Skip to main content

Advertisement

SpringerLink
Log in

European clinical practice guidelines on the use of chemotherapy for advanced oesophageal and gastric cancers: a critical review using the AGREE II and the AGREE-REX instruments

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Purpose

To assess the methodological quality of all relevant and recent European clinical practice guidelines (CPGs) for advanced oesophageal and gastric cancers, and to synthesise their recommendations on the use of chemotherapy.

Methods

We searched PubMed, EMBASE, guidelines repositories, and other sources from 2010 onwards. We appraised quality using AGREE-II and AGREE-REX.

Results

11 CPGs were included (five high, five low, and one moderate quality). Most guidelines showed deficiencies in the domain “applicability”, with only three scoring above 60%. Nine did not report having sought the views and preferences of the target population. The lowest scores for AGREE-REX were item Values and Preferences of Target Users (1.6; SD 1.3), and item Values and Preferences of Policy/Decision-Makers (1.8; SD 1.7). The domain Clinical Applicability got the highest score and the domain Implementability got the lowest.

Conclusions

An urgent area of research is how to develop credible and implementable recommendations on the clinical use of CT for advanced oesophageal and gastric cancer. Systematic review registration: PROSPERO (CRD42021236753).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bettio M, Carvalho RN, Dimitrova N, Dyba T. Measuring the cancer burden in Europe: The European Cancer Information System (ECIS). Ann Oncol. 2019;30:v675.

    Article  Google Scholar 

  2. Hofmarcher T, Lindgren P. The cost of cancers of the digestive system in Europe. https://digestivecancers.eu/wp-content/uploads/2020/10/IHE_DiCE_HealthEcoStudy_2020.pdf. Accessed 9 Aug 2021.

  3. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  4. Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol. 2013;19:5598–606.

    Article  Google Scholar 

  5. Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.

    Article  Google Scholar 

  6. SEER Cancer Statistics Review, 1975–2018. https://seer.cancer.gov/csr/1975_2018/index.html. Accessed 9 Aug 2021.

  7. Gavin AT, Francisci S, Foschi R, Donnelly DW, Lemmens V, Brenner H, Anderson LA, EUROCARE-4 Working Group. Oesophageal cancer survival in Europe: a EUROCARE-4 study. Cancer Epidemiol. 2012;36:505–12.

    Article  CAS  Google Scholar 

  8. Schleicher SM, Bach PB, Matsoukas K, Korenstein D. Medication overuse in oncology: current trends and future implications for patients and society. Lancet Oncol. 2018;19:e200–8.

    Article  Google Scholar 

  9. Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, Nagpal S, Saini V, Srivastava D, Chalmers K, et al. Evidence for overuse of medical services around the world. Lancet. 2017;390:156–68.

    Article  Google Scholar 

  10. Santero M, Pérez-Bracchiglione J, Acosta-Dighero R, Meade AG, Antequera A, Auladell-Rispau A, Quintana MJ, Requeijo C, Rodríguez-Grijalva G, Salas-Gama K, et al. Efficacy of systemic oncological treatments in patients with advanced esophageal or gastric cancers at high risk of dying in the middle and short term: an overview of systematic reviews. BMC Cancer. 2021;21:712.

    Article  CAS  Google Scholar 

  11. Alonso-Coello P, Irfan A, Sola I, Gich I, Delgado-Noguera M, Rigau D, Tort S, Bonfill X, Burgers J, Schunemann H. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. BMJ Qual Saf. 2010;19:e58–e58. https://doi.org/10.1136/qshc.2010.042077.

    Article  Google Scholar 

  12. Johnston A, Kelly SE, Hsieh S-C, Skidmore B, Wells GA. Systematic reviews of clinical practice guidelines: a methodological guide. J Clin Epidemiol. 2019;108:64–76.

    Article  Google Scholar 

  13. Brouwers MC, Kerkvliet K, Spithoff K. The AGREE Reporting Checklist: a tool to improve reporting of clinical practice guidelines. BMJ. 2016;352:i1152.

    Article  Google Scholar 

  14. Iturrioz RR, Gutiérrez-Ibarluzea I, Batarrita JA, Puerto MAN, Domínguez AR, León IM, de la Blanca EBP. Valoración de escalas y criterios para la evaluación de guías de práctica clínica. Rev Esp Salud Publica. 2004. https://doi.org/10.1590/s1135-57272004000400004.

    Article  Google Scholar 

  15. Zeng X, Zhang Y, Kwong JSW, Zhang C, Li S, Sun F, Niu Y, Du L. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid Based Med. 2015;8:2–10.

    Article  Google Scholar 

  16. Dans AL, Dans LF. Appraising a tool for guideline appraisal (the AGREE II instrument). J Clin Epidemiol. 2010;63:1281–2.

    Article  Google Scholar 

  17. Vlayen J, Aertgeerts B, Hannes K, Sermeus W, Ramaekers D. A systematic review of appraisal tools for clinical practice guidelines: multiple similarities and one common deficit. Int J Qual Health Care. 2005;17:235–42.

