1. Clinical Practice Guidelines The ESMO Perspective Andrés Cervantes Professor of Medicine

2. WHAT ARE CLINICAL PRACTICE GUIDELINES?
Systematically developed evidence-based statements aiming:
To assist practitioners in appropriate clinical decision-making (best clinical practice)
To improve quality of healthcare and outcomes for patients
To influence national policies for efficient allocation of resources and for better delivery systems

3. Research to Clinical Practice Cycle
Clinical Research
Congress Presentation
Peer Review Publication
Clinical Practice Guidelines
Clinician Education
Clinical Practice?
Audit
Feedback

4. WHAT ARE CLINICAL PRACTICE GUIDELINES?
They need to be trustworthy :
Be based on a systematic review of the existing evidence
Be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups
Be based on an explicit and transparent process that minimizes distortions, biases and conflict of interest
Consider important patients subgroups and patients preferences, as appropriate
Provide a clear explanation of the logical relationships between alternative care options and health outcomes, and rating LoE and GoR
Be revised and updated when new evidence warrants modifications of recommendations

5. HISTORY & EVOLUTION OF ESMO GUIDELINES
ESMO first began to work on the development of guidelines in 1999 in order to help define the minimum standards of medical oncology practice for Eastern European countries.
From the ESMO Minimum Clinical Recommendations were published.
In 2006 ESMO started to produce the ESMO Clinical Recommendations addressing a wider audience.
In 2007 the Consensus Conference derived guidelines were established.
Since 2010 they are called ESMO Clinical Practice Guidelines.
The ESMO Guidelines Committee continue to strive for improvement of ESMO Guidelines with each new publication

6. A u t h o r s (Multidisciplinary)
The Structure of the ESMO GL Committee
S u b j e c t E d i t o r s Breast Cancer
2. Gynaecological Cancer 3. Haematological Malignancies 4. Lung Cancer 5. Head and Neck Cancer
6. Urogenital Cancer 7. Upper and lower GI tract cancers 8. Pancreato-hepatobiliary cancers 9. Sarcoma & GIST 10. Supportive Care 11. Palliative Care
12. Rare Tumors
E d i t o r i a l B o a r d Chairman & Co-Chairman 2 Members 1 ESMO Officer
R e v i e w e r s 5 ESMO Faculty Members per Topic on a multidisciplinary platform
A u t h o r s (Multidisciplinary)

7. Guidelines: topics & authors selection process
GLWG annual strategy meeting
Identification of Guidelines requiring update and new titles
Subject Editors (SEs) propose lead authors
Manuscript & author information included in on-line system
SEs and lead authors identify co-authors (4/5 in total, multidisciplinary)
GLWG Editorial Board approve lead authors
Author invitations sent via on-line system (including deadlines and template)
Authors accept invitations & deadlines (or repeat steps 3-6)

8. Guidelines: Production process
Authors review literature, grade evidence and produce 1st draft
SEs select 5 reviewers per manuscript (ESMO faculty preference)
Reviewers submit their comments via on-line system
Review comments compiled, anonymised and sent to authors
Authors address review comments in revised manuscript
Review step repeated with revised manuscript until SE sign-off
Final sign-off by GLWG Chair
Manuscripts sent to Annals of Oncology for production
Copy-editing & proof review (SEs & Chair). Approved for print by ESMO.

9. WHAT KIND OF CLINICAL PRACTICE GUIDELINES?
Average number of pages (2014): 9.5
Evidence based
Disease or topic oriented
Available on the ESMO website
Only those requiring update are published in Annals of Oncology
NUMBER OF CLINICAL PRACTICE GUIDELINES

10. ESMO Clinical Practice Guidelines
Adherence to clinical practice guidelines improves patient outcomes
Produced by leading European Experts
Multidisciplinary editorial teams
Based on published peer reviewed data
IDS modified grading system
Published in Annals of Oncology-Open access
Updated over 1-2 year cycle
Scientific and Education Resources

11. ESMO NEW CLINICAL PRACTICE GUIDELINES 2014
Gastrointestinal tumours
Anal cancer *
Metastatic colorectal cancer *
Gastrointestinal stromal tumours
Lung cancer
Metastatic non-small-cell lung cancer (NSCLC) *
Urogenital tumours
Bladder cancer*
Renal cell carcinoma
Haematological malignancies
Myelodysplastic syndromes * NEW
Hodgkin’s lymphoma *
Follicular lymphoma *
Mantle cell lymphoma NEW
CNS malignancies
High-grade glioma *
Sarcomas
Soft tissue sarcomas
Bone sarcomas
Supportive and palliative care
Bone health in cancer patients * NEW
Advanced care planning NEW
Management of refractory symptoms at the end of life and palliative sedation NEW
*Published individually on-line ahead of print
For all other existing titles published versions
are considered current and remain available online

