We've listed 1166 guidelines under your selection of . The most recent guidelines are first.
This is a clinical practice guideline for women with ductal carcinoma in situ (DCIS) of the breast. The guideline examines the optimal surgical management of these patients, as well as radiotherapy in patients who have undergone breast-conserving surgery. The role of tamoxifen in the management of these patients is also discussed.
This is a clinical practice guideline for patients with Barrett's esophagus (BE), which is the only identifiable premalignant condition for esophageal adenocarcinoma (EAC). The guideline examines endoscopic eradication therapy (EET) and its role in the management of BE-related neoplasia. Outcomes of interest include progression to cancer, cancer-specific and all-cause mortality, adverse events, and recurrence rates.
This is a clinical practice guideline for patients aged 16 or older who have primary brain tumours or brain metastases. Specifically, the guideline examines the diagnoses and management of radiologically identified glioma, meningioma, and brain metastases. Follow-up care after treatment and supportive care are also discussed, and additional recommendations are provided on the referral of adults with primary brain tumours or brain metastases for neurological rehabilitation assessment.
This is a clinical practice guideline for patients with solid tumours or hematological malignancies, and those with myelodysplastic syndromes (MDS). The guideline examines the management of anemia and iron deficiency in these patients using erythropoiesis-stimulating agents (ESAs), iron preparations for intravenous or oral administration, red blood cell transfusions, or combinations of these treatments. When and for whom treatment should be considered, as well as appropriate dose, are discussed.
This is a clinical practice guideline for adult patients with metastatic colorectal cancer. The guideline examines treatment options, including different chemotherapy regimens, and metastasectomy. Other topics of discussion include palliative chemotherapy regimens, and treatment of liver metastasis. Outcomes of interest include adverse effects, overall survival, and quality of life.
This is a clinical practice guideline for adults with solid tumours and non-myeloid malignancies who are receiving myelosuppressive chemotherapy. The guideline examines the use of myeloid growth factors (MGFs) in these patients as a method for reducing the incidence of neutropenia. Topics of interest include the benefits and risks of MGFs, as well as their use in prophylactic, therapeutic, and post-transplant settings.
This is a clinical practice guideline for adults and children experiencing cancer-related fatigue (CRF). The guideline discusses screening for CRF, as well as evaluation approaches using focused history, assessment of treatable contributing factors, and patient clinical status. General strategies for managing CRF are discussed, and the guideline examines pharmacological and non-pharmacological treatments for patients based on their placement within the care continuum (i.e. active treatment, post-treatment, and end-of-life).
This is a clinical practice guideline for patients with thymomas and thymic carcinomas. The guideline examines the diagnosis, staging, and treatment these mediastinal tumours. Surgical resection and radiation therapy are discussed as treatment options.
This is a clinical practice guideline for patients with pancreatic adenocarcinoma. The guideline examines risk factors and genetic predisposition, pancreatic cancer screening, diagnosis and staging, systemic therapy approaches, radiation and chemoradiation approaches, surveillance of patients with resected disease, as well as palliative and supportive care. Management of metastatic disease, locally advanced disease, resectable and borderline resectable disease, and recurrent disease after resection is also considered.
This is a clinical practice guideline for patients with myelodysplastic syndromes (MDS). The guideline discusses diagnostic classification, evaluation, prognostic stratification, therapeutic options, and recommended treatment approaches for MDS. There is a particular focus on supportive care, and the guideline also provides recommendations for the management of thrombocytopenia and iron overload, the treatment of related anemia, the use of low-intensity therapy (i.e. hypomethylating agents or biologic response modifiers and immunosuppressive therapy), and high-intensity therapy.
This is a clinical practice guideline for patients with multiple myeloma. The guideline examines the primary therapy and surveillance/follow-up tests for both solitary plasmacytoma and smoldering (asymptomatic) myeloma, and the primary therapy and monitoring for active (symptomatic) myeloma. Stem cell transplants (SCT), including autologous SCT, tandem SCT, and allogeneic SCT, as well as follow-up after stem cell transplants, are also discussed. In addition, the guideline considers diagnostic tests, response criteria, maintenance therapy, treatment of progressive or relapsed myeloma, and supportive care treatment.
This is a clinical practice guideline for adults with classical Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). The guideline discusses the clinical management of patients with CHL and NLPHL, focusing on patients who do not have serious intercurrent disease. Treatment options examined include chemotherapy, high dose therapy and autologous stem cell rescue (HDT/ASCR), and involved site radiation therapy (ISRT).
This is a clinical practice guideline for patients with head and neck cancers. The guideline examines workup and staging, treatment, and follow-up for various head and neck cancers including cancer of the lip, oral cavity, oropharynx, hypopharynx, nasopharynx, and larynx, as well as paranasal tumours, very advanced head and neck cancers, occult primary cancer, salivary gland tumours, and mucosal melanoma of the head and neck. Nutrition, supportive care, comorbidities, quality of life, and dental evaluation and management are also discussed.
