Recommendations of perioperative systemic therapies considering age or comorbidities in the National Comprehensive Cancer Network (NCCN) guidelines and quality of cited evidence

Abstract

Importance

Perioperative therapy for cancer is offered to reduce the recurrence and improve overall long-term outcomes. Age and comorbidities of patients can influence the effectiveness and/or safety of perioperative therapy. It is important that key national guidelines, such as the National Comprehensive Cancer Network (NCCN) guidelines, reflect the benefit of perioperative therapy for key subpopulations of patients. However, this has not been evaluated.

Objective

To evaluate the perioperative treatment guidance, with regards to age and comorbidities, reported in the NCCN guidelines

Design setting, and participants

Cross-sectional study of NCCN recommendations regarding age and comorbidity in perioperative settings.

Intervention

not applicable.

Main outcome and measure

The existence of age or comorbidity-specific guidelines for perioperative therapy, the presence of literature support for these specific guidelines, and where they exist.

Results

Only 2 of the 10 cancer types studied had specific guidelines on perioperative therapy based on age, and 4 out of 10 had guidelines on perioperative therapy considering patients’ comorbidities. Half of 10 cancer guidelines (5 out of 10) and 4 out 10 had vague advice on consideration of age and comorbidities respectively. A total of 30 recommendations were made across the guidelines studied. Studies that were cited to support these recommendations were often pooled analyses of RCTs or subgroup analysis of randomized controlled trials (RCTs) (33 %).

Conclusion and relevance

This study shows the lack of age and comorbidity-specific guidelines for many cancer types in the NCCN guidelines. In addition, several of these recommendations, when they exist, are also not supported by strong evidence such as RCTs. There is a need for more comprehensive guidelines that make recommendations accounting for patient-intrinsic factors.