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An Analysis of the Evidence Informing Clinical Practice Guidelines in the Management and Treatment of Breast Cancer

Published:April 28, 2022DOI:https://doi.org/10.1016/j.clbc.2022.04.009

      Abstract

      Objective

      The aim of this study was to assess the methodological quality and accuracy of reporting within systematic reviews (SRs) that provide evidence to form clinical practice guidelines (CPGs) in the management and treatment of breast cancer.

      Methods

      The 5 included CPGs for breast cancer management among National Comprehensive Cancer Network and European Society for Medical Oncology were searched for all SRs and meta-analyses. The characteristics of each study along with their methodological reporting were extracted from each SR using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) tools. Our second objective was to compare SRs produced by Cochrane groups vs non-Cochrane.

      Results

      Our study included 5 CPGs for the management of breast cancer, containing 1341 total references with 69 being unique SRs we analyzed. PRISMA completeness percent had a mean 76.3% (n = 69), while AMSTAR-2 completeness score mean was 66.5% (n = 59). Cochrane SRs were found to adhere far better to PRISMA (0.91 vs. 0.74) and AMSTAR-2 (0.95 vs. 0.62) guidelines compared to the non-Cochrane SRs.

      Conclusion

      The reporting quality of SRs that underpin CPGs in breast cancer management widely varies. We recommend that authors of SRs adopt a more uniform approach in assessing the quality of reporting within their studies. In addition, CPGs should use a more standardized method to seek out evidence to establish their recommendations. With improved reporting, clinicians may have increased confidence in CPGs and thus increased utilization of CPGs in clinical decision making.

      Keywords

      Abbreviations:

      CPG (Clinical practice guideline), SR (systematic review), NCCN (National Comprehensive Cancer Network), ESMO (European Society for Medical Oncology), PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses), AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2), ESMO/ABC5 (5th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer, ABC 5), ESMO/EBC (Early Breast Cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up), ESMO/BCY4 (ESO-ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women, BCY4), ESMO/BRCA (Prevention and Screening in BRCA Mutation Carriers and Other Breast/Ovarian Hereditary Cancer Syndromes: ESMO Clinical Practice Guidelines for Cancer Prevention and Screening), NCCN/BC (NCCN Clinical Practice Guidelines in Oncology: Breast Cancer)
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