This is a clinical practice guideline for patients with chronic lymphocytic leukemia, or small lymphocytic lymphoma. The guideline examines the diagnosis, staging, treatment, and follow-up of these patients. Prognosis and treatment algorithms are presented based on patient characteristics such as age, and genetic profile.
This is a clinical practice guideline for patients with bladder cancer. Non-muscle-invasive urothelial bladder cancer, muscle-invasive urothelial bladder cancer, metastatic (Stage IVB) urothelial bladder cancer, non-urothelial carcinomas of the bladder, upper tract urothelial carcinoma (UTUC), urothelial carcinomas of the prostate, and primary carcinomas of the urethra are all specifically discussed. The guideline provides algorithms for diagnosis, staging, treatment, and follow-up.
This is a clinical practice guideline discussing colorectal cancer (CRC) screening in adults. Recommendations are made for three groups of patients, stratified by their risk of developing CRC: average risk, increased risk, and high risk syndromes. Screening modalities examined include structural screening tests, such as colonoscopy, flexible sigmoidoscopy, and computed tomographic colonography, as well as fecal-based tests, which include fecal occult blood test, and combined stool deoxyribonucleic acid/fecal immunochemical (DNA/FIT) tests.
This is a clinical practice guideline for women who are at increased risk of developing breast cancer. The guideline examines the elements of risk, risk assessment, risk-reduction interventions, and the components of risk-reduction counselling. Risk-reduction interventions considered are lifestyle modifications, risk-reduction surgery, and risk-reduction agents including Tamoxifen, Raloxifene, and Aromatase. Monitoring patients on risk reduction agents, and managing the side effects of these agents are also discussed.
This is a clinical practice guideline for patients with diagnosed or suspected thyroid carcinoma. The guideline discusses the initial workup, diagnosis, staging, treatment, and follow up of patients with differentiated, papillary, follicular, medullary, and anaplastic thyroid carcinoma, as well as Hürthle cell carcinoma. Surgery, radiation therapy, and systemic therapy are discussed as treatment options.
This is a clinical practice guideline for patients with small cell lung cancer. The guideline examines the diagnosis, staging, prognostic factors, treatment, and surveillance of these patients. Treatment options discussed include systemic therapy, radiotherapy, and surgical resection. Systemic therapy is further examined in elderly patients, and as a second-line (and beyond) treatment. Radiotherapy treatments considered include thoracic radiotherapy, prophylactic cranial irradiation, and palliative radiotherapy.
This is a clinical practice guideline for the management of squamous cell carcinoma (SCC) of the penis. The guideline examines the diagnosis, treatment, and follow-up for patients with this form of cancer. Outcomes of interest include optimizing therapeutic efficacy and minimizing treatment-related morbidity.
This is a clinical practice guideline for adult patients with ovarian cancer, fallopian tube cancer, or primary peritoneal cancer. Recommendations are provided for screening, staging, diagnosis, treatment, and follow-up. Treatment options discussed include debulking surgery, chemotherapy, and radiation therapy. Management of drug reactions is also discussed.
This is a clinical practice guideline for patients with T-cell lymphoma. The guideline examines the diagnostic workup, staging, treatment, follow-up, and supportive care for the most common subtypes of T-cell lymphoma. These subtypes include peripheral T-cell lymphomas (PTCLs), breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), mycosis fungoides (MF) and Sézary syndrome (SS), primary cutaneous CD30+ T-cell lymphoproliferative disorders, T-cell large granular lymphocytic leukemia (TGLL), adult T-cell leukemia/lymphoma (ATLL), T-cell prolymphocytic leukemia (TPLL), and extranodal NK/T-cell lymphomas (ENKL), nasal type.
A clinical practice guideline on the diagnosis, workup, treatment and surveillance of B-cell lymphoma (BCL) in pediatric and adult patients. The guideline focuses on the most common B-cell lymphomas: follicular lymphoma (FL), marginal zone lymphomas (MZL), nodal MZL, splenic MZL, gastric MALT lymphoma, mantle cell lymphoma (MCL), diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), AIDS-related B-cell lymphoma, post-transplant lymphoproliferative disorders, and Castleman's disease. Additional consideration is paid to the classification systems used in NHL, the role of PET scans in assessment and staging, principles of radiation therapy, and supportive care considerations.
This is a clinical practice guideline for the management of colon cancer. Recommendations are made for diagnosis, pathologic staging, surgical management, perioperative treatment, surveillance, and management of recurrence. Principles for the management of metastatic disease are also provided.