    Article  Google Scholar 

  18. Brouwers MC, Spithoff K, Kerkvliet K, Alonso-Coello P, Burgers J, Cluzeau F, Férvers B, Graham I, Grimshaw J, Hanna S, et al. Development and validation of a tool to assess the quality of clinical practice guideline recommendations. JAMA Netw Open. 2020;3: e205535.

    Article  Google Scholar 

  19. Yepes-Nuñez JJ, Urrútia G, Romero-García M, Alonso-Fernández S. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología. 2021. https://www.sciencedirect.com/science/article/pii/S0300893221002748.

  20. Santero M, Melendi SE, Gonzalez L, Acosta-Dighero R, Solà I, Meade A-G, Quintana MJ, Urrutia G, Bonfill X. Paper 1: Clinical practice guidelines on the use of chemotherapy for nonintestinal digestive advanced cancer in Europe: a critical appraisal using the AGREE II instrument. 2021. https://osf.io/dq3ay/. Accessed 26 Jul 2021.

  21. Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E. Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice G. Washington: Clinical Practice Guidelines We Can Trust. National Academies Press (US) Copyright; 2011.

    Google Scholar 

  22. Veritas Health Innovation. Covidence systematic review software. https://www.covidence.org/. Accessed 9 Aug 2021.

  23. Makarski J, Brouwers MC. The AGREE Enterprise: a decade of advancing clinical practice guidelines. Implement Sci. 2014. https://doi.org/10.1186/s13012-014-0103-2.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86:420–8.

    Article  CAS  Google Scholar 

  25. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychol Methods. 1996;1:30–46. https://doi.org/10.1037/1082-989x.1.1.30.

    Article  Google Scholar 

  26. R Core Team. R: A language and environment for statistical computing. 2021. www.r-project.org.

  27. Lordick F, Mariette C, Haustermans K, Obermannová R, Arnold D, ESMO Guidelines Committee. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:v50–7.

    Article  CAS  Google Scholar 

  28. Stahl M, Mariette C, Haustermans K, Cervantes A, Arnold D, ESMO Guidelines Working Group. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):51–6.

    Article  Google Scholar 

  29. Stahl M, Budach W, Meyer H-J, Cervantes A, ESMO Guidelines Working Group. Esophageal cancer: Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v46–9.

    Article  Google Scholar 

  30. Committee NCE, Others. Diagnosis, staging and treatment of patients with oesophageal or oesophagogastric junction cancer: National Clinical Guideline No. 19: Summary. https://www.lenus.ie/bitstream/handle/10147/626876/3f3d0e24578b43279e31ffac30193cb7.pdf?sequence=1.

  31. Martin-Richard M, Díaz Beveridge R, Arrazubi V, Alsina M, Galan Guzmán M, Custodio AB, Gómez C, Muñoz FL, Pazo R, Rivera F. SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016). Clin Transl Oncol. 2016;18:1179–86.

    Article  CAS  Google Scholar 

  32. Gallego J, Cervantes A, Pericay C, Isla D. SEOM clinical guidelines for the treatment of oesophageal cancer. Clin Transl Oncol. 2011;13:520–4.

    Article  Google Scholar 

  33. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, ESMO Guidelines Committee. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:v38–49.

    Article  CAS  Google Scholar 

  34. Waddell T, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), European Society of Radiotherapy and Oncology (ESTRO) . Gastric cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24(Suppl 6):vi57-63.

    Article  Google Scholar 

  35. Okines A, Verheij M, Allum W, Cunningham D, Cervantes A, ESMO Guidelines Working Group. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl 5):v50–4.

    Article  Google Scholar 

  36. Zaanan A, Bouché O, Benhaim L, Buecher B, Chapelle N, Dubreuil O, Fares N, Granger V, Lefort C, Gagniere J, et al. Gastric cancer: French intergroup clinical practice guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO). Dig Liver Dis. 2018;50:768–79.

    Article  Google Scholar 

  37. De Manzoni G, Marrelli D, Baiocchi GL, Morgagni P, Saragoni L, Degiuli M, Donini A, Fumagalli U, Mazzei MA, Pacelli F, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastr Cancer. 2017;20:20–30.

    Article  Google Scholar 

  38. Alsina Maqueda M, Boladeras Inglada AM, Bugès Sanchez C, Calvo-Campos M, Canals-Subirats E, Caro-Gallarín M, Creus Costas G, Fort-Casamartina E, Galán Guzmán M, Gilabert-Sotoca M, et al. ICO-ICS Praxi per al tractament mèdic i amb irradiació de càncer gàstric i d’unió esofagogàstrica. 2019. http://hdl.handle.net/11351/6061. Accessed 17 Aug 2021.

  39. Martín-Richard M, Carmona-Bayonas A, Custodio AB, Gallego J, Jiménez-Fonseca P, Reina JJ, Richart P, Rivera F, Alsina M, Sastre J. SEOM clinical guideline for the diagnosis and treatment of gastric cancer (GC) and gastroesophageal junction adenocarcinoma (GEJA) (2019). Clin Transl Oncol. 2020;22:236–44.

