Skip to main content

Advertisement

SpringerLink
Log in

Treatments for non-small cell lung cancer: a systematic quality assessment of clinical practice guidelines

  • RESEARCH ARTICLE
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Aim

To evaluate the methodological quality of clinical practice guidelines (CPGs) on treatments for non-small cell lung cancer (NSCLC).

Methods

We searched MEDLINE, CPG developer websites, lung cancer societies, and oncology organizations to identify CPGs providing recommendations on treatments for NSCLC. The methodological quality for each CPG was determined independently by three appraisers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument.

Results

Twenty-two CPGs met the eligibility criteria. The median scores per AGREE II domain were: scope and purpose 90.7% (64.8–100%), stakeholder involvement 76.9% (27.8–96.3%); rigor of development 80.9% (27.1–92.4%); clarity of presentation 89.8% (50–100%); applicability 46.5% (12.5–87.5%); and editorial independence 91.7% (27.8–100%). Most of the CPGs (54.5%) were rated as “recommended with modifications” for clinical use.

Conclusions

Overall, the methodological quality of CPGs proving recommendations on the management of NSCLC is moderate, but there is still room for improvement in their development and implementation.

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

Similar content being viewed by others

References

  1. Wild CP, Weiderpass E, Stewart BW. 2020 World Cancer Report: cancer research for cancer development: In Wild CP, Weiderpass E Stewart BW, (eds). International Agency for Research on Cancer. Lyon

  2. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. 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.

    Article  PubMed  Google Scholar 

  3. Malhotra J, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. Eur Respir J. 2016;48:889–902.

    Article  PubMed  Google Scholar 

  4. Wu X, Denise B-B, Zhan F, Zhang J. Determining association between lung cancer mortality worldwide and risk factors using fuzzy inference modeling and random forest modeling. Int J Environ Res Public. 2022. https://doi.org/10.3390/ijerph192114161.

    Article  Google Scholar 

  5. Cortés-Jofré M, Rueda JR, Asenjo-Lobos C, Madrid E, Bonfill CX. Drugs for preventing lung cancer in healthy people. Cochrane Database Syst Rev. 2022. https://doi.org/10.1002/14651858.CD002141.pub3.

    Article  Google Scholar 

  6. Cheng ES, Egger S, Hughes S, Weber M, Steinberg J, Rahman B, et al. Systematic review and meta-analysis of residential radon and lung cancer in never-smokers. Eur Respir Rev. 2021;30:1–14.

    Article  Google Scholar 

  7. Relli V, Trerotola M, Guerra E, Alberti S. 2019 Abandoning the notion of non-small cell lung cancer. Trends Mol Med. 2019;25:585–94.

    Article  PubMed  Google Scholar 

  8. Chansky K, Detterbeck FC, Nicholson AG, Rusch VW, Vallières E, Groome P, et al. The IASLC lung cancer staging project: external validation of the revision of the TNM stage groupings in the of the TNM classification of lung cancer. J Thorac Oncol. 2017;12:1109–21.

    Article  PubMed  Google Scholar 

  9. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics. CA Cancer J Clin. 2023;73:17–48.

    Article  PubMed  Google Scholar 

  10. Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc. 2019;94:1623–40.

    Article  CAS  PubMed  Google Scholar 

  11. Hassan Murad M. Clinical practice guidelines a primer on development and dissemination. Mayo Clin Proc. 2017;92(423):33.

    Google Scholar 

  12. Hollon SD, Teachman BA. Advantages of developing clinical practice guidelines using international standards. Psychotherapy. 2019;56:340–6.

    Article  PubMed  Google Scholar 

  13. McAlister FA, Van Diepen S, Padwal RS, Johnson JA, Majumdar SR. How evidence-based are the recommendations in evidence-based guidelines? PLoS Med. 2007;4:1325–32.

    Article  Google Scholar 

  14. Eikermann M, Holzmann N, Siering U, Rüther A. Tools for assessing the content of guidelines are needed to enable their effective use–a systematic comparison. BMC Res Notes. 2014;7(1):853.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. Development of the AGREE II, part 2: assessment of validity of items and tools to support application. CMAJ. 2010. https://doi.org/10.1503/cmaj.091716.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Alberta Health Services (AHS). Non-small cell lung cancer stage III. Clinical practice guideline LU-003. Alberta. 2012. www.albertahealthservices.ca

  17. Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cáncer american college of chest physicians evidence-based clinical practice guidelines. Chest. 2013. https://doi.org/10.1378/chest.12-2359.