This is a clinical practice guideline for women with breast cancer. The guideline examines staging, pathology assessment, and treatment approaches for pure noninvasive carcinomas, stage I, IIA, IIB, IIIA, or III invasive breast cancer, and stage IV metastatic or recurrent breast cancer. Special situations considered include Paget's disease, phyllodes tumours of the breast, breast cancer during pregnancy, inflammatory breast cancer, and axillary breast cancer.
This is a clinical practice guideline for patients with primary bone cancer. The guideline examines systemic therapy agents and radiation therapy for chordoma, chondrosarcoma, Ewing sarcoma, osteosarcoma, and giant-cell tumours of bone (GCTB). The guideline also discusses the management of relapsed disease.
This clinical practice guideline is for the management of squamous cell anal carcinoma. The guideline provides recommendations on staging, treatment, and follow-up. The effectiveness of treatment options such as surgery, chemotherapy, and radiation therapy are compared. Guidance is also provided on dosing regimens, treatment of recurrence, and surveillance following treatment of recurrence.
This is a clinical practice guideline for adolescent, young adult (AYA), and adult patients with acute lymphoblastic leukemia (ALL). The guideline reviews the classification of ALL subtypes based on immunophenotype and cytogenetic/molecular markers, and provides recommendations on risk assessment and stratification for risk-adapted therapy, as well as treatment strategies for Philadelphia chromosome (Ph)-positive and Ph-negative ALL. The guideline also provides recommendations for supportive care.
This is a clinical practice guideline for patients who have received treatment for prostate cancer. The guideline examines the various imaging modalities that can be effectively used for the follow-up of these patients. Variations of imaging modalities such as transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and computed tomography (CT) are discussed, and the appropriateness of different techniques is examined for different clinical situations.
This is a clinical practice guideline for individuals with average, moderate, or high risk of developing colorectal cancer. The guideline the examines the appropriateness of various screening procedures including computed tomography (CT) colonography, X-ray barium enema double-contrast, magnetic resonance colonography, and X-ray barium enema single-contrast. The guideline also considers age, family medical history of colorectal cancer, and presence of other conditions or risk factors.
This is a clinical practice guideline for adult patients with symptomatic endobronchial disease in non-small cell lung cancer. The guideline examines the use of high dose rate endobronchial brachytherapy (HDREB) for the palliation of respiratory symptoms in these patients. Specific topics discussed include the appropriate dose of HDREB, toxicity, and fatal hemoptysis.
This is a clinical practice guideline for patients with castration-resistant prostate cancer (CRPC). The guideline examines treatment options for six index patients that represent the most common clinical scenarios. Recommendations are based on the presence or absence of metastatic disease, the degree of symptoms, the patient's performance status, and whether or not their has been prior treatment with docetaxel-based chemotherapy. A scale for defining patient performance status is also provided.
This is a clinical practice guideline for patients with squamous cell cancers (SCC) of the anal canal and perianal region. The guideline specifically examines management options for premalignant and malignant squamous neoplasms of the anus and perianal region. Recommendations are provided regarding screening options, primary treatment, and surveillance for SCC and perianal squamous cell cancers.
This is a clinical practice guideline for patients with malignant pleural mesothelioma (MPM). The guideline provides recommendations on the investigation of suspected MPM, and the subsequent care and management of individuals with proven MPM. Topics of interest include the preferred investigation pathway of suspected cases of MPM, biomarkers, and the role of different treatments including chemotherapy.
This is a clinical practice guideline for the diagnosis and management of early and locally advanced breast cancer. The guideline provides recommendations on referral, diagnosis, preoperative assessment, genetic testing, surgical procedures, breast reconstruction, psychological support, and adjuvant therapies such as endocrine therapy and bisphosphonate therapy.
This is a clinical practice guideline for adult patients with chronic lymphocytic leukemia. The guideline examines the diagnostic and staging criteria, treatment strategies, and follow-up and supportive care practices for these patients. First and second line treatment options are discussed for newly diagnosed, relapsed, and refractory disease.
This is a clinical practice guideline for adult patients with acute myeloid leukemia (AML). The guideline examines the diagnostic criteria and prognostic markers of acute myeloid leukemias. Different management options for acute myeloid leukemia are discussed, including chemotherapy, hematopoietic stem cell transplantation, and palliation.
This is a clinical practice guideline for patients who have been diagnosed with or are suspected of having advanced/metastatic prostate cancer. The guideline provides guidance on the staging, treatment, and follow up procedures for these patients. Topics of interest include radiotherapy techniques, the use of bone scans to assist in staging, and follow-up using active surveillance within a cancer clinic.
