Biomedical subjects
National Comprehensive Cancer Network
Publications and source records attributed to National Comprehensive Cancer Network.
Colon cancer clinical practice guidelines in oncology.
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Rectal cancer clinical practice guidelines in oncology.
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Anal canal cancer clinical practice guidelines in oncology.
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Myeloid growth factors clinical practice guidelines in oncology.
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Senior adult oncology clinical practice guidelines in oncology.
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Pancreatic adenocarcinoma: Clinical Practice Guidelines in Oncology.
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Central nervous system cancers: Clinical Practice Guidelines in Oncology.
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Melanoma: treatment guidelines for patients (Part 1).
The mutual goal of the National Comprehensive Cancer Network (NCCN) and the American Cancer Society partnership is to provide patients and the general public with state of the art cancer treatment information in understandable language. This treatment information is based on the professional guidelines developed by the NCCN. It is intended to assist patients in a discussion with their doctor about the treatment that is best for their specific situation. Part I of these guidelines addresses melanoma risk factors, prevention, diagnosis, stages, prevention, and clinical trials. Part II (June 2005) will describe decision trees for evaluation and treatment.
Melanoma: treatment guidelines for patients (part 2).
The mutual goal of the National Comprehensive Cancer Network (NCCN) and the American Cancer Society partnership is to provide patients and the generalpublic with state of the art cancer treatment information in understandable language. This treatment information is based on the professional guidelines developed by the NCCN. It is intended to assist patients in a discussion with their doctor about the treatment that is best for their specific situation. Part I of these guidelines addressed melanoma risk factors, prevention, diagnosis, stages, prevention, and clinical trials (Vol. 17, No 2, pp. 119-131). Part II describes decision trees for evaluation and treatment.
Shifting guidelines for myeloid growth factors: applications in cancer chemotherapy.
Neutropenia is a frequent dose-limiting complication of chemotherapy. Although myeloid growth factors decrease the risk of febrile neutropenia and the resulting complications of hospitalizations, dose delays, and dose reductions, not all patients need or benefit from the prophylactic administration of myeloid growth factors. A recent risk model showed that the predictors of febrile neutropenia include anthracycline use, poor performance status, and low pretreatment blood counts. These predictors may be used in addition to the intensity of the chosen chemotherapy regimen to determine whether a patient warrants primary prophylaxis with myeloid growth factors. The 2005 guidelines of the National Comprehensive Cancer Network call for primary prophylactic use in all patients with a risk of febrile neutropenia above 20%. Other recent studies show that pegylated filgrastim is also effective at preventing febrile neutropenia in patients receiving intermediate- risk chemotherapy.
The 2004 Perugia Antiemetic Consensus Guideline process: methods, procedures, and participants.
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National Comprehensive Cancer Network guidelines for the management of prostate cancer.
Guidelines for the management of prostate cancer issued by the National Comprehensive Cancer Network provide a basis for rational treatment decisions. These guidelines represent consensus recommendations by a panel of experts that are evidence based and are designated according to the degree of consensus within the expert panel. The initial stratification point is the patient's life expectancy (>5 or <5 years). If life expectancy is >5 years, the recommended intervention is based on clinical stage, prostate-specific antigen (PSA) level, and Gleason score, as well as the presence of symptoms. These assessments establish the patient's risk of recurrence after therapy. Specific initial therapies are then recommended according to whether the risk category is low, intermediate, high, or very high. The guidelines also describe the appropriate use of observation ("watchful waiting") versus active intervention in certain patients. After definitive therapy, patients should be monitored with PSA determinations, digital rectal examination, and bone scans, as outlined in the guidelines. Patients who exhibit increasing PSA levels after prostatectomy are candidates for salvage therapy with androgen ablation, radiotherapy, or observation. If PSA levels begin to increase after radiotherapy, surgery may then be an additional option. Systemic salvage therapy generally consists of androgen ablation; the benefit of total androgen blockade versus initial monotherapy remains controversial. Relapse after initial androgen ablation is treated with an antiandrogen, if none had been administered previously. Patients refractory to further hormonal manipulations are observed or receive palliative therapy, including chemotherapy. The treatment of prostate cancer is complex. Optimal treatment is risk-adapted to the specific characteristics of the cancer and the expected longevity and personal preferences of the patient.
