Cancer Treatment and Prevention Guidelines Fall Short on Presenting Full Benefits and Harms
Most cancer prevention and screening recommendation statements fail to quantify benefits and harms or present them in an uneven manner, according to a recent study. Such presentation of guidelines might limit both clinicians and patients in making informed decisions.1
To evaluate the presentation of harms and benefits in cancer screening and prevention guidelines, Tanner Caverly, MD, MPH, Health Services Research Fellow, Veterans Affairs Medical Center, the University of Michigan Medical Center, Ann Arbor, and colleagues examined available recommendations. The recommendations were from the United States Preventive Services Task Force, the American Cancer Society, the American College of Physicians, the National Comprehensive Cancer Network, and other guidelines within the National Guidelines Clearinghouse. The evaluation was conducted between November 2013 and January 2014 and was reviewed through July 2015.
Guidelines were rated as comparable when they presented absolute effects for both benefits and harms. Recommendations that were not scored as comparable were scored incomplete or asymmetric. Among 32 guidelines examined, 55 recommendations for interventions to prevent or detect breast, prostate, colon, cervical, or lung cancer were evaluated. Less than one-third (30.9%, n=17) received a comparable rating. Most (54.5%) ratings were asymmetric (n=30), and 8 ratings (14.5%) were incomplete. In total, 69% were not rated as comparable.
“Improved presentation of benefits and harms in guidelines would better ensure that clinicians and patients have access to the information required for making informed decisions,” the authors wrote.
“Clarity about benefits and harms would promote more accurate perceptions about important outcomes and support clinician and patient decision-making regarding whether an intervention is appropriate given the context and the patient's preferences. Although absolute effects are difficult to know precisely, firm recommendations should not be made without guideline developers and clinicians at least estimating how big the absolute benefits and harms are most likely to be.”
1. Caverly TJ, Hayward RA, Reamer E, et al. Presentation of benefits and harms in US cancer screening and prevention guidelines: systematic review [published online ahead of print February 24, 2016]. J Natl Cancer Inst. doi:10.1093/jnci/djv436.