This is a clinical practice guideline for adults with any type of cancer. The guideline focuses on the screening, assessment, and treatment of cancer-related pain. Specific topics discussed include universal pain screening, management of pain in both opioid-naïve and opioid-tolerant patients, management of opioid-induced adverse effects, procedure-related pain and anxiety, management strategies for specific cancer pain syndromes, adjuvant analgesics for neuropathic pain, psychosocial support, and education for both patients and caregivers.
This is a clinical practice guideline for patients with prostate cancer. The guideline examines various treatment options including active surveillance, radical prostatectomy, radiation therapy, other local therapies, androgen deprivation therapy, chemotherapy, and immunotherapy. It also discusses risk stratification, imaging, and estimates of life expectancy. Recommendations are provided for the initial diagnosis, clinical assessment, and staging evaluation, as well as for treatment, which are based on both the level of risk, and specific disease present.
This is a clinical practice guideline for hepatobiliary cancers. The guideline examines the clinical management of patients with hepatocellular carcinoma (HCC), gallbladder cancer, as well as intrahepatic and extrahepatic cholangiocarcinoma. Risk factors, diagnosis, staging and prognosis, and treatment are discussed for the different conditions.
This is a clinical practice guideline for women with epithelial ovarian cancers, specifically focusing on patients with type-2 ovarian cancers. The guideline examines diagnostic imaging methods, used for both staging and evaluating potential recurrence. Imaging modalities discussed include x-ray, magnetic resonance imaging (MRI), fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), and computed tomography (CT).
This is a clinical practice guideline for adult patients who have been diagnosed with or are suspected of having lymphoma. The guideline discusses Hodgkin lymphoma, as well as the most common non-Hodgkin lymphomas (T-cell and B-cell). Recommendations are provided on diagnosis, staging, treatment, management, and follow up care.
This is a clinical practice guideline developed for adult men who have elected to participate in an early prostate cancer detection program. The guideline provides a set of sequential recommendations detailing screening and evaluation strategies for maximizing the detection of prostate cancer that is effectively treatable and that, if left undetected, represents a risk to the patient. Several techniques designed to improve the identification of significant cancer, while avoiding the detection of indolent disease, are highlighted, including imaging, biomarker testing, and biopsy.
This is a clinical practice guideline for patients living with HIV (PLWH) who are diagnosed with cancer. The guideline focuses primarily on PLWH who develop non-small cell lung cancer (NSCLC), anal cancer, Hodgkin lymphoma, or cervical cancer. General advice is also provided regarding HIV management during cancer therapy, in addition to topics such as drug-drug interactions (DDI) between antiretroviral treatments and cancer therapies, initial workup, radiation therapy, surgical management, and supportive care.
This is a clinical practice guideline for survivors of childhood cancer. The guideline provides recommendations for the endocrine treatment of hypothalamic-pituitary and growth disorders in these patients. Specific conditions discussed include impaired linear growth, growth hormone deficiency, central precocious puberty, hypogonadotropic hypogonadism, and thyroid-stimulating hormone deficiency.
This is a clinical practice guideline on the testing for human papillomavirus (HPV) in patients with head and neck carcinomas. The guideline provides recommendations on the types of head and neck cancer that warrant HPV testing, testing methodologies, and how to report test results. Testing methodologies discussed include immunohistochemistry p16, polymerase chain reaction, and in situ hybridization. Outcomes of interest include negative predictive value and positive predictive value.
This clinical practice guideline discusses the prevention and management of chemotherapy induced nausea and vomiting (CINV) in pediatric cancer patients. Acute, delayed, anticipatory, breakthrough and refractory CINV are discussed. Recommendations are provided on assessment as well as pharmacological and non-pharmacological interventions. Antiemetic dosing recommendations are also provided.
This is a clinical practice guideline for adult cancer patients. The guideline examines the management cancer-related pain, and provides recommendations on treatment options such as non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and medical cannabis. The principles of pain management, and the treatment of mild, moderate, and severe pain are discussed, as is the invasive management of refractory pain.
This is a clinical practice guideline for children undergoing treatment for leukemia, or other forms of cancer. The guideline examines strategies for the prevention, assessment, and treatment of venous thromboembolism (VTE). Management of thrombocytopenia and coagulopathy, as well as therapy options for menstrual suppression, are also discussed.
This is a clinical practice guideline for patients with chronic lymphocytic leukemia (CLL). The guideline provides recommendations on treatment and supportive care for these patients. Specific topics discussed include the initial approach to patient management, clinical and molecular assessment prior to treatment, front-line therapies, treatment of extremely frail patients, maintenance therapy, management of relapsed or refractory CLL, and management of side-effects during targeted therapy.
This is a clinical practice guideline for patients with testicular germ cell tumours (GCTs). The guideline examines the clinical presentation, workup, primary treatment, and pathologic diagnoses of these patients. Separate recommendations are provided for different stages of pure seminomas and nonseminomas, and the guideline also discusses second-line and subsequent therapies for metastatic GCTs.
