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Ovarian Cancer: The Recognition and Initial Management of Ovarian Cancer

These clinical guidelines review a number of clinical questions that involve the detection, diagnosis and initial management of ovarian cancer and which focus on areas of uncertainty or where there is a wide variation in clinical practice.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: April 2011

HER2 Testing to Manage Patients With Breast Cancer or Other Solid Tumors

Systematic review of trastuzumab outcomes among breast cancer patients who have negative, equivocal, or discordant HER2 assay results; use of HER2 assay results to predict outcomes of chemotherapy or hormonal therapy regimen for breast cancer; use of serum HER2 to monitor treatment response or disease progression in breast cancer patients; and use of HER2 testing to manage patients with lung, ovarian, prostate, or head and neck tumors. Also, narrative review of concordance of HER2 assays.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: November 2008

Immediate Osseointegrated Implants for Cancer Patients: A Review of Clinical and Cost-Effectiveness [Internet]

Oral cancers can develop in any part of the mouth, but most oral cancers start within the tongue or the floor of the mouth. They can also spread or originate from the bony structures of the mandibles. Oral cancers are commonly treated with ablative surgery alone or in combination with radiation and/or chemotherapy. Ablative surgeries may range from minor soft tissue trimming to a major resection of the tongue and jaw and face bones. Ablative surgeries of the face and mouth can introduce significant defects in the orofacial region. If not restored, these defects can compromise essential functions such as mastication, speech, and even breathing. Therefore, prosthetic rehabilitation is planned along with the ablative surgery. Oral prosthetics are usually constructed for edentulous patients, and they are stabilized and retained over the jaw bones. However, their stability and retention can be compromised due to the ablative surgery conducted on oral soft tissues and bone. The use of osseointegrated implants is suggested to improve the stability and retention of oral prosthetics in oral cancer patients. Osseointegrated implants are metallic, or even ceramic, structures which can be fixed within the jaw bones. They are connected to external structures which can be used to anchor oral prostheses. Classically, oral prostheses are put directly on the defective area and rely on the remaining oral structure for retention and stability. The purpose of this report is to review the evidence of the clinical effectiveness and cost-effectiveness of immediate osseointegrated implants for cancer patients.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: January 13, 2015

Systematic guideline search and appraisal, as well as extraction of new and relevant recommendations, for the DMP “Breast cancer”: Executive summary of final report V06-05, Version 1.0

The aim of this research was to specify a possible need for revision of the existing DMP for breast cancer (DMP 2005) by means of a systematic search for evidence-based CPGs and a synthesis of the key recommendations.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 29, 2008

Epoetin and Darbepoetin for Managing Anemia in Patients Undergoing Cancer Treatment: Comparative Effectiveness Update [Internet]

To update the 2006 systematic review of the comparative benefits and harms of erythropoiesis-stimulating agent (ESA) strategies and non-ESA strategies to manage anemia in patients undergoing chemotherapy and/or radiation for malignancy (excluding myelodysplastic syndrome and acute leukemia), including the impact of alternative thresholds for initiating treatment and optimal duration of therapy.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2013

Mismatch Repair Deficiency Testing for Patients with Colorectal Cancer: A Clinical and Cost-Effectiveness Evaluation [Internet]

Surveyed Canadian laboratory managers and directors have identified DNA mismatch repair (dMMR) testing as a laboratory test that is potentially over-utilized. According to clinical experts, dMMR testing appears to be transitioning from an approach aimed at identifying patients and families with Lynch syndrome into a tumour phenotyping procedure that can be used to predict the prognosis of colorectal cancer (CRC) and to guide decisions for adjuvant chemotherapy. The use of a test with a prognostic and predictive value falls under the realm of “personalized medicine.” According to oncology and pathology experts, this recent application of dMMR testing is the major driver of new test requisitions. This transition has led to an increased demand for the test, with unclear benefits for the patient or family members. In general, there is a lack of clarity regarding when the tests should be ordered and the impact of dMMR status on CRC outcomes in the current era of oxaliplatin- and irinotecan-based chemotherapy. The central question, however, is whether universal dMMR testing of primary CRC tumours is a viable and desirable option given the known limitations of Lynch syndrome pre-selection criteria based on age, history, and pathology, and recognizing the potential utility of dMMR for personalizing cancer therapy. Missed cases of Lynch syndrome resulting from a targeted dMMR testing strategy that is restricted to pre-selected high-risk individuals (e.g., selected based on the Revised Bethesda Guidelines) can be problematic and costly for the system, which would potentially support broader (universal) dMMR testing of all CRC tumours. Alternatively, universal testing carries with it additional costs associated with testing all CRC patients, most of whom will not have Lynch syndrome.

