD(Res) FRCS Consultant HPB Surgeon The Basingstoke Hepatobiliary Unit United Kingdom Surgical Management of
More informationMDT IMPROVEMENT PROJECT. Professor Muntzer Mughal, UCLH
MDT IMPROVEMENT PROJECT Professor Muntzer Mughal, UCLH 1995..assessment and management of rare cancers in multidisciplinary teams.. 2000 the care of all patients with cancer should be formally reviewed
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Metastatic Malignancy of Undefined Primary Origin (MUO)
North of Scotland Cancer Network Clinical Management Guideline for Metastatic Malignancy of Undefined Primary Origin (MUO) UNCONTROLLED WHEN PRINTED DOCUMENT CONTROL Original Prepared by NMcL April 2016
More informationColorectal Cancer Network Site Specific Group. Clinical Guidelines. June 2017
Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services Colorectal Cancer Network Site Specific Group June 2017 Revision due: April 2019 Page 1 of 31 VERSION CONTROL THIS IS A CONTROLLED DOCUMENT.
More informationLow back pain and sciatica in over 16s NICE quality standard
March 2017 Low back pain and sciatica in over 16s NICE quality standard Draft for consultation This quality standard covers the assessment and management of non-specific low back pain and sciatica in young
More informationColorectal cancer: pathology
UK NEQAS for Molecular Pathology Colorectal cancer: pathology Nick West Pathology & Tumour Biology May 2013 Colorectal cancer (CRC) 40,695 new cases in 2010 15,708 deaths Management of CRC Surgery Main
More informationState-of-the-art of surgery for resectable primary tumors
Early colorectal cancer State-of-the-art of surgery for resectable primary tumors (Special focus on rectal cancer surgery) Stefan Heinrich & Hauke Lang Department of General, Visceral and University Hospital
More informationBowel Cancer in England and Wales A summary report about the management and outcomes of people with bowel cancer
Bowel Cancer in England and Wales A summary report about the management and outcomes of people with bowel cancer Based on findings from the National Bowel Cancer Audit Background How are patients diagnosed?
More informationPATHWAY FOR INVESTIGATION OF ADULTS PRESENTING WITH ASCITES. U/S Abdo/pelvis shows ascites without obvious evidence of 1 liver disease
PATHWAY FOR INVESTIGATION OF ADULTS PRESENTING WITH ASCITES U/S Abdo/pelvis shows ascites without obvious evidence of 1 liver disease Refer back to original requester with this paperwork and review previous
More informationThe Virtual Lung Nodule Clinic
The Virtual Lung Nodule Clinic Poster No.: C-1023 Congress: ECR 2016 Type: Educational Exhibit Authors: S. Higgins, F. C. Lyall, J. Taylor, J. goldman, S. Rolin, B. 1 2 1 2 2 3 2 2 3 Soar ; Torbay/UK,
More informationDelivering 62 Day GP Cancer Waits in a Complex Landscape. Hannah Marder Cancer Manager University Hospitals Bristol
Delivering 62 Day GP Cancer Waits in a Complex Landscape Hannah Marder Cancer Manager University Hospitals Bristol Overview The 62 day GP target Cancer pathways What causes breaches? Good practice and
More informationStaging Issues: Lung Cancer & Mesothelioma. Mick Peake Clinical Lead, NCIN Chair, Lung SSCRG
Staging Issues: Lung Cancer & Mesothelioma Mick Peake Clinical Lead, NCIN Chair, Lung SSCRG Staging systems Non-Small Cell Lung Cancer (>85%): UICC TNM v6 used until 1.1.10 transition since then to v7
More informationADJUVANT CHEMOTHERAPY FOR RECTAL CANCER
ESMO Preceptorship Programme Colorectal Cancer Barcelona November, 25-26, 2016 ADJUVANT CHEMOTHERAPY FOR RECTAL CANCER Andrés Cervantes Professor of Medicine OLD APPROACH TO RECTAL CANCER Surgical resection
More information