    Article  PubMed  Google Scholar 

  18. Socinski MA, Evans T, Gettinger S, Hensing TA, Van Dam SL, Ireland B, et al. Treatment of stage IV non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: american college of chest physicians evidence-based clinical practice guidelines. Chest. 2013. https://doi.org/10.1378/chest.12-2361.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, et al. Treatment of stage III non-small cell lung cancer: diagnosis and management of lung cáncer american college of chest physicians evidence-based clinical practice guidelines. Chest. 2013. https://doi.org/10.1378/chest.12-2360.

    Article  PubMed  Google Scholar 

  20. Scottish Intercollegiate Guidelines Network (SIGN). Management of lung cancer a national clinical guideline. 2014. www.sign.ac.uk/pdf/sign50eqia.pdf.

  21. Kulkarni S, Vella E, Coakley N, Cheng S, Gregg R, Ung YC, et al. Guideline the use of systemic treatment in the maintenance of patients with non-small cell lung cancer. J Thor Oncol. 2015. https://doi.org/10.1016/j.jtho.2016.03.007.

    Article  Google Scholar 

  22. Álvarez FV, Trueba IM, Sanchis JB, López-Rodó LM, Rodríguez Suárez PM, de Cos Escuín JS, et al. Recommendations of the Spanish society of pneumology and thoracic Surgery on the diagnosis and treatment of non-small-cell lung cancer. Arch Bronconeumol. 2023;52(Suppl 1):2–62.

    Google Scholar 

  23. Ellis PM, Vella ET, Ung YC. Systemic treatment for patients with advanced non-small cell lung cáncer program in evidence-based care guideline version 3. Amsterdam: Elsevier; 2016.

    Google Scholar 

  24. Falkson CB, Vella ET, Yu E, El-Mallah M, Mackenzie R, Ellis PM, et al. Radiotherapy with curative intent in patients with early stage, medically inoperable, non-small cell lung cáncer Program in evidence-based care evidence-based Series. Current Oncol. 2017. https://doi.org/10.3747/co.24.3358.

    Article  Google Scholar 

  25. Instituto Catalan de Oncología. ICOpraxis para el tratamiento médico de cáncer de pulmón de célula no pequeña. ICO. 2016;2:1–125.

    Google Scholar 

  26. Swaminath A, Vella ET, Ramchandar K, Robinson A, Simone C, Sun A, et al. Treatment of patients with stage III (N2 or N3) non-small cell lung cancer. guideline 7–3 version 3 a quality initiative of the program in evidence-based care (PEBC). Cancer Care Ontario. 2017. Available from: http://www.cancercare.on.ca/.

  27. Moeller B, Balagamwala EH, Chen A, Creach KM, Giaccone G, Koshy M, et al. Palliative thoracic radiation therapy for non-small cell lung cancer: 2018 update of an american society for radiation oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol Pract Radiat Oncol. 2018;8:245–50.

    Article  PubMed  Google Scholar 

  28. Majem M, Juan O, Insa A, Reguart N, Trigo JM, Carcereny E, et al. SEOM clinical guidelines for the treatment of non-small cell lung cancer. Clin Transl Oncol. 2018;21:3–17.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Facchinetti F, Pilotto S, Metro G, Baldini E, Bertolaccini L, Cappuzzo F, et al. Treatment of metastatic non-small cell lung cancer: 2018 guidelines of the Italian association of medical oncology (AIOM). Tumori. 2016;105:3–14.

    Article  Google Scholar 

  30. Barrón-Barrón F, Guzmán-De Alba E, Alatorre-Alexander J, Aldaco-Sarvide F, Bautista-Aragón Y, Blake-Cerda M, et al. Guía de Práctica Clínica Nacional para el manejo del Cáncer de Pulmón de células no pequeñas en estadios tempranos, localmente avanzados y metastásicos. Salud Publica Mex. 2019;61:359.

    Article  PubMed  Google Scholar 

  31. Akamatsu H, Ninomiya K, Kenmotsu H, Morise M, Daga H, Goto Y, et al. The japanese lung cancer society guideline for non-small cell lung cancer, stage IV. Int J Clin Oncol. 2019;24:731–70.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, et al. Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up the ESMO guidelines committee. Ann Oncol. 2020;3(1):71.

    Google Scholar 

  33. Remon J, Soria JC, Peters S. Early and locally advanced non-small-cell lung cancer: an update of the ESMO clinical practice guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol Ann Oncol. 2021;32:1637–42.

    Article  CAS  PubMed  Google Scholar 

  34. Daly ME, Singh N, Ismaila N, Antonoff MB, Arenberg DA, Bradley J, et al. Management of stage III non-small-cell lung cancer: ASCO guideline. J Clin Oncol. 2022;40:1356–84.

