Published Ahead of Print on November 12, 2013 as 10.1200/JCO.2013.50.7442
The latest version is at http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2013.50.7442
JOURNAL OF CLINICAL ONCOLOGY
A S C O
S P E C I A L
A R T I C L E
Follow-Up Care, Surveillance Protocol, and Secondary
Prevention Measures for Survivors of Colorectal Cancer:
American Society of Clinical Oncology Clinical Practice
Guideline Endorsement
Jeffrey A. Meyerhardt, Pamela B. Mangu, Patrick J. Flynn, Larissa Korde, Charles L. Loprinzi, Bruce D. Minsky,
Nicholas J. Petrelli, Kim Ryan, Deborah H. Schrag, Sandra L. Wong, and Al B. Benson III
Jeffrey A. Meyerhardt and Deborah H.
Schrag, Dana-Farber Cancer Institute,
Boston, MA; Pamela B. Mangu, American Society of Clinical Oncology; Kim
Ryan, Fight Colorectal Cancer, Alexandria, VA; Patrick J. Flynn, Minnesota
Oncology, Minneapolis; Charles L.
Loprinzi, Mayo Clinic, Rochester, MN;
Larissa Korde, University of Washington, Seattle, WA; Bruce D. Minsky, MD
Anderson Cancer Center, Houston, TX;
Nicholas J. Petrelli, Helen Graham
Cancer Center, Newark, DE; Sandra L.
Wong, University of Michigan Medical
School, Ann Arbor, MI; and Al B.
Benson III, Lurie Comprehensive
Cancer Center, Northwestern University, Chicago, IL.
Published online ahead of print at
www.jco.org on November 12, 2013.
ASCO Clinical Practice Guidelines
Committee approval: April 26, 2013.
Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this
article.
Corresponding author: American Society of Clinical Oncology, 2318 Mill Rd,
Suite 800, Alexandria, VA 22314;
e-mail: guidelines@asco.org.
© 2013 by American Society of Clinical
Oncology
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Purpose
The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing
recent clinical practice guidelines that have been developed by other professional organizations.
Methods
The Cancer Care Ontario (CCO) Guideline on Follow-up Care, Surveillance Protocol, and Secondary
Prevention Measures for Survivors of Colorectal Cancer was reviewed by ASCO for methodologic
rigor and considered for endorsement.
Results
The ASCO Panel concurred with the CCO recommendations and recommended endorsement,
with the addition of several qualifying statements.
Conclusion
Surveillance should be guided by presumed risk of recurrence and functional status of the patient
(important within the first 2 to 4 years). Medical history, physical examination, and carcinoembryonic antigen testing should be performed every 3 to 6 months for 5 years. Patients at higher risk
of recurrence should be considered for testing in the more frequent end of the range. A computed
tomography scan (abdominal and chest) is recommended annually for 3 years, in most cases.
Positron emission tomography scans should not be used for surveillance outside of a clinical trial.
A surveillance colonoscopy should be performed 1 year after the initial surgery and then every 5
years, dictated by the findings of the previous one. If a colonoscopy was not preformed before
diagnosis, it should be done after completion of adjuvant therapy (before 1 year). Secondary
prevention (maintaining a healthy body weight and active lifestyle) is recommended. If a patient is
not a candidate for surgery or systemic therapy because of severe comorbid conditions,
surveillance tests should not be performed. A treatment plan from the specialist should have clear
directions on appropriate follow-up by a nonspecialist.
J Clin Oncol 31. © 2013 by American Society of Clinical Oncology
0732-183X/13/3199-1/$20.00
DOI: 10.1200/JCO.2013.50.7442
R
INTRODUCTION
In 2006, the American Society of Clinical Oncology
(ASCO) Board of Directors approved a policy and a
set of procedures for endorsing clinical practice
guidelines that have been developed by other professional organizations. The goal of the endorsement
policy is to increase the number of high-quality,
ASCO-vetted guidelines available to the ASCO
membership. Endorsement of guidelines will be
considered in selected circumstances, either on request from related professional organizations at the
discretion of the ASCO Clinical Practice Guidelines
Committee (CPGC) or when ASCO seeks to endorse the guideline of another organization in lieu of
undertaking its own guideline on the same topic. Of
note, guidelines considered for endorsement by
ASCO are typically developed from established
guideline development groups and are based on systematic reviews of the literature.
