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Publication - Consultation Paper

Review of Upper GI Cancer Quality Performance Indicators Consultation

Published: 16 Dec 2016
Part of:
Health and social care
ISBN:
9781786527028

Inviting views on the revised upper gastrointestinal (GI) cancer Quality Performance Indicators (QPIs).

37 page PDF

599.2kB

37 page PDF

599.2kB

Contents
Review of Upper GI Cancer Quality Performance Indicators Consultation
Appendix 1: QPI Development Process

37 page PDF

599.2kB

Appendix 1: QPI Development Process

Preparatory Work and Scoping

The preparatory work involved the development of a structured briefing paper by Healthcare Improvement Scotland. This paper took account of existing, high quality, clinical guidance and provided a basis for the development of QPIs.

The scope for development of Upper GI cancer QPIs and a search narrative were defined and agreed by the Upper GI Cancer QPI Development Group. The table below shows the final criteria used in the literature search.

Table 1 - Upper GI Cancer Search Criteria

Inclusion

Exclusion

Topics (population/patient): Oesophageal (esophageal), gastric

Topics (intervention): Diagnosis, staging, surgery, non-surgical management, treatment, palliative chemotherapy, radiotherapy and surgery.
Adults only
Date: 2005 to present day

Topics: Communication/information, end of life care, pain management, prevention, screening and secondary liver cancer.

A systematic search was carried out by Healthcare Improvement Scotland using selected websites and two primary medical databases to identify national and international guidelines. The list of websites and the Medline and Embase search strategies are set out in appendix 1. Of 39 relevant documents identified, 21 were excluded on the grounds that they were duplicate publications, not guidelines or had inadequate methodological information. The 18 remaining guidelines were appraised for quality using the AGREE II instrument. The instrument assesses the methodological rigour and precision used when developing a guideline. Sixteen of the guidelines were recommended for use (see below).

Literature Search Strategies

Guideline web sites:

Medline search strategy: (139 results)

1. esophageal neoplasms/ or intestinal neoplasms/ or stomach neoplasms/

2. ((esophag$ or oesophag$ or gullet) adj3 (cancer$ or tumo?r$ or neoplasm$ or carcinoma$)).ti,ab.

3. ((stomach or gastric) adj3 (cancer$ or neoplasm$ or tumo?r$ or carcinoma$)).ti,ab.

4. or/1-3

5. guideline.pt.

6. (guideline$ or guidance).ti,ab.

7. Clinical Audit/

8. Guideline/ or Practice Guideline/

9. Quality Indicators, Health Care/

10. or/5-9

11. 4 and 10

12. limit 11 to (english language and yr="2005 -Current")

13. limit 12 to (comment or editorial or letter)

14. 12 not 13

Embase search strategy: (53 results)

1. stomach cancer/

2. esophagus tumor/ or esophagus carcinoma/

3. esophagus cancer/

4. ((gastric or stomach) adj3 (cancer$ or carcinoma$ or tumo?r$ or neoplasm$)).ti,ab.

5. ((oesophag$ or esophag$ or gullet) adj3 (cancer$ or carcinoma$ or tumo?r$ or neoplasm$)).ti,ab.

6. or/1-5

7. (guideline$ or guidance).ti.

8. practice guideline/

9. or/7-8

10. 6 and 9

11. limit 10 to (english language and yr="2005 -Current")

12. limit 11 to (editorial or letter)

13. 11 not 12

Note:

Terms ending in "/" are terms from the database subject index (controlled vocabulary).
$ =truncation ( e.g. cancer$ will find cancer or cancers or cancerous)
?=wildcard ( e.g. tumo?r will find tumor or tumour)
ADJ3 will find combinations of terms in any order separated by up to 3 other terms ( e.g. kidney ADJ3 cancer will find cancer of the kidney)
.ti will find term in title field
.ab will find term in abstract field
.pt = publication type
* = major descriptor
exp= explode (will find this term and all related narrower terms in index tree)

Recommended Guidelines included in Briefing Paper

Guidelines recommended for use

Guideline

Summary of appraisal

Grading System

1. Association of Comprehensive Cancer Centres ( ACCC). Gastric Carcinoma. (2009)

An excellent and robust guideline intended for all professionals involved in diagnostics, treatment and guidance of patients with a gastric carcinoma.