    Article  PubMed  Google Scholar 

  35. Pisters K, Kris MG, Gaspar LE, Ismaila N. Adjuvant systemic therapy and adjuvant radiation therapy for stage I-IIIA completely resected non-small-cell lung cancer: asco guideline rapid recommendation update. J Clin Oncol. 2022;40:1127–9.

    Article  CAS  PubMed  Google Scholar 

  36. Ettinger DS, Wood DE, Aisner DL, Akerley W, Bauman JR, Bharat A, et al. Non-small cell lung cancer, version 3.2022, NCCN clinical practice guidelines in oncology. Natl Compr Canc Netw. 2022;20:497–530.

    Article  Google Scholar 

  37. Singh N, Temin S, Baker S, Blanchard E, Brahmer JR, Celano P, et al. Therapy for stage IV non-small-cell lung cancer without driver alterations: ASCO living guideline. J Clin Oncol. 2022;40:3323–43.

    Article  CAS  PubMed  Google Scholar 

  38. Madera M, Franco J, Solà I, Bonfill X, Alonso-Coello P. Screening and diagnosis of oral cancer: a critical quality appraisal of clinical guidelines. Clin Oral Investig. 2019;23:2215–26.

    Article  PubMed  Google Scholar 

  39. Madera Anaya MV, Franco JV, Merchán-Galvis ÁM, Gallardo CR, Bonfill CX. Quality assessment of clinical practice guidelines on treatments for oral cancer. Cancer Treat Rev. 2018;65:47–53.

    Article  PubMed  Google Scholar 

  40. Santero M, Meade AG, Acosta-Dighero R, González L, Melendi S, Solà I, 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. 2022;24:1588–604.

    Article  PubMed  Google Scholar 

  41. Zhou X, Yang Y, Li C, Gu S, Hou W, Lai X, et al. What information can we gain from the quality appraisal of guidelines with physical activity recommendations for cancer patients A systematic review using the AGREE II and AGREE-REX tools. Supportive Care Cancer. 2023. https://doi.org/10.1007/s00520-022-07567-5.

    Article  PubMed  Google Scholar 

  42. Noyahr JK, Tatucu-Babet OA, Chapple LAS, Barlow CJ, Chapman MJ, Deane AM, et al. Methodological rigor and transparency in clinical practice guidelines for nutrition care in critically ill adults: a systematic review using the AGREE II and AGREE-REX tools. Nutrients. 2022. https://doi.org/10.3390/nu14132603.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hoydonckx Y, Kumar P, Flamer D, Costanzi M, Raja SN, Peng P, et al. Quality of chronic pain interventional treatment guidelines from pain societies: assessment with the AGREE II instrument. Eur J Pain. 2020;24:704–21.

    Article  PubMed  Google Scholar 

  44. Al Wattar BH, Fisher M, Bevington L, Talaulikar V, Davies M, Conway G, et al. Clinical practice guidelines on the diagnosis and management of polycystic ovary syndrome: a systematic review and quality assessment study. J Clin Endocrinol Metab. 2021;6:2436–46.

    Article  Google Scholar 

  45. Rabassa M, Hernández Ponce Y, Garcia-Ribera S, Johnston BC, Salvador Castell G, Manera M, et al. Food-based dietary guidelines in Spain: an assessment of their methodological quality. Eur J Clin Nutr. 2022;76:350–9.

    Article  PubMed  Google Scholar 

  46. Angel G, Trujillo C, Mallama M, Alonso-Coello P, Klimek M, Calvache JA. Methodological transparency of preoperative clinical practice guidelines for elective surgery. PLoS ONE. 2023. https://doi.org/10.1371/journal.pone.0272756.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Merchan-Galvis AM, Caicedo JP, Valencia-Payán CJ, Calvache JA. Methodological quality and transparency of clinical practice guidelines for difficult airway management using the appraisal of guidelines research & evaluation II instrument: a systematic review. Eur J Anaesthesiol. 2020;37:451–6.

    Article  PubMed  Google Scholar 

  48. Deana NF, Zaror C, Seiffert A, Aravena-Rivas Y, Muñoz-Millán P, Espinoza-Espinoza G, et al. Quality appraisal of clinical practice guidelines on provision of dental services during the first months of the COVID-19 pandemic. J Evid Based Dent Pract. 2021. https://doi.org/10.1016/j.jebdp.2021.101633.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ng JY, Nault H, Nazir Z. Complementary and integrative medicine mention and recommendations: A systematic review and quality assessment of lung cancer clinical practice guidelines. Integr Med Res. 2021. https://doi.org/10.1016/j.imr.2020.100452.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Yang Y, Lu J, Ma Y, Xi C, Kang J, Zhang Q, et al. Evaluation of the reporting quality of clinical practice guidelines on lung cancer using the RIGHT checklist. Transl Lung Cancer Res. 2021;10:2588–602.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Yao X, Ma J, Wang Q, Kanters D, Ali MU, Florez ID. A comparison of agree and right: which clinical practice guideline reporting checklist should be followed by guideline developers? J Gen Intern Med. 2020;35:894–8.