OVERVIEW OF THE ASCO GUIDELINE
ENDORSEMENT PROCESS
The guideline under endorsement consideration is
reviewed and approved by the ASCO CPGC. The
CPGC review includes two parts: methodologic review and content review. The content review is completed by an ASCO Panel (Appendix Table A1,
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1
Meyerhardt et al
online only). The methodologic review is completed by a member of
the CPGC Methodology Subcommittee and/or by ASCO guideline
staff using the Rigour of Development subscale of the Appraisal of
Guidelines for Research and Evaluation II (AGREE II) instrument
(www.agreetrust.org). The Rigour subscale consists of seven items
that assess the quality of the processes used to gather and synthesize the
relevant data and the methods used to formulate the guideline recom-
mendations (Appendix Table A2, online only). In addition to this
methodologic review, ASCO staff conducts literature searches to identify relevant studies and additional systematic reviews, meta-analyses,
and guidelines that have been published since the guideline under
endorsement was completed.
The content review is completed by an ASCO Panel. The Panel
members are asked to complete an eight-item Guideline Endorsement
THE BOTTOM LINE
ASCO endorses the CCO Practice Guideline on Follow-up Care, Surveillance Protocol, and Secondary
Prevention Measures for Survivors of CRC, with qualifying statements
Intervention
● Follow-up, surveillance, and secondary prevention measures for survivors of CRC, stages II and III (not stage I or resected metastatic disease, both of which have minimal data to provide guidance)
Target Audience
● Medical, surgical, and radiation oncologists, primary care providers, and others involved in the delivery of care for CRC survivors
● Patients and family members of patients who have survived CRC
ASCO Key Recommendations
● Surveillance should be guided by presumed risk of recurrence and functional status of patient where early detection would lead to
aggressive treatment including surgery. It is especially important in the first 2 to 4 years, when the risk of recurrence is the greatest.
● A medical history, physical examination, and CEA testing should be performed every 3 to 6 months for 5 years. The frequency of
visits and testing should be driven by the data showing that 80% of recurrences occur in the first 2 to 2.5 years from date of surgery and 95% occur by 5 years. Patients at a higher risk of recurrence should be considered for testing in the more frequent end of
the range.
● Abdominal and chest imaging using a CT scan is recommended annually for 3 years. For high-risk patients, it is reasonable to
consider imaging every 6 to 12 months for the first 3 years. Outside of a clinical trial, PET scans are not recommended
for surveillance.
● For patients with rectal cancer, a pelvic CT is also recommended. Clinician judgment, considering risk status, should be used to
determine the frequency of pelvic scans (eg, annually for 3 to 5 years). For those patients who have not received pelvic radiation, a
rectosigmoidoscopy should be performed every 6 months for 2 to 5 years.
● A surveillance colonoscopy should be performed approximately 1 year after the initial surgery. The frequency of subsequent surveillance colonoscopies should be dictated by the findings of the previous one, but they generally should be performed every 5
years if the findings of the previous one are normal. If a complete colonoscopy was not performed before diagnosis, a colonoscopy
should be done as soon as reasonable after completion of adjuvant therapy and not necessarily at the 1-year time point.
● Any new and persistent or worsening symptoms warrant the consideration of a recurrence.
● Despite the lack of high-quality evidence on secondary prevention in CRC survivors, it is reasonable to counsel patients on maintaining a healthy body weight, being physically active, and eating a healthy diet.
● A treatment plan from the specialist should be sent to the patient’s other providers, particularly the primary care physician, and it
should have clear directions on appropriate follow-up.
● If a patient is not a surgical candidate or a candidate for systemic therapy because of severe comorbid conditions, surveillance tests
should not be performed.
Methods
● The ASCO Panel reviewed methodology employed in the guideline on CRC follow-up, considered results from the AGREE II
review instrument, and considered the guideline content to determine appropriateness for endorsement.
