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Guidelines in Cardio-Oncology: The Balance Between Evidence and Expert Opinion

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Abstract

Purpose of review

While expert opinion is an important tool in the development of clinical practice guidelines (CPGs), it must be used judiciously and balanced with the available evidence. In this review, we carefully examine the role of balancing evidence and expert opinion in the context of the 2022 European Society of Cardiology (ESC) Cardio-Oncology guidelines, including the factors that influence the weight given to expert opinion and potential impact on health care systems adhering to specific guideline recommendations.

Recent findings

In an attempt to be all-encompassing, the 2022 ESC guidelines risk diluting important recommendations with low-quality recommendations lacking consensus. Adherence to, as well as deviation from, guidelines may have important unintended consequences to stakeholders.

Summary

The 2022 ESC guidelines should be viewed as a catalyst for the cardio-oncology community to generate higher quality evidence to address existing gaps in knowledge while also recognizing the current constraints in providing care to patients with cancer.

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Acknowledgements

All authors contributed significantly to the preparation of the manuscript. Writing original draft and literature review: DL. Critical appraisal, review and editing: RC, EM, EC, WG, MA, and RK.

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Authors and Affiliations

  1. Division of Cardiology, University of Washington Medical Center, Seattle, WA, 98195, USA

    Douglas J. Leedy MD, Marta Alhama-Belotto MD, Ruchi Kapoor MD, PhD, Elina Minami MD & Richard K. Cheng MD, MSc

  2. Division of Medical Oncology, University of Washington Medical Center, Seattle, WA, USA

    William R. Gwin III MD

  3. Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Eric J. Chow MD, MPH

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Correspondence to Douglas J. Leedy MD.

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Dr. Eric J. Chow reports grants from Abbot Laboratories, outside of the submitted work. Douglas J. Leedy declares that he has no conflict of interest. Marta Alhama-Belotto declares that she has no conflict of interest. William R Gwin III declares that he has no conflict of interest. Ruchi Kapoor declares that she has no conflict of interest. Elina Minami declares that she has no conflict of interest. Richard K. Cheng declares that he has no conflict of interest.

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Leedy, D.J., Alhama-Belotto, M., Gwin, W.R. et al. Guidelines in Cardio-Oncology: The Balance Between Evidence and Expert Opinion. Curr Treat Options Cardio Med 25, 639–654 (2023). https://doi.org/10.1007/s11936-023-01014-2

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