This is a clinical practice guideline for patients with non-small cell lung cancer. The guideline examines the risk factors, classification factors, diagnostic evaluation, pathologic evaluation, staging, predictive and prognostic biomarkers, treatment, and surveillance of lung cancer. Treatment approaches considered include surgery, radiation therapy, and combined modality therapy. The discussion on initial therapy is stratified by disease stage.
This is a clinical practice guideline for patients with chronic myeloid leukemia (CML). The guideline discusses diagnosis and workup, staging, and management options for these patients, and includes specific considerations for children with CML. The guideline separates treatment options based on characteristics such as genetic profile, and phase (i.e. chronic phase, accelerated phase, and blast phase). Topics discussed include toxicities and response milestones for different treatment options.
This is a clinical practice guideline for adults with muscle-invasive bladder cancer (MIBC). The guideline compares variations of imaging modalities for staging MIBC, such as x-ray, magnetic resonance imaging (MRI), fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), and computed tomography (CT). Outcomes of interest include diagnostic accuracy, sensitivity, specificity, and adverse health effects.
This is a clinical practice guideline for older patients with cancer. The guideline provides recommendations for comprehensive geriatric assessments, as well as treatment modalities such as surgery, radiation therapy (RT), chemotherapy, and targeted therapy. Disease-specific issues are also addressed for breast cancer, central nervous system cancers, gastrointestinal cancers, genitourinary cancers, gynecological cancers, head and neck cancers, lung cancers, melanoma, and hematologic malignancies.
This clinical practice guideline provides recommendations on the use of Mohs micrographic surgery (MMS) for adult patients diagnosed with skin cancer. MMS is compared to other surgical excision techniques, as well as other treatment modalities such as radiation. Guidance is provided on the indications and considerations for appropriate use of MMS, including disease stage, aesthetic outcomes, patient comorbidities, and patient preferences. Outcomes of interest include cure rate, recurrence rate, quality of life, and adverse events.
This is a clinical practice guideline for adult men who are at average risk of developing prostate cancer. The guideline examines screening methods for the early detection of prostate cancer for the purpose of reducing mortality. Outcomes of interest include prostate cancer incidence, mortality, quality of life, and the diagnostic performance of each of the tests, including the harms of testing (premature death and complications from both testing and biopsy).
This is a clinical practice guideline for patients who have been treated for non-metastatic renal cell carcinoma (RCC). The guideline examines the follow-up of these patients, and recommendations are provided for surveillance, clinical assessment, blood biochemistry tests, and imaging techniques.
This is a clinical practice guideline for asymptomatic adults who are at average risk of developing colorectal cancer (CRC). The guideline examines screening for CRC, and provides recommendations that are stratified by age.
This is a clinical practice guideline for patients with mantle cell lymphoma (MCL), a type of B-cell non-Hodgkin lymphoma (NHL). The guideline examines the management of these patients, and includes recommendations on first-line treatment, assessment of treatment response, and second-line treatment (and beyond). Autologous stem cell transplantation (ASCT) for patients with MCL is also discussed.
This is a clinical practice guideline for adult men with a suspicion or recent diagnosis of localized prostate cancer. The guideline examines staging, treatment options, and follow-up for these patients. Management is discussed for low, intermediate, and high-risk disease. Treatment options considered include variations of radical prostatectomy, brachytherapy, external beam radiotherapy, cryosurgery, and active surveillance.
This is a clinical practice guideline for patients with aggressive pituitary tumours and carcinomas, which provides recommendations on diagnosis, treatment, and follow-up. Treatment options such as surgery, radiotherapy, and temozolomide are examined. Further guidance on dosing regimens, adverse effects, discontinuation, and combination chemotherapies is provided for temozolomide. Recurrence, non-responders, and systemic metastasis are also discussed.
This is a clinical practice guideline for patients with adrenocortical carcinoma (ACC). The guideline examines the diagnostic criteria and management options for ACC. Topics of interest include a discussion of the best prognostic markers for ACC, treatment options including mitotane treatment, and supportive therapies.
This is a clinical practice guideline for hepatocellular carcinoma (HCC) occurring in adult patients with cirrhosis. The guideline examines techniques for surveillance and screening, diagnostic evaluation methods, and the various therapeutic options for the treatment of HCC. Outcomes of interest include the sensitivity and specific of screening tests, as well as morbidity, recurrence, and survival.
This is a clinical practice guideline for asymptomatic adults. The guideline discusses the screening of lung cancer using computed tomography (CT) scans. Different recommendations are provided based on age, as well as smoking status.