● A literature search was conducted to evaluate new articles published since the CCO search; results were reviewed by the ad
hoc Panel.
A link1 to the CCO guideline can be found at http://www.asco.org/endorsements/CRC/FU or on the CCO Web site at
https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileIdⴝ124839.
2
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ASCO CRC Follow-Up and Surveillance: CCO Guideline Endorsement
Content Review Form (Appendix Table A3, online only) that assesses
the perceived clarity and clinical utility of the recommendations and
the degree to which the recommendations are consistent with the
content reviewers’ interpretation of the available data on the topic in
question. This form was adapted by ASCO from the Cancer Care
Ontario (CCO) Program in Evidence-Based Care (PEBC) Practitioner Feedback instrument. Final review and approval are competed by
the ASCO CPGC after approval by the ASCO Panel.
Disclaimer
The information contained herein, including but not limited to
clinical practice guidelines and other guidance, is based on the best
available evidence at the time of creation and is provided by ASCO to
assist providers in clinical decision making. The information should
not be relied on as being complete or accurate, nor should it be
considered as inclusive of all proper treatments or methods of care or
as a statement of the standard of care. With the rapid development of
scientific knowledge, new evidence may emerge between the time
information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent
evidence. The information address only the topics specifically identified therein and is not applicable to other interventions, diseases, or
stages of diseases. This information does not mandate any particular
product or course of medical treatment. Furthermore, the information is not intended to substitute for the independent professional
judgment of the treating provider, because the information does not
account for individual variation among patients. Recommendations
reflect high, moderate, or low confidence that the recommendation
reflects the net effect of a given course of action. The use of words like
must, must not, should, and should not indicate that a course of action
is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other
courses of action in certain cases. In all cases, the selected course of
action should be considered by the treating provider in the context of
treating the individual patient. Use of the information is voluntary.
ASCO provides this information on an as-is basis and makes no
warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a
particular use or purpose. ASCO assumes no responsibility for any
injury or damage to persons or property arising out of or related to any
use of this information or for any errors or omissions.
Guidelines and Conflicts of Interest
The ASCO Panel was assembled in accordance with ASCO Conflicts of Interest Management Procedures for Clinical Practice Guidelines (ASCO procedures are summarized at http://www.asco.org/
rwc). Members of the Panel completed the ASCO disclosure form,
which requires disclosure of financial and other interests that are
relevant to the subject matter of the guideline, including relationships
with commercial entities that are reasonably likely to experience direct
regulatory or commercial impact as the result of promulgation of the
guideline. Categories for disclosure include employment relationships, consulting arrangements, stock ownership, honoraria, research
funding, and expert testimony. In accordance with the procedures, the
majority of the members of the ASCO Panel did not disclose any such
relationships.
www.jco.org
CCO PRACTICE GUIDELINE ON FOLLOW-UP CARE,
SURVEILLANCE PROTOCOL, AND SECONDARY PREVENTION
MEAUSRES FOR SURVIVIORS OF COLORECTAL CANCER
CCO Guideline Clinical Questions, Target Population,
and Intended Users
The CCO guideline1 addresses five clinical questions that are
addressed in this ASCO Endorsement and one question (No. 6) that
was specific to Ontario, Canada.
1. Which evaluations (eg, colonoscopy, computed tomography
[CT], carcinoembryonic antigen [CEA], liver function, complete blood count [CBC], chest x-ray, history, and physical
examination) should be performed for surveillance for recurrence of cancer?
2. What is a reasonable frequency of these evaluations
for surveillance?
3. Which symptoms and/or signs potentially signify a recurrence of CRC and warrant investigation?
4. What are the common and/or significant long-term and late
effects of CRC treatment?