CADTH Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: September 2015

Autologous stem cell transplantation for breast cancer: Executive summary of final report N05-03E, Version 1.0

The aims of this investigation were to assess studies on certain types of autologous stem cell transplantation in breast cancer patients: compared to cytostatic therapy without stem cell support, and compared with each other.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 15, 2009

Screening for Hepatocellular Cancer in Chronic Liver Disease: A Systematic Review [Internet]

In the Veterans Health Administration (VHA), there has been a marked increase in the prevalence of cirrhosis from chronic hepatitis C infection with a corresponding increase in the number of hepatocellular cancer (HCC) diagnoses. From 1996 to 2006, the prevalence of cirrhosis among Veterans with chronic hepatitis C infection rose from 9 to 18.5%, and the prevalence of HCC rose from 0.07 to 1.3%. In the general population, the incidence of HCC rose between 1992 and 2005 from 3.1/100,000 to 5.1/100,000, with localized tumors accounting for most of the increase. While, on average, the 5-year survival of HCC is low (13 to 16.5%), the survival of early-stage disease has risen.

Evidence-based Synthesis Program - Department of Veterans Affairs.

Version: January 2014

The Diagnosis and Treatment of Lung Cancer (Update)

This guidance updates and replaces NICE clinical guideline 24 (published February 2005).

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: April 2011

Prostate Cancer: Diagnosis and Treatment

The original Prostate Cancer: Diagnosis and Treatment Guideline published in 2008 was the first clinical guideline produced by the National Collaborating Centre for Cancer (NCC-C); accordingly this is now the first NCC-C clinical guideline to be reviewed and updated. Many areas of the original guideline are unchanged as there is little or no new evidence; other aspects have been completely rewritten. As ever there are still many topics where the research evidence is incomplete or conflicting, and so the Guideline Development Group (GDG) have been required to reach a consensus using the evidence available to them in several areas. In places where it was clear that further work needed to be done, new research recommendations have been made which we hope will be used as the basis for future research work.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: January 2014

Fecal DNA Testing in Screening for Colorectal Cancer in Average-Risk Adults [Internet]

To review the evidence on fecal DNA testing to screen for colorectal cancer in adults at average risk for colorectal cancer.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: February 2012

Lifestyle Interventions for Four Conditions: Type 2 Diabetes, Metabolic Syndrome, Breast Cancer, and Prostate Cancer [Internet]

To synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of lifestyle interventions to control progression of type 2 diabetes, progression to diabetes from metabolic syndrome, or recurrence of breast cancer and prostate cancer. Lifestyle interventions were defined as any intervention that included exercise, diet, and at least one other component (e.g., counseling, stress management, smoking cessation).

Technology Assessment Report - Agency for Healthcare Research and Quality (US).

Version: May 26, 2011

The Clinical Effectiveness and Cost-Effectiveness of Different Surveillance Mammography Regimens After the Treatment for Primary Breast Cancer: Systematic Reviews, Registry Database Analyses and Economic Evaluation

Following primary breast cancer treatment, the early detection of ipsilateral breast tumour recurrence (IBTR) or ipsilateral secondary cancer in the treated breast and detection of new primary cancers in the contralateral breast is beneficial for survival. Surveillance mammography is used to detect these cancers, but the optimal frequency of surveillance and the length of follow-up are unclear.

Health Technology Assessment - NIHR Journals Library.

