Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Marko Skelin; Bruna Perkov-Stipičin; Sanja Vušković; Marina Šandrk Plehaček; Ane Bašić; David Šarčević; Maja Ilić; Ivan Krečak

doi:10.32604/or.2024.048948

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Oncol Res. 2024 Apr 23;32(5):807-815. doi: 10.32604/or.2024.048948. eCollection 2024.

Authors

Marko Skelin^{1

2

3}, Bruna Perkov-Stipičin¹, Sanja Vušković⁴, Marina Šandrk Plehaček⁵, Ane Bašić⁶, David Šarčević⁷, Maja Ilić⁸, Ivan Krečak^{2

3

9}

Affiliations

¹ Pharmacy Department, General Hospital of Šibenik-Knin County, Šibenik, Croatia.
² Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
³ Undergraduate Study in Nursing, University of Applied Sciences, Šibenik, Croatia.
⁴ Department of Oncology, University Hospital Center Zagreb, Zagreb, Croatia.
⁵ Pharmacies Joukhadar, Sveta Nedelja, Croatia.
⁶ Pharmacies Prima Pharme, Zagreb, Croatia.
⁷ Pharmacy Department, General Hospital Zadar, Zadar, Croatia.
⁸ Pharmacy Department, General Hospital Pula, Pula, Croatia.
⁹ Department of Internal Medicine, General Hospital of Šibenik-Knin County, Šibenik, Croatia.

Abstract

Background: The European Society for Medical Oncology (ESMO) guidelines are among the most comprehensive and widely used clinical practice guidelines (CPGs) globally. However, the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated. This study assessed ESMO CPG levels of evidence (LOE) and grades of recommendations (GOR), as well as their trends over time across various cancer settings.

Methods: We manually extracted every recommendation with the Infectious Diseases Society of America (IDSA) classification from each CPG. We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.

Results: Among the 1,823 recommendations in the current CPG, 30% were classified as LOE I, and 43% were classified as GOR A. Overall, there was a slight decrease in LOE I (-2%) and an increase in the proportion of GOR A (+1%) in the current CPG compared to previous versions. The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials (LOE I-II) shows a decrease (71% vs. 63%, p = 0.009) while recommendations based on lower levels of evidence (LOE III-V) show an increase (29% vs. 37%, p = 0.01) between previous and current version. In the current versions, the highest proportion of LOE I (42%) was found in recommendations related to pharmacotherapy, while the highest proportion of GOR A recommendations was found in the areas of pathology (50%) and diagnostic (50%) recommendations. Significant variability in LOE I and GOR A recommendations and their changes over time was observed across different cancer types.

Conclusion: One-third of the current ESMO CPG recommendations are supported by the highest level of evidence. More well-designed randomized clinical trials are needed to increase the proportion of LOE I and GOR A recommendations, ultimately leading to improved outcomes for cancer patients.

Keywords: Clinical practice guidelines; ESMO guidelines; Grade of recommendation; Level of evidence.

MeSH terms

Europe
Evidence-Based Medicine / methods
Evidence-Based Medicine / standards
Humans
Medical Oncology* / methods
Medical Oncology* / standards
Neoplasms* / therapy
Practice Guidelines as Topic* / standards
Societies, Medical