5. On what secondary prevention measures should CRC survivors be counseled?
6. Are there preferred models of follow-up care in Ontario, ie,
should patient follow-up be done by a medical oncologist,
radiation oncologist, surgeon, advanced practice nurse, physician assistant, or primary care provider (eg, family physician, nurse practitioner, family practice nurse)? (for Ontario,
Canada; not applicable for ASCO)
The target population included CRC survivors (adult patients
who have completed primary treatment for stage II or III CRC and
who are without evidence of disease). Whether these recommendations are extrapolated to stage I patients (ASCO note: or a patient with
metastatic CRC who underwent metastatectomy and is currently
without evidence of disease, because there are few to no data for
surveillance in these groups) is left to the discretion of the health care
provider. Intended users are:
1. Clinicians (eg, medical oncologist, radiation oncologist,
surgeon, advanced practice nurse, physician assistant, primary care provider [family physician, nurse practitioner,
family practice nurse]) involved in the delivery of care for
CRC survivors
2. Patients and families of patients who have survived CRC
3. Health care organizations and system leaders responsible
for offering, monitoring, or providing resources for CRC
survivorship protocols
(Section reprinted with permission. © Cancer Care Ontario. All
rights reserved.)
SUMMARY OF CCO GUIDELINE DEVELOPMENT METHODOLOGY
The CCO guideline was developed under the auspices of the CCO
PEBC by a guideline development group convened in partnership
with CCO’s Survivorship Programs, including clinical experts and
methodologists. The literature search included MEDLINE, EMBASE,
and the Cochrane Database of Systematic Reviews and a search on the
Internet for guidelines relevant to the research questions (using the
PEBC preferred list of guideline developers and guideline directories
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3
Meyerhardt et al
of Canadian and international health organizations, including the
National Guidelines Clearinghouse). The literature search spanned
from 2000 to June 2012. The ASCO Panel conducted an updated
search through March 2013 and found no additional guidelines relevant to the CCO research questions.
To summarize, the CCO Guideline identified 11 clinical practice
guidelines (Table 2 in CCO Guideline; ASCO Data Supplement 1) on
follow-up protocols for CRC survivors to inform recommendations
for their research questions No. 1 to 5. AGREE II evaluations were
reported for the 11 included guidelines, and the scores for each of the
evaluations across different domains are summarized in the CCO
Guideline. The ASCO clinical authors confirmed that these guidelines
are still valid and in use by clinicians.
The recommendations from each of the identified guidelines
are consistent across all the guidelines. The consensus of the CCO
Colorectal Cancer Survivorship Working Group was that all the
included guidelines were of sufficient quality to inform the development of Ontario-specific recommendations (Table 3 in CCO
Guideline; ASCO Data Supplement 2). PEBC, ASCO, Cancer
Council Australia, Australian Cancer Network, New Zealand
Guidelines Group, and National Comprehensive Cancer Network
practice guidelines were considered to be of higher quality or of
greater relevance than those remaining.2-5,7-12
Links to the CCO search terms and quorum diagram are provided in Data Supplements 3 and 4, respectively, as are details of an
updated ASCO search about positron emission tomography (PET)
scans for surveillance.
On the basis of the available evidence and expert opinion, the
CCO Working Group made recommendations for adult patients who
have completed primary treatment for stage II or III CRC and who are
without evidence of disease. The conclusions of CCO Guideline are
provided in Data Supplement 5. More detailed recommendations
with key evidence and qualifying statements are found in the
CCO Guideline.
searched from June 2012 to March 2013. The CCO inclusion criteria
were applied to the review of the literature search results. The updated
search yielded no new publications that satisfied the CCO inclusion criteria.
RESULTS OF THE ASCO CONTENT REVIEW
The ASCO Panel reviewed the guideline in question and concurs that
the recommendations are clear, thorough, and based on the most
relevant scientific evidence in this content area and that they present
options that will be acceptable to patients. Overall, the ASCO Panel
agrees with the recommendations as stated in the CCO Guideline,
with the qualification that ongoing research studies may alter the
recommendations. Of note, the CCO Guideline does not include
explicit recommendations for follow-up care, surveillance protocol,
or secondary prevention measures for survivors of stage I CRC; recommendations for follow-up on chemotherapy-induced peripheral
neuropathy; or targeted recommendation for patients with high-risk
hereditary syndromes. Therefore, these issues are not addressed in the
ASCO endorsement.
