NCCN Guidelines Become Resource Stratified for Global Use

Resource constraints may confine the ability of physicians to deliver optimal cancer care to all patients across the world, which the National Comprehensive Cancer Network (NCCN) is acknowledging by resource stratifying its Guidelines.

“While the incidence of cancer is much greater in the more developed parts of the world, cancer mortality is essentially the same across all parts of the globe,” Robert Carlson, MD, chief executive officer of NCCN, said during a session at the 20th Annual Conference. “So cancer mortality is a huge problem in the less developed parts of the world.”

The NCCN is starting to provide treatment options based on resources available around the world for 4 of its guidelines: breast, cervical, and hepatobiliary cancers.

The basic level denotes the minimum level of cancer-specific treatment needed to achieve a measurable level of success of treatment. However, providers should use the highest level of resource that are available to them and if basic treatments or higher are not available, then palliative and best supportive care should be provided.

Currently, NCCN Guidelines are consistently written at the maximum resource level. The stratification guide at the basic level starts with the core resources necessary for any breast healthcare system to function. Next is the limited level, which adds in additional therapies that are not cost prohibitive and improve disease-oriented outcomes in a major way. The enhanced level further adds resources and some therapies that are constrained in a low-resource setting. Finally, the maximal level is the experience in the United States.

Dr Carlson explained that it is important to note that to move up to the next level, all resources for the proceeding levels should be available to all patients, as NCCN is not looking to create a 2-tiered healthcare system.

Wui-Jin Koh, MD, from Fred Hutchinson Cancer Research Center, presented the results of the resource stratified cervical cancer guidelines, which are now posted on the NCCN website. The disease is common worldwide and highly represented in less resource-capable areas of the world, he explained.

“We do recognize that this is a work in progress, because we do have to engage our international colleagues for their input and review,” he said.