Transforming the NCCN Guidelines

During his keynote speech at the National Comprehensive Cancer Network (NCCN)’s 20th Annual Conference, Chief Executive Officer Robert Carlson, MD, spent the majority of his time discussing the NCCN Guidelines because they are the core of its services.

At the annual meeting, held March 12-14 in Hollywood, Florida, NCCN will unveil its Guidelines for Smoking Cessation. In 1996, the NCCN only had 10 guidelines: breast cancer, colorectal cancer, non-small cell lung cancer, small cell lung cancer, acute myelogenous leukemia, prostate cancer, ovarian cancer, pediatric neuroblastoma, pediatric osteosarcoma, and pediatric acute lymphoblastic leukemia.

“Looking back at those guidelines now, they were both complicated and visionary for 1996 and simple in comparison to today’s guidelines,” Dr Carlson said. “If we look just at the original 7 adult guidelines and compare them with their 2015 versions, it is remarkable how the guidelines and guidelines panels have expanded.”

Celebrating 20 years, Dr Carlson spent some time looking back at the history of NCCN, which was formed at a time when academic cancer centers were facing a number of threats, including the health maintenance organization movement and outside forces looking to dictate to physicians and patients on the care provided.

During this time, the guidelines were born, so that the original member institutions could assure that academic cancer centers would have a central role in deciding optimal and appropriate cancer care.

“The vision was to utilize the guidelines as a way of convincing payers that the academic centers provided effective and efficient care,” he explained.

Providing the guidelines free of charge was crucial, although controversial at the time. There were more than 6 million downloads of the guidelines in 2014. He attributes the rapid adoption of the guidelines to their use of graphical displays across the continuum of care, which makes them intuitive for clinicians to use.

Dr Carlson added that the guidelines have not been without controversy. For example, he explained the controversy from the first and second annual meetings surrounding the use of high-dose chemotherapy with bone marrow transplant in the treatment of metastatic breast cancer.

Today, the guidelines can be criticized for having too many options and too much choice; however, he feels these are a strength of the guidelines as they provide a range of choices for the best treatment among a range of appropriate options.

They are continuing to improve upon the guidelines, and one challenge in using the guidelines has been comparing multiple diagnostic and treatment options in an efficient manner. He acknowledged that patients have different value systems and priorities when they select a treatment. One may focus on effectiveness over safety and cost, while another only cares about cost. As a result, NCCN has developed a method of displaying efficacy, safety, quality of evidence, consistency of evidence, and affordability that will allow clinicians to quickly scan through options and focus on the one that best fits their patient’s preferences.

“As strong as the NCCN Guidelines are, we are not satisfied with where we are,” Dr Carlson said. “There are several initiatives that will transform the use and impact of the NCCN guidelines over the next few years.”