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Recommendations for supportive care and best supportive care in NCCN clinical practice guidelines for treatment of cancer: Differences between solid tumor and hematologic malignancy guidelines

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Abstract

Purpose

It is unclear how NCCN guidelines recommend “supportive care” and “best supportive care” in oncology practice. We examined the usage of “supportive care” and “best supportive care” in NCCN guidelines and compared between solid tumor and hematologic malignancy guidelines.

Methods

We reviewed all updated NCCN Guidelines for Treatment of Cancer in October 2019. We documented the frequency of occurrence, definition, and timing of introduction of each term. We compared between solid tumor and hematologic malignancy guidelines.

Results

We identified a total of 37 solid tumor and 16 hematologic guidelines. Thirty-seven (70%) guidelines mentioned “supportive care” and 36 (68%) mentioned “best supportive care.” Hematologic guidelines were significantly more likely than solid tumor guidelines to use the term “supportive care” (median occurrence 19 vs. 2; P = 0.001) and to describe “supportive care” as management of cancer-related complications (N = 11/15, 73% vs. N = 2/22, 9%; P < 0.001). Domains of specialist palliative care were infrequently mentioned (N = 10/37, 27%). In contrast, solid tumor guidelines were significantly more likely than hematologic guidelines to mention “best supportive care” (median occurrence 6 vs. 0; P = 0.016). This term was rarely defined and mostly used in the advanced disease setting.

Conclusion

“Supportive care” and “best supportive care” were frequently used in NCCN guidelines, with significant variations in usage between solid tumor and hematologic oncologists. “Supportive care” was mostly limited to management of cancer-related complications and treatment adverse effects in NCCN guidelines, highlighting the need to go beyond the traditional biomedical model to more a patient-centered care model with greater integration of palliative care.

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Funding

This work was supported in part by National Institutes of Health (NIH) / National Cancer Institute grants (R01CA214960‐01A1; R01CA225701‐01A1; R01CA231471-01A1 to D.H.) and a National Institute of Nursing Research grant (1R21NR016736‐01 to D.H.). This work was also supported in part by a National Institutes of Health Cancer Center Support grant (P30CA016672 to D.U.).

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Authors and Affiliations

  1. Department of Palliative Care, Rehabilitation, and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, FCT5.6046, 1515 Holcombe, Houston, TX, 77030, USA

    Li Mo, Eduardo Bruera & David Hui

  2. The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Li Mo

  3. Department of Biostatistics, University of Texas M.D. Anderson Cancer Center, Houston, TX, 77030, USA

    Diana L. Urbauer

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  1. Li Mo
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  2. Diana L. Urbauer
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  3. Eduardo Bruera
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  4. David Hui
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Contributions

Study concept and design: David Hui and Li Mo. Data acquisition/analysis and interpretation: all authors. Manuscript preparation/critical revision for important intellectual content: David Hui and Li Mo. Final approval: all authors.

Corresponding author

Correspondence to David Hui.

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The Institutional Review Board at MD Anderson Cancer Center reviewed the protocol and provided approval to proceed without the need for full committee review.

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Mo, L., Urbauer, D.L., Bruera, E. et al. Recommendations for supportive care and best supportive care in NCCN clinical practice guidelines for treatment of cancer: Differences between solid tumor and hematologic malignancy guidelines. Support Care Cancer 29, 7385–7392 (2021). https://doi.org/10.1007/s00520-021-06245-2

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  • DOI: https://doi.org/10.1007/s00520-021-06245-2

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