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Clinical Practice Guidelines in B.C: and the Strategy for Cancer Control Recommendations

Clinical Practice Guidelines in B.C: and the Strategy for Cancer Control Recommendations. Susan O’Reilly Head, Division of Medical Oncology B.C. Cancer Agency & University of British Columbia. Provincial Systemic Program Leader, B.C. Cancer Agency. BCCA Provincial Guidelines Development.

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Clinical Practice Guidelines in B.C: and the Strategy for Cancer Control Recommendations

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  1. Clinical Practice Guidelines in B.C: and the Strategy for Cancer Control Recommendations Susan O’Reilly Head, Division of Medical Oncology B.C. Cancer Agency & University of British Columbia. Provincial Systemic Program Leader, B.C. Cancer Agency

  2. BCCA Provincial Guidelines Development Provincial Tumour Groups • Multidisciplinary groups - site specific e.g. breast, lung, GI • Medical/Radiation/Surgical Oncologists • Pharmacists • Variable participation of other disciplines

  3. Con’t • 20 year history • Review new scientific data presented at international meetings • Abstracts • Peer reviewed papers • Local (BC) outcomes/experience • Propose new guidelines for surgical, radiation and systemic therapy/symptom management • Promulgate and practice according to guidelines • Cancer Management Manual

  4. Priorities and Evaluation Committee, BCCA • Broad-based representation of various programs/processes statistical expertise, • Expert panels (curative/chronic/preventative) • Rank new program/guideline proposals according to scientific merit

  5. Scientific review based on 5 levels of evidence • e.g: level 1 - Scientifically, well-designed, phase III randomized study with sufficient numbers of patients accrued and adequate length of follow-up to determine statistically relevant difference between two or more alternative treatment strategies.

  6. Con’t • Reasonable assessment of early data when “Level 1” may not have been achieved yet. e.g. large phase II studies or rare cancer diagnoses • Assessment of cost/benefit • New programs - new drugs/combinations • Emerging role in evaluating merit of existing programs

  7. Provincial Systemic Therapy Program Responsible for: • BCCA Provincial Oncology Budget • BCCA operating budget for Systemic (medical oncology programs) in BCCA and community centers • Interactive treatment and educational information on website www.bccancer.bc.ca

  8. Con’t • Standards • Policies • Guidelines • Protocols on line (180) Planning/Approval/ Costing/Implementation

  9. Outcomes evaluation (with tumor groups) • Education “ • Research “ • Strategic and financial planning • Pharmacoeconomics

  10. Professional Treatment Guidelines • American Society of Clinical Oncology • Canadian Medical Association • Various national/international professional societies

  11. Canadian (National) Guidelines • Well-developed adjuvant breast cancer guidelines • Strengths: • Expert/multidisciplinary/multiprovincial unifying standard • Weakness: • Protracted consultation process • Difficulty to be timely when patients/doctors anxious for access • Provincial Ministries of Health require early budget advice

  12. Provincial Guidelines • Cancer Care Ontario • Sophisticated guideline process • Centrally coordinated and lead (Dr. George Browman) • Clearly defined process • Various levels of guideline development in other provinces • Labour intensive but • Good local “buy in”

  13. CANADIAN GUIDELINE DEVELOPMENT An evolving process: • Canadian Association of Provincial Cancer Agencies (CAPCA) • Various CAPCA Advisory Committees • Interprovincial Drug Strategies and Guidelines Working Group (IDSGWG) • IDSGWG Extranet: Provincial formularies, guidelines • Canadian Strategy for Cancer Control (Health Canada/CAPCA/CCS/NCIC)

  14. CANADIAN STRATEGY FOR CANCER CONTROL/CAPCA/CCS/NCIC Guideline Development Project • Leader - Dr. G. Browman • Workshop September 2002, Ottawa • Broad Scope: • Prevention • Screening • Therapy • Supportive care • Palliative Care • Agreement to strike expert working groups

  15. National coordinating infrastructure proposed • Respectful of existing initiatives • Build capacity/methodologies • Set priorities • Conduct inventory • Facilitate patient/public versions

  16. Con’t • Dissemination/implementation/ evaluation/updating/after care • Research • Education for primary health care providers

  17. Do We Need National Consensus? Therapy Guidelines Provinces are more similar than different BUT Major differences exist in several areas

  18. Con’t • Access to: • First line Gleevec (imatinab) for chronic myeloid leukemia • CHOP + Rituximab for first line aggressive lymphomas • Bisphosphonates • Oxaliplatin for colon cancer • Variable funding policies for “take-home” drugs • Will some problems be solved by Kirby or Romanow Report?

  19. Lack of symptom management/palliative guidelines • Psychosocial support guidelines not clearly understood or developed (confusion re: “funding” versus “guidelines”)

  20. Will Canadian guidelines be timely and feasible? • Enhance consistency? • Improve outcomes? • Improve access? • Improve cost effectiveness? • Support implementation?

  21. Questions • Are Canadian clinical practice guidelines a positive or negative influence on standards of care and access to care? • Will Canadian guidelines be achievable in a timely fashion and be responsive to new evidence?

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