Version: September 2011

Screening for Cervical Cancer: A Decision Analysis for the U.S. Preventive Services Task Force [Internet]

Despite recommendations from the U.S. Preventive Services Task Force (USPSTF) regarding the age at which to begin and end cervical cancer screening, as well as the interval at which to conduct screening, there is limited direct evidence beyond that inferred from epidemiologic and natural history studies to support these recommendations. In addition, concerns about the poor sensitivity (approximately 50 percent) of cytology-based screening have led to the development of new tests with potentially improved sensitivity for the detection of cervical intraepithelial neoplasia (CIN) grades 2 and 3. Although there is widespread use of these tests—including the Hybrid Capture 2 high-risk human papillomavirus (HPV) deoxyribonucleic acid (DNA) test—the USPSTF has, to date, not recommended their use due to a lack of definitive evidence regarding their performance in screening. The availability of new data, including data from randomized controlled trials, suggests a need to re-evaluate the previous recommendations. Simulation modeling can provide additional guidance on the risks, benefits, and resources associated with different screening test strategies, as well as the trade-offs involved in varying the age at which to begin and end screening.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: May 2011

PCA3 Testing for the Diagnosis and Management of Prostate Cancer [Internet]

We performed a comparative effectiveness review that examined the use of the prostate cancer antigen 3 (PCA3) gene in improving initial or repeat biopsy decisions in patients identified at risk for prostate cancer, or in improving decisionmaking about treatment choices (e.g., active surveillance vs. aggressive therapy) in patients with prostate cancer positive biopsies. Comparators included total prostate specific antigen (PSA) elevations, free PSA, PSA density, PSA velocity, externally validated nomograms, complexed PSA, and multivariate models.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2013

Advanced Breast Cancer: Diagnosis and Treatment

Breast cancer is the most common cancer for women in England and Wales, with about 37,000 new cases diagnosed and 11,000 deaths recorded in England and Wales each year. In men breast cancer is rare, with about 270 cases diagnosed, and 70 deaths in England and Wales each year. Of these new cases in women and men, around 10% are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, there is a significant number of women who have been previously treated with curative intent who subsequently develop either a local recurrence or metastases. Over recent years there have been important developments in the investigation and management of these patients including new chemotherapy, and biological and hormonal agents. There is some evidence of practice variation across the country and of patchy availability of certain treatments and procedures. A clinical guideline will help to address these issues and offer guidance on best practice.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: February 2009

Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

In the United States, dietary supplements are commonly used to prevent chronic diseases, including cardiovascular disease (CVD) and cancer.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: November 2013

Local Hepatic Therapies for Metastases to the Liver From Unresectable Colorectal Cancer [Internet]

To characterize the comparative effectiveness and harms of various local hepatic therapies for metastases to the liver from unresectable colorectal cancer (CRC) in two distinct populations: patients with liver-dominant metastases (i.e., majority of disease located in the liver) who are not eligible for continued systemic chemotherapy because their disease is refractory (i.e., they have experienced disease progression while on therapy), and patients who are candidates for local liver therapies as an adjunct to systemic chemotherapy. Local hepatic therapies include ablation, embolization, and radiotherapy approaches.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: December 2012

The Value of FDG Positron Emission Tomography/Computerised Tomography (PET/CT) in Pre-Operative Staging of Colorectal Cancer: A Systematic Review and Economic Evaluation

In the UK, colorectal cancer (CRC) is the third most common malignancy (behind lung and breast cancer) with 37,514 cases registered in 2006: around two-thirds (23,384) in the colon and one-third (14,130) in the rectum. Treatment of cancers of the colon can vary considerably, but surgical resection is the mainstay of treatment for curative intent. Following surgical resection, there is a comprehensive assessment of the tumour, it's invasion characteristics and spread (tumour staging). A number of imaging modalities are used in the pre-operative staging of CRCs including; computerised tomography (CT), magnetic resonance imaging, ultrasound imaging and positron emission tomography (PET). This report examines the role of CT in combination with PET scanning (PET/CT ‘hybrid’ scan). The research objectives are: to evaluate the diagnostic accuracy and therapeutic impact of fluorine-18-deoxyglucose (FDG) PET/CT for the pre-operative staging of primary, recurrent and metastatic cancer using systematic review methods; undertake probabilistic decision-analytic modelling (using Monte Carlo simulation); and conduct a value of information analysis to help inform whether or not there is potential worth in undertaking further research.

Health Technology Assessment - NIHR Journals Library.

Version: September 2011

Treatment of Nonmetastatic Muscle-Invasive Bladder Cancer [Internet]

Although the standard treatment for nonmetastatic muscle-invasive bladder cancer is cystectomy and neoadjuvant chemotherapy, there is interest in bladder-preserving therapy as an alternative, and there is uncertainty about the need for and optimal extent of lymph node dissection and optimal chemotherapy regimens and timing of administration.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: June 2015

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