12. ESMO Clinical Practice Guidelines 2015
20 titles scheduled (updates and new)
Early breast cancer
Acute lymphoblastic diseaseNEW
Supportive care for head & neck cancerNEW
Malignant mesothelioma
Thymic malignanciesNEW
Extranodal aggressive lymphomasNEW
Central venous access devicesNEW
Pancreatic cancer
Diffuse large B-cell lymphoma
DyspnoeaNEW
Prostate cancer
Early integration of palliative interventionNEW
Chronic lymphocytic leukaemia
Chronic myeloid leukaemia
Malnutrition/cachexiaNEW
Myeloproliferative neoplasiasNEW
Melanoma
Management of oral and gastrointestinal mucositis
Hairy cell leukaemiaNEW
T-cell lymphomaNEW

13. ESMO CLINICAL PRACTICE GUIDELINES
Available:
In an annual supplement of Annals of Oncology
On the ESMO website (
On the OncologyPRO website (oncologypro.org)
Translated:
Through Oxford University Press
In collaboration with National Cancer Societies
Presented:
During Guidelines Interactive Sessions (every year since 2002).
To audiences of up to 3200 attendees.

14. WHAT KIND OF CLINICAL PRACTICE GUIDELINES?
CONSENSUS CONFERENCE DERIVED GUIDELINES
To address pre-selected questions to multidisciplinary experts on specific tumour types
1-2 days meeting
Funded by ESMO or other professional networks
Update every 2-5 years
Published in Annals of Oncology
NUMBER OF CONSENSUS CONFERENCES HELD PER YEAR

15. Consensus Conference Schedule
2010
2011
2012
2013
2014
2015
Lung
Prostate
Sarcoma& GIST
Endometrial
Lymphomas
Colorectal
Lymphoma -
Sarcoma & GIST
Advanced CRC
Nausea and vomiting
ESO-ESMO ABC
(Advaced Breast Cancer)
Melanoma
Myeloproliferative neoplasms

16. CLINICAL PRACTICE GUIDELINES: Download figures
Downloads within first 6 months post publication
Total Average per manuscript
2009 (54 manuscripts)
2010 (55 manuscripts)
2011 (13 manuscripts)
2012 (21 manuscripts)
2013 (20 manuscripts) 16

17. ESMO Clinical Practice Guidelines: PDF downloads
Data provided by Annals of Oncology, April 2015

18. Top 20 countries: traffic based on unique page views (Jan-Mar 2015)
Evolution of the ESMO Clinical Practice Guidelines pages on the ESMO website
Top 20 countries: traffic
based on unique page views (Jan-Mar 2015)
Country
Unique page views
United States
15466
Switzerland
14562
United Kingdom
12151
Italy
11525
Germany
11048
Spain
10844
Portugal
10342
India
8804
France
6331
Romania
5078
Egypt
4408
Brazil
4132
Mexico
4095
Poland
4092
Australia
3851
Greece
3201
Belgium
3104
Turkey
3030
Malaysia
2762
Canada
2639
Rest of World
62788
Unique Page views: the number of visits during which the a page was viewed one or more times

19. Evolution of the ESMO Clinical Practice Guidelines pages on the ESMO website
Date
Change Description
>> MON 24 SEPTEMBER 2012
Single welcome page with links to Annals of Oncology
MON 24 SEPTEMBER 2012
1. Introduction of TOPICS sub pages in addition to the welcome page
TUES 23 APRIL 2013
Launch of new ESMO website
THURS 3/FRI 4 OCTOBER 2013
2. Introduction of individual guidelines pages, with embed of the Annals web pages and a link to the PDF download
23 OCTOBER 2014
3. Guidelines pages moved up a level in the ESMO website. All Topics can now be viewed in the top menu, for easier navigation
N Peters, Web dept.
24 April 2015

21. ESMO Clinical Practice Guidelines pages: unique page views on the ESMO website
Introduction of individual Topics pages
Introduction of individual Guidelines pages
Guidelines pages moved up a level
Unique Page views: the number of visits during which the a page was viewed one or more times

22. Unique Page views per month
Evolution of the ESMO Clinical Practice Guidelines pages on the ESMO website
Unique Page views per month
2011
2012
2013
2014
2015
Jan
8723
7793
8612
53643
66332
Feb
9013
7916
8318
46535
64780
Mar
9741
8702
8701
59550
74142
Apr
7992
7347
15351
54303
May
8794
7991
31764
58029
Jun
5073
7402
27803
53724
Jul
5108
7439
34709
55231
Aug
5328
7861
32364
57446
Sep
7212
11047
43330
85356
Oct
8134
11505
72648
84698
Nov
8287
9062
64784
69150
Dec
6125
6673
46505
56485
total
89530
100738
394889
734150
Unique Page views: the number of visits during which the a page was viewed one or more times

23. ESMO Pocket Guidelines 2015

24. ESMO APP VERSION GUIDELINES 2015
All of the latest pocket guidelines are now available
on the ESMO Guidelines app
The app also includes the ESMO Guides for Patients
– several languages are available
Available from iTunes and GooglePlay

25. N Peters, Web & Data Services dept.
Future Developments
Improve updating frequency for all titles
Review of methodology
Introduce interactive apps-Pilot late 2015
Integration of MCBS in 2016
3/7/14
N Peters, Web & Data Services dept.

26. Thanks