    Article  Google Scholar 

  40. Rivera F, Grávalos C, García-Carbonero R, SEOM (Spanish Society of Clinical Oncology). SEOM clinical guidelines for the diagnosis and treatment of gastric adenocarcinoma. Clin Transl Oncol. 2012;14:528–35.

    Article  CAS  Google Scholar 

  41. Lerut T, Stordeur S, Verleye L. Update of the national guideline on upper gastrointestinal cancer-appendix. Good Clinical Practice (GCP). Brussels: Belgian Health Care Knowledge Centre (KCE). 2012. KCE Report 179S. D/2012/10.273/35. https://kce.fgov.be/sites/default/files. 2014.

  42. Allum WH, Blazeby JM, Griffin SM, Cunningham D, Jankowski JA, Wong R, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, the British Society of Gastroenterology and the British Association of Surgical Oncology. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60:1449–72.

    Article  CAS  Google Scholar 

  43. National Institute for Health and Care Excellence (Great Britain). Oesophago-gastric cancer: assessment and management in adults. 2018.

  44. Bauer K, Schroeder M, Porzsolt F, Henne-Bruns D. Comparison of international guidelines on the accompanying therapy for advanced gastric cancer: reasons for the differences. J Gastr Cancer. 2015;15:10–8.

    Article  Google Scholar 

  45. Gärtner FR, Portielje JE, Langendam M, Hairwassers D, Agoritsas T, Gijsen B, Liefers G-J, Pieterse AH, Stiggelbout AM. Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case. BMJ Open. 2019;9: e032483.

    Article  Google Scholar 

  46. Homepage—Digestive Cancer Europe [Internet]. 2020. https://digestivecancers.eu/. Accessed 24 Aug 2021.

  47. Braga S. Why do our patients get chemotherapy until the end of life? Ann Oncol. 2011;22:2345–8.

    Article  CAS  Google Scholar 

  48. Florez ID, Brouwers MC, Kerkvliet K, Spithoff K, Alonso-Coello P, Burgers J, Cluzeau F, Férvers B, Graham I, Grimshaw J, et al. Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation-Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement. Implement Sci. 2020;15:1–8.

    Article  Google Scholar 

  49. Selva A, Sanabria AJ, Pequeño S, Zhang Y, Solà I, Pardo-Hernandez H, Selva C, Schünemann H, Alonso-Coello P. Incorporating patients’ views in guideline development: a systematic review of guidance documents. J Clin Epidemiol. 2017;88:102–12.

    Article  Google Scholar 

  50. Hoffmann-Eßer W, Siering U, Neugebauer EAM, Brockhaus AC, Lampert U, Eikermann M. Guideline appraisal with AGREE II: systematic review of the current evidence on how users handle the 2 overall assessments. PLoS ONE. 2017;12: e0174831.

    Article  Google Scholar 

Download references

Acknowledgements

Marilina Santero is a doctoral candidate for the Ph.D. in Methodology of Biomedical Research and Public Health. Universitat Autònoma de Barcelona, Barcelona, Spain.

Funding

Funding was provided by Instituto de Salud Carlos III (Grant nos. PFIS FI19/00335, PI18/00034).

Author information

Authors and Affiliations

  1. Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/ Sant Antoni Maria Claret N° 167. Pavelló 18, 08025, Barcelona, Spain

    Marilina Santero, Adriana Gabriela Meade, Ivan Solà, Gerard Urrútia, Maria Jesús Quintana & Xavier Bonfill Cosp

  2. Universitat Autònoma Barcelona, Barcelona, Spain

    Marilina Santero, Gerard Urrútia, Maria Jesús Quintana & Xavier Bonfill Cosp

  3. School of Physiotherapy, Faculty of Health Sciences, Universidad San Sebastián, Santiago, Chile

    Roberto Acosta-Dighero

  4. Hospital Prof Dr Rodolfo Rossi, La Plata, Argentina

    Lucas González

  5. Hospital General de Agudos Carlos G. Durand, Buenos Aires, Argentina

    Santiago Melendi

  6. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Ivan Solà, Gerard Urrútia, Maria Jesús Quintana & Xavier Bonfill Cosp

Authors
  1. Marilina Santero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adriana Gabriela Meade
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Acosta-Dighero
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lucas González
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Santiago Melendi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ivan Solà
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gerard Urrútia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Jesús Quintana
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xavier Bonfill Cosp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marilina Santero.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable.  

Informed consent

This is a systematic review article that doesn’t need informed consent or any ethical approvals in its current form.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santero, M., Meade, A., Acosta-Dighero, R. et al. European clinical practice guidelines on the use of chemotherapy for advanced oesophageal and gastric cancers: a critical review using the AGREE II and the AGREE-REX instruments. Clin Transl Oncol 24, 1588–1604 (2022). https://doi.org/10.1007/s12094-022-02807-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-022-02807-w

Keywords

Search

Navigation