Many organizations develop guidelines for the prevention, diagnosis, and treatment of cancer (prostate cancer included). And the differences between these guidelines can be striking and controversial … depending on who participates in the process of guideline development, who is writing them, how decisions are made, and who has additional input as expert third parties.
The American Cancer Society (ACS) has traditionally developed their guidelines based on a process of evidence review by specialists in cancer management (medical oncologists and other relevant specialists, such as urologists and radiation oncologists in the case of prostate cancer). However, they are about to adopt a radically different model, described in detail a new article in the Journal of the American Medical Association. Additional information is available in a media release from the ACS and in an article on the Reuters web site.
The new process proposed by the ACS is very different. It will eliminate all specialists (who have inevitable, potential conflicts of interest) from voting on or actually writing all final guidelines. These specialists will still be able to offer their views and their input to the process, but they will not be able to actually decide or otherwise determine the content of actual guidelines … because the guidelines will be written by “generalists” — primary care physicians, public health physicans, etc., who have no personal “skin in the game” when it comes to the treatment of patients. Each guidelines committee will also include at least one patient advocate … who will hopefully be someone who is truly committed to objectivity and is not selected because of his or her “political” importance and associations (a common problem with the selection of patient representatives on national committees).
The available information is explicit that the new process is intended to be highly transparent, and is based on a set of processes laid out in a report from the Institute of Medicine, published in March this year.
It is going to be extremely interesting to compare the recommendations of guidelines developed by this new process with the historic guidelines on prostate cancer issued by the ACS as well as those issued by other organizations (the National Institutes of Health, the National Comprehensive Cancer Network, and the American Urological Association being the prime examples in the case of prostate cancer). Quite when the ACS will get around to issuing its first guidelines on prostate cancer using this process has yet to be clarified. However, The “New” Prostate Cancer InfoLink suspects they are going to be very different from anything we are used to seeing from any of the historic guideline-setting organizations. For starters, I don’t think a guideline developed by this process will use the words “gold standard” for any currently available form of treatment of localized prostate cancer!
We can hardly wait to see what comes out of this process! And of course even with such new guidelines in place, the willingness of members of the specialist treatment community to abide by such guidelines could also be open to considerable question.