Critical Evaluation of the Quality and Recommendations of Clinical Practice Guidelines for Nasopharyngeal Carcinoma

Abstract

Given the distinct biological characteristics and regional distribution of nasopharyngeal carcinoma (NPC) compared with other head and neck cancers, and uncertainties regarding therapeutic strategies, physicians require high-quality clinical practice guidelines (CPGs) to provide transparent recommendations for NPC treatment. This study aimed to critically appraise the quality of NPC CPGs and assess the consistency of their recommendations. We identified CPGs that provided recommendations on the diagnosis and management of NPC published up to December 2015. Four investigators independently appraised CPG quality using the Appraisal of Guidelines for Research& Evaluation (AGREE) II instrument. Key recommendations by CPGs were also evaluated. A total of 7 CPGs were eligible for this study: 5 produced by professional organizations or governmental agencies and 2 were developed based on expert consensus. Of the 6 AGREE II domains, the applicability domain scored consistently low across CPGs (range, 13.5%-30.2%); no CPG achieved a score of>50% in all 6 domains. The scope and purpose domain (≥73.6% for 4 CPGs) and editorial independence domain (≥75.0% for 6 CPGs) scored highest. Of the 23 AGREE II items, 9 scored less than half of the points available in all 7 CPGs. The recommendations by CPGs were consistent in general; heterogeneity mainly existed among recommended therapeutic strategies. Variation exists in NPC CPG development processes and recommendations. Increased efforts are required to make comprehensive resources available to guide healthcare providers and enhance delivery of high-quality, evidence-based care for NPC. International collaboration is necessary to enable the development of high-quality and regionally relevant CPGs for NPC.

A critical appraisal of the quality of head and neck cancer imaging guidelines using the AGREE II tool: A EuroAIM initiative

“…Domain 3, “Rigor of development,” scored an average percentage score of 33.85% since methods for searching or evaluating evidences were not always specified and no guideline authors’ team applied the Delphi or Glaser technique to achieve a mutual agreement among experts . However, it should be noted that certain items in this domain (eg, items 12 and 14) may not attract enough attention and, even if not reported, these methodological aspects are often adequately performed . Regarding domain 5 “Applicability,” facilitators and barriers for guidelines’ application, resource implications, advice on how the recommendation can be put into practice as well as monitor or auditing criteria were not clearly specified in the guidelines under evaluation, resulting in the rather poor average score of 33.85%.…”

“…26 However, it should be noted that certain items in this domain (eg, items 12 and 14) may not attract enough attention and, even if not reported, these methodological aspects are often adequately performed. 16,27,28 Regarding domain 5 "Applicability," facilitators and barriers for guidelines' application, resource implications, advice on how the recommendation can be put into practice as well as monitor or auditing criteria were not clearly specified in the guidelines under evaluation, resulting in the rather poor average score of 33.85%. Interestingly, this domain score was also found to be low in previous appraisals of clinical guidelines published in HNC, 15,16,18 suggesting that the applicability of recommendations is underestimated during guidelines drafting.…”

“…16,27,28 Regarding domain 5 "Applicability," facilitators and barriers for guidelines' application, resource implications, advice on how the recommendation can be put into practice as well as monitor or auditing criteria were not clearly specified in the guidelines under evaluation, resulting in the rather poor average score of 33.85%. Interestingly, this domain score was also found to be low in previous appraisals of clinical guidelines published in HNC, 15,16,18 suggesting that the applicability of recommendations is underestimated during guidelines drafting. Finally, as also occurred in previous evaluations, 21,22,29 domain 6 "Editorial Independence" was the most critically underperforming with an average score of 27.08% and the lowest variability (SD 4.17%), since neither an explicit statement that the funding body interests have not influenced the final recommendations nor "no conflict of interest" statement were provided in two out of three guidelines.…”

“…Among various quality appraisal instruments developed for evaluating guidelines quality in terms of methodological rigor and transparency, 13 the Appraisal of Guidelines for Research & Evaluation version 2.0 (AGREE II) has been validated and proved to be a reliable tool 14 being already applied for clinical practice guidelines in different fields, including HNC. [15][16][17][18][19] In this setting, the European Network for the Assessment of Imaging in Medicine (EuroAIM) was founded by the European Institute for Biomedical Imaging Research (EIBIR) 20 with the purpose of seeking evidence for the best use of radiological technology. Recently, EuroAIM has focused its activity on the evaluation of the quality of guidelines in different fields of diagnostic imaging.…”

NCCN Guidelines Insights: Head and Neck Cancers, Version 1.2018

“…35 Taken together, results thus far suggest that induction chemotherapy prior to CRT in patients with locally advanced NPC may potentially impact tumor control, compared with CRT without additional chemotherapy. 32, 36 Expert groups (eg, ESMO, NCI) differ in their clinical practice guidelines regarding use of induction chemotherapy for these patients, 37 and the NCCN Guidelines Panel could not reach uniform consensus in this regard. Clinical trials are currently ongoing to address the role of induction chemotherapy prior to CRT for patients with locoregionally advanced NPC (eg, ClinicalTrials.gov iden- 38 Induction chemotherapy (followed by CRT) is also recommended for patients with NPC with either T1,N1-3 or T2-T4,any N lesions (see NASO-2, page 482).…”