Aim
The European Commission (EC) initiatives on breast, cervical, colorectal, gastric, lung and prostate cancers provide concrete instruments to help healthcare professionals, patients and policy makers in ensuring high-quality screening and follow up. Under these initiatives, the most up-to-date evidence-based recommendations on prevention, screening and diagnosis together with quality assurance schemes for healthcare settings are made available.
The EC initiatives develop evidence-based, Europe-wide guidance and standards for high-quality cancer care designed to support equitable access to evidence-based care across Europe, regardless of where people live or receive treatment. By promoting consistent, high-quality approaches based on the latest scientific evidence, these initiatives seek to reduce inequalities in cancer care, thereby contributing to reduce the burden of cancer and improve outcomes.
Description
The European cancer guidelines are a collection of recommendations on prevention, screening and diagnosis of the six most common cancer sites which are informed by the most current and best available evidence. They leverage pioneering methodological innovations in guideline development that enable more rigorous, transparent and standardised evidence evaluation and decision-making.
Specifically, the European cancer guidelines are developed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and its Evidence to Decision (EtD) framework. This internationally recognised, structured, and transparent process supports the rating of the quality of the evidence and the strength of recommendations, thereby facilitating the development of recommendations based on the best available research evidence. The GRADE EtD framework is applied using the online GRADEpro Guideline Development Tool (GRADEpro GDT).
Approach
The guideline recommendations are developed by the respective European Commission initiative working group, whose members include healthcare professionals, epidemiologists, guideline developers, and patients and/or caregivers. The working group’s decisions rely on structured input from topic-specific groups of experts in collaboration with an independent evidence-review team, and on feedback from experts at large via public consultations at multiple stages of the process.
This standardised, transparent process consists of the following essential steps:
The working group prioritises a set of healthcare questions from a broader list, including questions retrieved from existing cancer-specific guidelines. The questions are posed using the globally recognised PICO format (population, intervention, comparison, outcome), used in evidence-based healthcare.
Selected example of a potential healthcare question: Should organised mammography screening programme vs. an opportunistic or non-organised mammography screening programme be used for early detection of breast cancer in asymptomatic women?
- Topic-specific groups, composed of experts from the EC initiative working group and the respective expert pool, are created and tasked to address specific prioritised healthcare questions, beginning with reaching an agreement of protocols for the systematic reviews.
- An external and independent evidence-review team, with specific expertise in the field, conducts systematic reviews for each healthcare question.
- The topic-specific groups evaluate the quality of the evidence retrieved and use the GRADE EtD framework to reach consensus on the recommendations to propose to the working group, including the strength of each. The GRADE EtD framework systematically assesses 12 criteria, including the balance between desirable and undesirable effects, the certainty of the evidence, people’s values, cost-effectiveness and feasibility.
- As part of the monitoring and evaluation of recommendations that are issued, the topic-specific groups identify and assess candidate quality indicators linked to steps in the care pathway, against three criteria: scientific soundness, responsiveness and feasibility. The quality indicators determined to be scientifically sound, responsive and feasible are proposed to the working group to be considered for inclusion in the European quality assurance scheme for cancer services.
- The respective EC initiative working group makes the final judgement on the EtD frameworks based on the proposals coming from the topic-specific groups.
- If a recommendation is not adequate for a formal certainty of evidence rating according to GRADE, a good practice statement may be developed.
- Recommendations are updated as new evidence becomes available, following a regular and systematic updating process.
Implementation
Healthcare authorities and professionals can adopt the European cancer guidelines as formulated or adapt them to their local context. All information, including underpinning systematic reviews are publicly accessible.
Abbreviations
- EC: European Commission
- EtD: Evidence to Decision
- GRADE: Grading of Recommendations Assessment, Development and Evaluation
- PICO: Population, Intervention, Comparator, Outcome
Descriptions of the methodology for the development of European quality assurance schemes developed under the umbrella of the EC initiatives of cancer screening and care are accessible for the initiatives on breast, cervical, and colorectal cancer.