Oncology guidelines usage in a low and middle-income country.

Abstract

e18211 Background: Healthcare providers often rely on clinical practice guidelines to help inform and optimize patient care. However, most of these guidelines are from reputable organizations that are based in developed countries. There is a paucity of data about the status of guidelines in low and middle-income countries (LMIC), specifically in terms of their availability, usage and quality. Objective: To determine utilization of oncology guideline and potential barriers to usage in a LMIC among clinical and radiation oncologist (RADONCS) Methods: A cross-sectional survey was conducted with the use of an online questionnaire that was administered to practicing RADONCS in Nigeria via the Association’s email and social media database. In addition, paper questionnaires were administered in person at regional clinical meetings. Results: Survey response rate was 53.4% in a sample of 101 RADONCS from the database. Sixty-nine percent of respondents were consultants and 30% were residents. About 17% had greater than ten years’ experience managing cancer patients, while 43% had less than five years’ experience. All of the respondents are involved in the chemotherapy administration while only about half are involved in the screening and diagnosis of cancer patients. Ninety-three percent report using guidelines in managing patients and the top 3 guidelines used were National Comprehensive Cancer Network (90%), American Society of Clinical Oncology (50%) and European Society of Medical Oncology (46%). The major three barriers to guideline utilization were inadequate facilities for proper guideline implementation, the guideline is not applicable to setting and information in guideline is overwhelming. Potential facilitators include providing adequate facilities, developing local guidelines and increase awareness on the use of guidelines. Almost all respondents are in favour of using guidelines that are adapted to their practice setting. Conclusions: Our study shows that clinicians involved in the management of cancer patients in a LMIC are aware of cancer treatment guidelines. However, issues like inadequate facilities, inapplicability of guideline to local setting and complexity of information in guidelines hinder their usage.

Pharmaceutical payments to certified oncology specialists in Japan in 2016: a retrospective observational cross-sectional analysis

“…It did not include payments related to meals, transportation and accommodation, stock ownership, investment interest or payments from medical device companies, as is complied in the US’s Open Payments Data 30. The CPG authors strongly influence oncology practice, both in the USA and internationally32 by recommending treatment algorithms. They may well be identified as prime targets for representatives of pharma attempting to promote the sale of their anticancer products.…”

Clinicians’ attitudes and perceived barriers and facilitators to cancer treatment clinical practice guideline adherence: a systematic review of qualitative and quantitative literature

“…The 15 included studies comprised three interviewbased qualitative studies [53][54][55], two studies that utilized qualitative and quantitative methods, and presented results of each method separately [53,56], and 11 quantitative studies all using surveys [15,[57][58][59][60][61][62][63][64][65][66]. Most studies were from Australia (n = 5) [58,59,61,65,66] or Canada (n = 4) [15,54,56,57].…”

“…Three studies were published in the 1990s [59,62,65], two in the 2000s [15,61], and ten from 2010 to 2019 [53-58, 60, 63, 64, 66]. It is also worth noting that only one study focused on CPG implementation in low-and middle-income countries, concluding that while awareness of cancer CPGs was high among clinicians, CPG implementation was limited by inadequate facilities and CPGs that were overly complex and not applicable to the local context [63]. The remaining studies were situated in high income countries (Table 4).…”

NCCN News

“…• Adult Cancer Pain • Antiemesis (nausea and vomiting prevention) )-which were downloaded more than 10 million times across the world in 2018-are already being used by 90% of radiation oncologists in Nigeria, according to a study published in the Journal of Global Oncology on April 11, 2018. 3 But the study also found some clinicians can have difficulty implementing the recommendations due to facility resource limitations. The NCCN Harmonized Guidelines are helping to address that problem by including two tiers of treatment recommendations, which vary depending on access to resources like radiation equipment or laparoscopic surgical tools.…”