Cancer Screening Recommendations for Solid Organ Transplant Recipients: A Systematic Review of Clinical Practice Guidelines

Abstract

Solid organ transplant recipients (SOTRs) are at increased risk of developing and dying from cancer. However, controversies exist around cancer screening in this population owing to reduced life expectancy and competing causes of death. This systematic review assesses the availability, quality and consistency of cancer screening recommendations in clinical practice guidelines (CPGs). We systematically searched bibliographic databases and gray literature to identify CPGs and assessed their quality using AGREE II. Recommendations were extracted along with their supporting evidence. Thirteen guidelines were included in the review. CPGs for kidney recipients were the most frequent source of screening recommendations, and recommendations for skin cancer screening were most frequently presented. Some screening recommendations differed from those for the general population, based on literature demonstrating higher cancer incidence among SOTRs versus direct evidence of screening effectiveness. Relevant stakeholders such as oncology specialists, primary care providers and public health experts were not involved in the formulation of the screening recommendations. In conclusion, although several guidelines make recommendations for cancer screening in SOTRs, the availability of cancer screening recommendations varied considerably by transplanted organ. More studies are required to inform cancer screening recommendations in SOTRs, and guideline development should involve transplant patients, oncologists and cancer screening specialists. IntroductionMalignancy is a leading cause of death among solid organ transplant recipients (SOTRs) (1-3). Transplant recipients are known to be at a higher risk of developing and dying of cancer compared to the general population (4-7), and malignancies that develop in SOTRs are challenging to treat and have worse prognosis (8-11). Although early cancer diagnosis may improve cancer outcomes in this population, the reduced life expectancy and multiple comorbidities that exist in SOTRs make cancer screening controversial (12)(13)(14)(15)(16)(17)(18). No randomized controlled screening trials have been performed in SOTRs, and the performance of screening tests in this population is largely unknown (12).Clinical practice guidelines (CPGs) provide valuable tools for evidence-based medicine by reviewing current research and creating recommendations based on 19). Given the limited available evidence for cancer screening in SOTRs, most recommendations generally parallel the guidelines available for the general population. A number of CPGs for long-term care of SOTRs issued by transplant organizations include various cancer screening recommendations; however, the quality of these guidelines, consistency of the recommendations and supporting evidence are unknown. The purposes of this systematic review were to identify and assess the quality and consistency of cancer screening recommendations in CPGs for long-term care of SOTRs and to summarize evidence supporting these recommendations. 103© Copyright...

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