DISCUSSION
The ASCO Panel wants to highlight that the CCO recommendations
are primarily for patients with stage II or III cancer. There are insufficient data to provide guidance for follow-up for stage I patients or
patients with resected metastatic disease with no evidence of disease.
The ASCO Panel emphasizes that surveillance tests should only be
performed in patients in whom the results will change treatment
decisions. For example, if a patient is not a surgical candidate or a
candidate for systemic therapy because of severe comorbid conditions, surveillance tests should not be performed.
METHODS AND RESULTS OF THE ASCO UPDATED
LITERATURE SEARCH
Evaluations and Intervals: Medical Examination and
CEA Testing
The ASCO Panel added qualifying statements to the CCO recommendations based on its interpretation of the data presented in the
CCO Systematic Review and Guideline. Surveillance should be guided
by presumed risk of recurrence. This is especially important in the first
2 to 4 years, when the risk of recurrence is the greatest. For patients at
higher risk of recurrence, providers may want to consider more frequent interval testing.13
Although the data are insufficient to make a definitive recommendation about the frequency of CEA testing, the ASCO Panel
asserted that CEA may be checked between the range of 3 to 6 months
in the first 2 years, because 80% of recurrences occur in the first 2 to 2.5
years in patients with a high risk of recurrence. The ASCO Panel noted
that the end date for surveillance is particularly important given the
very high conditional survival rates at 4 to 5 years out from treatment
(curves start to flatten out at 3 years).13
A search for new evidence was conducted by ASCO guideline staff to
identify relevant randomized controlled trials, systematic reviews,
meta-analyses, and guidelines that have been published since the CCO
Guideline was completed. Following the strategies described in the
CCO Guideline, Medline and the Cochrane Library databases were
Imaging
The ASCO Panel concurs that abdominal and chest imaging
using a CT scan is recommended annually for 3 years, in most cases.
But ASCO recommends that clinician judgment be used to determine
the frequency of pelvic scans for high-risk patients (potentially every 6
RESULTS OF THE ASCO METHODOLOGIC REVIEW
The methodologic review of the CCO guideline was completed independently by two ASCO guideline staff members using the Rigour of
Development subscale from the AGREE II instrument, as discussed.
The score for the Rigour of Development domain is calculated by
summing the scores across individual items in the domain and standardizing the total score as a proportion of the maximum possible
score. Detailed results of the scoring for this guideline are available on
request to guidelines@asco.org. Overall, the CCO guideline scored
very high (85%) in terms of methodologic quality, with only minor
deviations from the ideal as reflected in the AGREE II items.
4
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ASCO CRC Follow-Up and Surveillance: CCO Guideline Endorsement
to 12 months). The ASCO Panel agrees that PET scans should not be
used for surveillance outside of the setting of a clinical trial.
An abstract presented at the ASCO 2013 Annual Meeting14 suggests that doing both CT scanning with CEA testing may not make a
difference in overall mortality, although proper evaluation of how to
apply results from this trial will require review of the full manuscript
once published.
Rectal Cancer
If the primary tumor was in the rectum, pelvic CT scans are also
recommended, and the ASCO Panel reiterates that clinician judgment
should be used to determine the frequency of pelvic scans for these
high-risk patients (every 6 to 12 months for 2 to 3 years, then annually
until 5 years from surgery) based on risk. (One member of the ASCO
Panel suggests 5 years of pelvic scans, if the primary tumor was located
in the rectum [v just 3 years in the CCO Guideline]).
The ASCO Panel wants to emphasize a footnote in Table 1 in the
CCO Guideline that states that patients with rectal cancer who have
not received pelvic radiation should receive a rectosigmoidoscopy
every 6 months for 2 to 5 years. The Panel wants to clarify that
colonoscopies should not necessarily be limited to those without radiation, because a T4 or N2 rectal cancer still has a reasonable local
recurrence rate despite optimal total mesorectal excision surgery and
radiation (pre- or postoperatively).15-17
Colonoscopy
The ASCO Panel wants to add a clarification to the CCO recommendation about the timing of follow-up colonoscopies. If a complete
colonoscopy was not performed before diagnosis, a colonoscopy
should be done as soon as is reasonable after completion of adjuvant
therapy and not necessarily at the 1-year time point.