This is a clinical practice guideline for adults with a family history of nonhereditary colorectal cancer (CRC) or adenoma. The guideline discusses screening for CRC in these individuals, and provides specialized recommendations based on the number of affected relatives, whether or not the relatives have CRC or colorectal adenoma, the severity of the relatives' disease, as well as how related the relatives are to the patient (i.e. first degree versus second degree relatives).
This is a clinical practice guideline for adults with advanced-stage lung cancer. Recommendations are provided for the molecular analysis of lung cancers to guide treatment decisions with targeted inhibitors. The guideline examines the genes that should be tested for lung cancer patients, the methods that should be used to perform molecular testing, the appropriateness of molecular testing for lung cancers that do not have an adenocarcinoma component, the testing that is indicated for patients with targetable mutations who have relapsed on targeted therapy, and the role of testing for circulating cell-free DNA in lung cancer patients.
This is a clinical practice guideline for adults with suspected pancreatic cancer, or those with newly diagnosed or recurrent pancreatic ductal adenocarcinoma. The guideline provides recommendations for the monitoring of people with an inherited high risk of pancreatic cancer. Recommendations are also made for diagnosis, staging, psychological support, pain and nutrition management, as well as management for resectable, borderline resectable, and unresectable cancer.
This is a clinical practice guideline for adult patients with advanced cancer who are experiencing constipation due to diagnosis or treatment. The guideline discusses the assessment, diagnosis, and management of constipation in these patients. Specific recommendations are provided for managing constipation in older adults with cancer, opioid-induced constipation, and fecal impaction. Management options considered include prevention and self-care, laxatives, suppositories, and enemas.
This is a clinical practice guideline for adults with cancer who are at risk for, or have been diagnosed with, delirium. The guideline provides recommendations regarding delirium prevention, diagnosis, screening, treatment and experiential impact. Pharmacological and non-pharmacological interventions are discussed. Guidance is also provided on education and support for the healthcare team and family members.
This is a clinical practice guideline for children with suspected or confirmed transient leukemia of Down syndrome (TL-DS). The guideline examines the clinical features and diagnosis of TL-DS, outcomes, risk factors for early death, and treatment of TL-DS, as well as monitoring for resolution of TL-DS and development of myeloid leukemia of Down syndrome (MI-DS). Fetal TL-DS, silent TL-DS and screening for mutations in the hematopoietic transcription factor gene GATA1 are also discussed.
This is a clinical practice guideline for lung cancer screening in adult patients. The guideline discusses the risk factors for lung cancer, selection of individuals for screening based on level of risk, and the benefits and risks of lung cancer screening. The accuracy of low-dose computed tomography (LDCT), multiple nonsolid nodules, and the concept of shared decision-making are also considered, along with the cost-effectiveness of screening.
This is a clinical practice guideline for the identification and treatment of psychosocial problems in patients with cancer. The guideline examines screening tools for distress and meeting psychosocial needs, the initial evaluation and treatment by oncology teams, psychological/psychiatric treatment by mental health professionals, social work and counseling services, and spiritual and chaplaincy care. The Distress Thermometer (DT) is discussed as a useful clinical tool for self-assessing patient distress. Both the DT and the guideline itself use the term "distress" due to its lack of associated stigmatization when compared to terms such as psychosocial, psychiatric, or emotional.
This is a clinical practice guideline for patients with any type of cancer who are experiencing or are at high risk for experiencing nausea and/or vomiting due to treatment. The guideline examines treatment options for nausea and/or vomiting induced by radiation therapy (RT), chemotherapy, targeted therapy, and immunotherapy. In addition to antiemetic treatment options, the guideline discusses the emetogenic potentials of different anticancer therapies.
This is a clinical practice guideline for the management of soft tissue sarcoma (STS) in adult patients. The guideline pertains to the following five subtypes of STS: (1) STS of extremity, superficial/trunk, or head and neck, (2) retroperitoneal or intra-abdominal STS, (3) gastrointestinal stromal tumours (GISTs), (4) desmoid tumours, and (5) rhabdomyosarcoma (RMS). The guideline provides recommendations for diagnosis, staging, treatment, palliative care, and surveillance. Surgery, chemotherapy, and radiotherapy are all examined as treatment options.
A clinical practice guideline on the diagnosis, work-up, and treatment of patients who have been diagnosed with or are suspected of having primary cutaneous B-cell lymphomas (PCBCLs). The guideline focuses on the three main types of PCBCLs: primary cutaneous marginal zone lymphoma (PCMZL), primary cutaneous follicle-center lymphoma (PCFCL), and primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, leg type). Recommendations for treatment are provided based on lymphoma type and whether treatment is for initial, relapsed, or refractory disease.
