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Clinical Practice Guidelines in B.C:


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Clinical Practice Guidelines in B.C:

  1. 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. 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. 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. 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. 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. 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. 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
  8. 8. Con’t • Standards • Policies • Guidelines • Protocols on line (180) Planning/Approval/ Costing/Implementation
  9. 9. • Outcomes evaluation (with tumor groups) • Education “ • Research “ • Strategic and financial planning • Pharmacoeconomics
  10. 10. Professional Treatment Guidelines • American Society of Clinical Oncology • Canadian Medical Association • Various national/international professional societies
  11. 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. 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. 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. 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. 15. • National coordinating infrastructure proposed • Respectful of existing initiatives • Build capacity/methodologies • Set priorities • Conduct inventory • Facilitate patient/public versions
  16. 16. Con’t • Dissemination/implementation/ evaluation/updating/after care • Research • Education for primary health care providers
  17. 17. Do We Need National Consensus? Therapy Guidelines Provinces are more similar than different BUT Major differences exist in several areas
  18. 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. 19. • Lack of symptom management/palliative guidelines • Psychosocial support guidelines not clearly understood or developed (confusion re: “funding” versus “guidelines”)
  20. 20. • Will Canadian guidelines be timely and feasible? • Enhance consistency? • Improve outcomes? • Improve access? • Improve cost effectiveness? • Support implementation?
  21. 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?