Overuse and Underuse of Follow-Up Testing
The ASCO Panel suggests that the clinician should consider rechecking CEA if the test result is going up or going up and down; in
this case, rechecking is not overuse, because it is not surveillance but
follow-up of abnormal results and appropriate use to test more frequently (Table 5 in CCO Guideline; ASCO Data Supplement 2). The
ASCO Panel also emphasizes that overuse must be considered differently for high-risk versus low-risk patients, so it is better to have some
flexibility in following these patients. Additional testing should not
always be considered overuse.
or institution-based nurse-coordinated care. The Panel wants to emphasize the need to provide the patient and the patient’s other providers, including the primary care physician, a treatment summary as well
as guidance on surveillance schedule.
Secondary Prevention of CRC
There are emerging data on the role of various host factors,
including diet and lifestyle, as secondary prevention for CRC survivors.18,19 While such data are based on prospective, observational
studies and lack confirmation from randomized clinical trials to date,
the Panel agrees with the CCO Guideline for secondary prevention in
CRC survivors. Patients should seek to maintain a healthy body
weight. Survivors should engage in a physically active lifestyle, seeking
to follow the recommendation of the American College of Sports
Medicine to strive to engage in at least 150 minutes a week of
moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week
of vigorous-intensity aerobic physical activity, or an equivalent
combination of moderate- and vigorous-intensity aerobic activity.20 However, any level of activity that the patient can do is
considered better than being physically inactive. Survivors should
be advised to eat a healthy diet. There remains uncertainty regarding regular use of an aspirin21,22 or cyclooxygenase inhibitor and in
which survivors; however, an ongoing randomized clinical trial
(CALGB [Cancer and Leukemia Group B] 80702) is being conducted by the National Cancer Institute cooperative groups on
whether celecoxib will improve outcomes in CRC survivors.23
Other interventions, including vitamin D, also require further
study to help provide guidance for secondary prevention.
ENDORSEMENT RECOMMENDATION
The ASCO Panel and the CPGC have reviewed the CCO Guideline
and endorse the adoption of this guideline, with the minor qualifying
statements above.
AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS
OF INTEREST
The author(s) indicated no potential conflicts of interest.
AUTHOR CONTRIBUTIONS
Communication With Patient’s Other Providers
Emerging evidence suggests that it is a reasonable option for CRC
survivors who have completed all treatment to be discharged from
specialist-led care to community-based family physician– coordinated
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Administrative support: Pamela B. Mangu
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4. Labianca R, Nordlinger B, Beretta GD, et al:
Primary colon cancer: ESMO clinical practice guidelines for diagnosis, adjuvant treatment and followup. Ann Oncol 21:v70-v77, 2010 (suppl 5)
5. National Comprehensive Cancer Network: NCCN
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http://www.health.govt.nz/publication/guidancesurveillance-people-increased-risk-colorectal-cancer
13. Sargent DJ, Patiyil S, Yothers G, et al: End
points for colon cancer adjuvant trials: Observations
and recommendations based on individual patient
data from 20,898 patients enrolled onto 18 randomized trials from the ACCENT Group. J Clin Oncol
25:4569-4574, 2007
14. Mant D, Perera R, Gray A, et al: Effect of 3-5 years
of scheduled CEA and CT follow-up to detect recurrence
of colorectal cancer: FACS randomized controlled trial.
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15. Gunderson LL, Jessup JM, Sargent DJ, et al:
Revised TN categorization for colon cancer based on
national survival outcomes data. J Clin Oncol 28:
264-271, 2010
16. Baxter NN, Hartman LK, Tepper JE, et al:
Postoperative irradiation for rectal cancer increases
the risk of small bowel obstruction after surgery.