This is a clinical practice guideline for patients with neuroendocrine or adrenal tumours. The guideline discusses the diagnosis, staging, treatment, and follow-up of patients with sporadic neuroendocrine tumours, originating from organs such as the lungs, thymus, and gastrointestinal (GI) tract. The guideline also examines the role of the genetic syndrome, multiple endocrine neoplasia (MEN), in developing parathyroid, pituitary, and pancreatic tumours.
This is a clinical practice guideline for malignant pleural mesothelioma (MPM). The guideline examines the clinical management options for these patients, which include surgery, radiation therapy (RT), and chemotherapy. The potential for multimodal therapy is also addressed.
This is a clinical practice guideline for patients with renal cell carcinoma (RCC). The guideline specifically examines the initial evaluation, staging, diagnosis, clinical management options, and follow-up of patients with clear cell carcinoma and non-clear cell carcinoma. Pharmacologic agents discussed include pazopanib, sunitinib, and nivolumab.
This is a clinical practice guideline for adults and children with gastric cancer. The guideline examines the pathology, initial workup, staging, treatment, follow-up, and supportive care of these patients. Treatment options discussed include lymph node dissection, laparoscopic resection, endoscopy, radiation therapy, combined modality therapy, chemotherapy (preoperative, perioperative, and postoperative), and targeted therapies.
This is a clinical practice guideline for adults with esophageal or esophagogastric junction cancer. The guideline examines the initial workup, histological staging, primary treatment, and follow-up of both squamous cell carcinoma and adenocarcinoma. Treatment modalities discussed include surgery, radiation therapy, combined modality therapy, chemotherapy, and targeted therapies.
This is a clinical practice guideline for the management of rectal cancer. The guideline provides recommendations regarding diagnosis, pathologic staging, surgical management, perioperative treatment, management of recurrent and metastatic disease, and patient surveillance. Outcomes of interest include safety and efficacy of treatment, adverse outcomes, and overall survival.
This is a clinical practice guideline for patients with acute myeloid leukemia (AML), including those with acute promyelocytic leukemia (APL). The guideline examines the initial evaluation of AML, risk stratifications based on cytogenetics and molecular markers, management options, as well as supportive care. Management strategies are separated based on whether patients are above or below sixty years of age.
This is a clinical practice guideline for asymptomatic men. The guideline discusses the appropriateness of periodic prostate-specific antigen (PSA) based screening for prostate cancer. Recommendations for screening are separated based on patient age.
This is a clinical practice guideline for the prevention and screening of skin cancer. Behavioural counselling recommendations are provided for young adults, adolescents, children, and parents of young children. Outcomes of interest include changes in sun protection behaviours, frequency of sunburn, and frequency of skin cancer.
This is a clinical practice guideline for women with an average risk of ovarian cancer. The guideline examines the benefits and harms of screening for ovarian cancer in these patients, including those of the screening test and of diagnostic evaluation. Screening tests considered include cancer antigen 125 (CA-125) screening and transvaginal ultrasound screening, on their own or combined. Outcomes of interest include ovarian cancer mortality, quality of life, false-positive rates, surgical complication rates, and the psychological effects of screening.
This is a clinical practice guideline for patients with cutaneous squamous cell carcinoma (cSCC). The guideline provides recommendations for the evaluation and management of patients with cSCC. Topics of interest include biopsy techniques and histopathologic assessment, tumour staging, surgical and non-surgical management, follow-up and prevention of recurrence, and management of advanced disease.
This is a clinical practice guideline for the management of febrile neutropenia in children, including those with cancer, and/or those who are undergoing hematopoietic stem cell transplantation (HSCT). The guideline examines the signs and symptoms of febrile neutropenia, as well as the evaluation of affected patients. Antibiotic selection and dose are recommended based on factors related to patient's condition, including stability on presentation, presence of penicillin allergy, and current treatment. Continued management of inpatients and management based on culture results are also discussed.
This is a clinical practice guideline for patients who are receiving systemic anticancer therapy. The guideline examines the management of infusion reactions (IRs), which can be either allergic reactions to foreign proteins, or non-immune-mediated reactions. Specific topics discussed include risk assessment, diagnosis, management, how to document an IR, drugs which may frequently cause IRs, and cases of rechallenge.
This is a clinical practice guideline for the diagnosis and treatment of patients with testicular cancer. The guideline examines the pathology of the illness, staging and classification systems, diagnostic evaluation, prognosis, disease management, and follow-up. Topics of interest include diagnostic tools, treatment with chemotherapy, and discussion of quality of life and long-term toxicities after curative treatment.
This is a clinical practice guideline for the management of muscle-invasive and metastatic bladder cancer. The guideline provides recommendations on prevention, staging, imaging, diagnosis, treatment, and follow-up. Treatment options such as neoadjuvant chemotherapy, radiotherapy, and radical surgery are discussed. Other topics of interest include risk factors, comorbidities, quality of life, and pelvic organ preservation techniques.