    Article  PubMed  Google Scholar 

  52. Chen YP, Wang YQ, Li WF, Chen L, Xu C, Lu TX, et al. Critical evaluation of the quality and recommendations of clinical practice guidelines for nasopharyngeal carcinoma. J Natl Compr Canc. 2017;15:336–44.

    Article  Google Scholar 

  53. Seiffert A, Zaror C, Atala-Acevedo C, Ormeño A, Martínez-Zapata MJ, Alonso-Coello P. Dental caries prevention in children and adolescents: a systematic quality assessment of clinical practice guidelines. Clin Oral Investig. 2018;22:3129–41.

    Article  PubMed  Google Scholar 

  54. Jolliffe L, Lannin NA, Cadilhac DA, Hoffmann T. Systematic review of clinical practice guidelines to identify recommendations for rehabilitation after stroke and other acquired brain injuries. BMJ Open. 2018. https://doi.org/10.1136/bmjopen-2017-018791.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Yadav P, Alsabban A, de Los RT, Varghese A, Ming JM, Milford K, et al. A systematic review of paediatric neurogenic lower urinary tract dysfunction guidelines using the appraisal of guidelines and research evaluation (AGREE) II instrument. BJU. 2018;13(5):520.

    Google Scholar 

  56. Simancas-Racines D, Montero-Oleas N, Vernooij RWM, Arevalo-Rodriguez I, Fuentes P, Gich I, et al. Quality of clinical practice guidelines about red blood cell transfusion. J Evid Based Med. J Evid Based Med. 2019;12:113–24.

    Article  PubMed  Google Scholar 

  57. Alarcon JD, Rubiano AM, Chirinos MS, Valderrama A, Gich I, Bonfill X, et al. Clinical practice guidelines for the care of patients with severe traumatic brain injury: a systematic evaluation of their quality. J Trauma Acute Care Surg. 2013;75:311–9.

    Article  PubMed  Google Scholar 

  58. Alonso-Coello P, Irfan A, Solà I, Gich I, Delgado-Noguera M, Rigau D, et al. The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies. Qual Saf Health Care. 2022. https://doi.org/10.1136/qshc.2010.042077.

    Article  Google Scholar 

  59. Kwah LK, Green J, Butler J, Lam L. Quality of clinical practice guidelines for management of limb amputations: a systematic review. Phys Ther. 2019;99:577–90.

    Article  PubMed  Google Scholar 

  60. Fuentes Padilla P, Martínez G, Vernooij RWM, Cosp XB, Alonso-Coello P. Nutrition in critically ill adults: a systematic quality assessment of clinical practice guidelines. Clin Nutr. 2016;35:1219–25.

    Article  PubMed  Google Scholar 

Download references

Funding

There was no source of funding involved in this work.

Author information

Authors and Affiliations

  1. Doctoral Program in Research Methodology and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain

    Marcela Cortés-Jofré

  2. Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción, Chile

    Marcela Cortés-Jofré

  3. Faculty of Dentistry, Department of Research, Universidad de Cartagena, Cartagena, Colombia

    Meisser Madera

  4. Programa de Odontología, Grupo GINOUS, Universidad del Sinú, Cartagena, Colombia

    Lesbia Tirado-Amador

  5. Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad de Desarrollo, Santiago, Chile

    Claudia Asenjo-Lobos

  6. Iberoamerican Cochrane Center, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain

    Xavier Bonfill-Cosp

  7. Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    Xavier Bonfill-Cosp

Authors
  1. Marcela Cortés-Jofré
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meisser Madera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lesbia Tirado-Amador
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claudia Asenjo-Lobos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xavier Bonfill-Cosp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meisser Madera.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not applicable.

Informed consent

Not applicable.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 25 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cortés-Jofré, M., Madera, M., Tirado-Amador, L. et al. Treatments for non-small cell lung cancer: a systematic quality assessment of clinical practice guidelines. Clin Transl Oncol 25, 3541–3555 (2023). https://doi.org/10.1007/s12094-023-03223-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-023-03223-4

Keywords

Search

Navigation