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17. Quirke P, Morris E: Reporting colorectal cancer. Histopathology 50:103-112, 2007
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19. Rock CL, Doyle C, Demark-Wahnefried W,
et al: Nutrition and physical activity guidelines for
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20. Schmitz KH, Courneya KS, Matthews C, et al:
American College of Sports Medicine roundtable on
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21. Sandler RS, Halabi S, Baron JA, et al: A
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adenomas in patients with previous colorectal cancer. N Engl J Med 348:883-890, 2003
22. National Cancer Institute: Colorectal cancer prevention: Aspirin. http://www.cancer.gov/cancertopics/
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ASCO CRC Follow-Up and Surveillance: CCO Guideline Endorsement
Acknowledgment
The Panel wishes to thank Alok Khorana, MD, and Yousef Zafar, MD, and the full Clinical Practice Guidelines Committee for their
thoughtful reviews of earlier drafts.
Appendix
Table A1. Members of the ASCO Guideline Panel
Panel Member
Institution
Al B. Benson III, Co-Chair
Jeffrey A. Meyerhardt, Co-Chair
Patrick J. Flynn
Larissa Korde
Charles L. Loprinzi
Bruce D. Minsky
Nicholas J. Petrelli
Kim Ryan
Deborah H. Schrag
Sandra L. Wong
Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
Dana-Farber Institute, Boston, MA
Minnesota Oncology, Minneapolis, MN
University of Washington, Seattle, WA
Mayo Clinic, Rochester, MN
MD Anderson Cancer Center, Houston, TX
Helen Graham Cancer Center, Newark, DE
Fight Colorectal Cancer, Alexandria, VA
Dana-Farber Cancer Institute, Boston, MA
University of Michigan Medical School, Ann Arbor, MI
Abbreviation: ASCO, American Society of Clinical Oncology.
Table A2. Rigour of Development Subscale of the Appraisal of Guidelines for Research and Evaluation II Instrument
Rigor of Development Subscale Item
Systematic methods were used to search for evidence.
The criteria for selecting the evidence are clearly described.
The strengths and limitations of the body of evidence are clearly described.
The methods used for formulating the recommendations are clearly described.
The health benefits, side effects, and risks have been considered in formulating the recommendations.
There is an explicit link between the recommendations and the supporting evidence.
The guideline has been externally reviewed by experts prior to its publication.
A procedure for updating the guideline is provided.
NOTE. Each subscale item is rated on a 7-point scale from 1 (strongly disagree) to 7 (strongly agree). The score for the Rigour of Development domain is calculated
by summing the scores across individual items in the domain and across all raters, subtracting the lowest possible score for that domain (1 ⫻ No. of items ⫻ No.
of raters), then standardizing the total score as a proportion of the maximum possible score (7 ⫻ No. of items ⫻ No. of raters) minus the lowest possible score.
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7
Meyerhardt et al
Table A3. ASCO Guideline Endorsement Content Review Formⴱ
Statement
Strongly Agree
Agree
Neither Agree or Disagree
Disagree
Strongly Disagree
Unsure
The results of the studies described in this
guideline are interpreted according to
my understanding of the data.
The recommendations in this report are
clear.
I agree with the recommendations as stated
in the guideline.
The recommendations are suitable for the
patients for whom they are intended.
The recommendations are too rigid to apply
to individual patients.
When applied, the recommendations will
produce more benefits for patients than
harms.
The guideline presents options that will be
acceptable to patients.
The guideline should be endorsed by ASCO.
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NOTE. This form was adapted from the Cancer Care Ontario Program in Evidence-Based Care Practitioner Feedback instrument.
Abbreviation: ASCO, American Society of Clinical Oncology.
ⴱ
Background and instructions when filling in the form are given as follows: ASCO considers clinical practice guidelines developed by other professional
organizations for endorsement. This is done by ASCO most often in lieu of undertaking its own guideline on the same topic. You have been asked to provide a
content review of a guideline that is under consideration for endorsement by ASCO. Please check the box that best applies for each of the following items. Guideline
title, organization, and reviewer name are also provided.
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© 2013 by American Society of Clinical Oncology
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Copyright © 2013 American Society of Clinical Oncology. All rights reserved.