NCCN Practice Guidelines for Prostate Cancer.
Systemic therapies for prostate cancer are likely to improve, and as they do, they will have enormous impact on the treatment of high-risk and locally advanced cancers. Further technical improvements in radiotherapy and alternative local modalities, such as cryoablation, are also likely, and will bring even more options for local control. It is certain these guidelines will continue to evolve.
NCCN Practice Guidelines for Cancer Pain.
The overall approach to pain management encompassed in these guidelines is comprehensive. It is based on objective pain assessments, utilizes both pharmacologic and nonpharmacologic interventions, and requires continual reevaluation of the patient. The NCCN Cancer Pain Practice Guidelines Panel believes that cancer pain can be well controlled in the vast majority of patients if the algorithms presented are systematically applied, carefully monitored, and tailored to the needs of the individual patient.
NCCN Practice Guidelines for Cancer-Related Fatigue.
These guidelines propose a treatment algorithm in which patients are evaluated regularly for fatigue, using a brief screening instrument, and are treated as indicated by their fatigue level. The algorithm's goal is to identify and treat all patients with fatigue that causes distress or interferes with daily activities or functioning. Management of fatigue begins with primary oncology team members who perform the initial screening and either provide basic education and counseling or expand the initial screening to a more focused evaluation for moderate or higher levels of fatigue. At this point the patient is assessed for the five primary factors known to be associated with fatigue: pain, emotional distress, sleep disturbance, anemia, and hypothyroidism. If any of these conditions are present, it should be treated according to practice guidelines, and the patient's fatigue should be reevaluated regularly. If none of the primary factors is present or the fatigue is unresolved, a more comprehensive assessment is indicated--with referral to other care providers as appropriate. The comprehensive assessment should include a thorough review of systems, review of medications, assessment of comorbidities, nutritional/metabolic evaluation, and assessment of activity level. Management of fatigue is cause-specific when conditions known to cause fatigue can be identified and treated. When specific causes, such as infection, fluid and electrolyte imbalances, or cardiac dysfunction, cannot be identified and corrected, nonpharmacologic and pharmacologic treatment of the fatigue should be considered. Nonpharmacologic interventions may include a moderate exercise program to improve functional capacity and activity tolerance, restorative therapies to decrease cognitive alterations and improve mood state, and nutritional and sleep interventions for patients with disturbances in eating or sleeping. Pharmacologic therapy may include drugs such as antidepressants for depression or erythropoietin for anemia. A few clinical reports of the use of corticosteroids and psychostimulants suggest the need for further research on these agents as a potential treatment modalities in managing fatigue. Basic to these interventions, the effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients' fatigue levels regularly and systematically and incorporates education and counseling regarding strategies for coping with fatigue (Johnson, 1999), as well as using institutional fatigue management experts for referral of patients with unresolved fatigue.
NCCN Practice Guidelines for Head and Neck Cancers.
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NCCN Practice Guidelines for Colorectal Cancer.
The NCCN Colorectal Cancer Guidelines panel believes that a multidisciplinary approach is necessary for the management of the patient with colorectal cancer. The panel endorses the concept that treatment of patients in a clinical trial has priority over standard or accepted therapy. The recommended surgical procedure for resectable colon cancer is an en bloc resection; laparoscopic surgery should be done only in the context of a clinical trial. For patients with stage III disease, 5-FU-based adjuvant therapy is recommended. A patient who has metastatic disease in the liver or lung should be considered for surgical resection if he or she is a candidate for surgery and if surgery can extend survival. Surgery should be followed by adjuvant chemotherapy. The panel advocates a conservative post-treatment surveillance program for colon and rectal carcinoma patients. Serial CEA determinations are appropriate if the patient is a candidate for aggressive surgical resection, should recurrence be detected. Abdominal and pelvic CT scans should be utilized only when there are clinical indications of possible recurrence. Patients whose disease progresses during 5-FU-based therapy should be treated with irinotecan or encouraged to participate in a phase I or phase II clinical trial.