Buckle Geoffrey C, DeBoer Rebecca, Xu Mary Jue, Mrema Alita, Rubagumya Fidel, Velloza Jennifer, Falade Ayo S, Van Loon Katherine
Division of Hematology/Oncology, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, USA.
Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA.
Cancer. 2025 Jan 1;131(1):e35573. doi: 10.1002/cncr.35573. Epub 2024 Sep 22.
Clinical practice guidelines are widely used in oncology to guide clinical decision making and inform health policy and planning. In recent years, the National Comprehensive Cancer Network and the American Society of Clinical Oncology, as well as other international groups, have developed resource-stratified guidelines to guide clinicians and policymakers on cancer diagnosis and management in settings with various levels of resource constraints. Current methods for developing resource-stratified guidelines rely heavily on supporting evidence originating from high-income countries. In this commentary, the authors discuss limitations of the existing methods to develop resource-stratified guidelines and offer perspective on ways to strengthen the guidelines and their evidence base. Pulling from conceptual frameworks in the health policy domain, the authors outline a more inclusive approach to evidence synthesis that seeks to integrate the growing volume of cancer research emerging from low- and middle-income countries. The authors also introduce a revised evidence framework that provides transparency into the generalizability of evidence within the guidelines. These changes have the potential to enhance resource-stratified guidelines and bring us one step closer to the goal of evidence-based guidelines that are appropriate for diverse settings and unique patient populations across the world.
临床实践指南在肿瘤学中被广泛用于指导临床决策，并为卫生政策和规划提供信息。近年来，美国国立综合癌症网络、美国临床肿瘤学会以及其他国际组织已制定了资源分层指南，以指导临床医生和政策制定者在资源限制程度不同的环境中进行癌症诊断和管理。目前制定资源分层指南的方法严重依赖于来自高收入国家的支持证据。在这篇评论中，作者讨论了现有制定资源分层指南方法的局限性，并就加强指南及其证据基础的方法提供了观点。作者借鉴卫生政策领域的概念框架，概述了一种更具包容性的证据综合方法，该方法旨在整合来自低收入和中等收入国家的越来越多的癌症研究。作者还引入了一个修订后的证据框架，该框架为指南内证据的可推广性提供了透明度。这些变化有可能加强资源分层指南，并使我们离实现适用于世界各地不同环境和独特患者群体的循证指南的目标更近一步。