No grading system in place

2. Cancer Care Ontario. Neoadjuvant or Adjuvant Therapy for Resectable Gastric Cancer. (2011)

A very clear guideline which used high quality methods to present evidence and recommendations in a clear way to inform decision making. However, the guideline does not meet many criteria under the domain applicability.

No grading system in place

3. Cancer Care Ontario. Systemic Therapy for Advanced Gastric Cancer. (2010)

This guideline used high quality methods to develop and present the evidence and recommendations. Applicability to Scotland would be in terms of technologies, patient ethnicities and age profiles, and although there is not enough information on the applicability domain, this guideline is recommended for use.

No grading system in place

4. Cancer Care Ontario. Preoperative and Postoperative Therapy for Resectable Esophogeal Cancer. (2008)

Scoring well on majority of the domains (scope, purpose, stakeholder involvement, rigour of development and clarity of presentation) this guideline provides clear evidence and recommendations, which appear adaptable to a UK setting.
Note: updated in 2008.

No grading system in place

5. NICE. Capecitabine for the treatment of advanced gastric cancer. (2010)

Clearly reports all the domains and has a transparent methodology.

No grading system in place

6. NICE. Palliative photodynamic therapy for advanced oesophageal cancer. (2007)

These guidelines clearly report all the domains and have a transparent methodology.

No grading system in place

7. NICE. Photodynamic therapy for early-stage oesophageal cancer. (2006)

8. NICE. Trastuzumab for the treatment of HER2-positive metastatic gastric cancer. (2010)

A good quality guideline which clearly reports all the domains and has a transparent methodology.

No grading system in place

9. Royal College of Pathologists. Dataset for the histopathological reporting of oesophageal carcinoma. (2nd edition) (2007)

Insufficient information on the majority of the AGREE domains. Suggestion to use this guideline where there is no other dataset for histopathological reporting of cancers.

Relevant to Scotland as it is produced by the Royal College of Pathologists.

No grading system in place

10. Royal College of Pathologists. Dataset for the histopathological reporting of gastric carcinoma. (2nd edition) (2007)

11. SIGN. Management of oesophageal and gastric cancer. (2006)

This guideline scores well on all the domains and has a transparent methodology.

SIGN grades of recommendation

12. Society of American Gastrointestinal and Endospcopic Surgeons ( SAGES). Staging laparoscopy for gastric cancer. (2007)

An updated guideline with a transparent methodology.

SAGES recommendation grading scale

13. Cancer Care Ontario. PET Imaging in Esophageal Cancer. (2009)

A report which scores well on majority of the domains (scope, purpose, stakeholder involvement, rigor of development and clarity of presentation) except for domain 5 (applicability and implementation issues). This is not covered in the guideline remit.

No grading system in place

14. Cancer Care Ontario. Combined Modality Radiotherapy and Chemotherapy in the Non-surgical Management of Localized Carcinoma of the Esophagus. (2005)

A useful guideline which scores well on majority of the domains (scope, purpose, stakeholder involvement, rigor of development and clarity of presentation). Evidence and recommendations are clear and have been updated and endorsed recently.

No grading system in place

15. Cancer Care Ontario. The Role of IMRT in Gastrointestinal Cancers. (2010)

Guideline used explicit methodology and standardised processes to develop and present evidence and summary statements, although it should be noted there is little information on domain 5 (applicability and implementation issues).

Recommended in terms of technology.
Note: Full systematic review is not yet published.

No grading system in place

16. American College of Gastroenterology. Role of Esophageal Stents in Benign and Malignant Diseases. (2010)

Although this recent guideline does not score well on a number domains, nor are its recommendations easily identifiable, its use is suggested specifically on the role of oesophageal stents.

Grading of Recommendations Assessment, Development and Evaluation system ( GRADE)


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