This is a clinical practice guideline discussing the treatment and prophylaxis of venous thromboembolism (VTE) in patients receiving treatment for solid (i.e. non-hematologic) tumours. The guideline examines the pharmacologic therapy and dosing options for both inpatients and ambulatory patients with established VTE or who are at risk for VTE (i.e. prophylaxis). The guideline also discusses common complications associated with antithrombotic therapy, as well as the follow-up of patients during its administration.
This is a clinical practice guideline on pneumococcal immunization for adult and pediatric cancer patients with solid tumours or hematologic cancers. The guideline provides recommendations on the type of vaccine and timing of immunization in relation to the type of treatment, therapy cycle, and severity of immunosuppression. Guidance is also provided on restrictions for immunization.
This is a clinical practice guideline for adult patients with desmoid tumours. The guideline provides recommendations for diagnosis, staging procedures, treatment, and follow-up. Treatment options including active surveillance, surgery, radiation therapy, and chemotherapy are examined. Topics of interest include desmoid tumours occurring during pregnancy, pain management, and rehabilitation.
This is a clinical practice guideline for adults with hepatocellular carcinoma (HCC). The guideline examines the goals of therapy, and provides recommendations for the treatment of patients with different stages of HCC, from very early stages to terminal stage. Outcomes of interest include rendering the patient free of disease, preventing recurrence, and improving quality of life.
This is a clinical practice guideline for adults with benign brain tumors. The guideline examines the appropriateness of stereotactic radiosurgery for treating these patients, as well as the appropriate dose for stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT). Recommendations are provided for benign brain tumors that can be treated with stereotactic radiotherapy, including vestibular schwannoma, pituitary adenomas, meningiomas, and other indications such as craniopharyngiomas and hemangioblastomas.
This is a clinical practice guideline discussing influenza immunization for adult and pediatric cancer patients. The guideline provides guidance on the timing of influenza immunization in relation to severity of immunosuppression and chemotherapy schedules, number of administrations, types of influenza vaccines, and contraindications and precautions for immunization. Recommendations for the immunization of family members and hospital or clinic staff are also provided.
This is a clinical practice guideline for the palliative care of patients with cancer. The guideline examines interventions such as symptom management, reassessment, and after-death care. The guideline provides an overview of the many considerations surrounding palliative care, such as cultural, ethical, legal, physical, psychological, social, spiritual, and existential issues.
This is a clinical practice guideline for women with vulvar cancer, and particularly those with squamous cell carcinoma (SCC) of the vulva. The guideline examines diagnosis and workup, as well as primary treatment, adjuvant radiotherapy and chemotherapy, and surveillance of these patients. Treatment options are discussed for early-stage disease, locally advanced disease, and metastases beyond the pelvis.
This is a clinical practice guideline for adults and children with acute leukemia (AL). The guideline examines laboratory testing for the initial workup of these patients, proper diagnosis, determination of prognostic factors, and possible future monitoring of ALs including acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and acute leukemias of ambiguous lineage. Specific topics addressed include the clinical and laboratory information that should be available during the initial evaluation, the appropriate specimens and sample types used, the types of tests that should be performed for all patients as well as for subsets of patients, the location of laboratory testing, and how test results and diagnosis should be correlated and reported.
This is a clinical practice guideline that informs primary care clinicians about the potential use of adjuncts to the conventional visual and tactile examination (CVTE) for the evaluation of lesions, including potentially malignant disorders (PMDs), in the oral cavity. The guideline examines the diagnostic test accuracy of cytologic testing, autofluorescence, tissue reflectance, vital staining, and salivary adjuncts. Outcomes of interest include incidence of oral cancer, oral cancer survival, and quality of life.
This is a clinical practice guideline for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) in pediatric cancer patients. The guideline provides recommendations on the use of pharmacological treatments for CINV, such as aprepitant and palonosetron. Outcomes of interest include CINV control rate and adverse events.
This clinical practice guideline provides recommendations on the follow-up of patients with endometrial cancer who are clinically disease free after receiving primary treatment. The guideline reviews symptomatic signs of possible recurrence. Recommendations are provided on follow-up intervals and diagnostic interventions, stratified by risk of recurrence.
This is a clinical guideline for the treatment of primary central nervous system diffuse large B-cell lymphoma (PCNS DLBCL). The guideline provides recommendations regarding chemotherapy and radiation therapy and the optimal regimens, radiation dose and schedule. Outcomes of interest include overall survival, measure of disease control (response rates and progression-free survival), and frequency of adverse events.
This is a clinical practice guideline for adults diagnosed non-metastatic cutaneous melanoma, located on the trunk, extremities, or head and neck. The guideline examines optimal excision margins and the use of sentinel lymph node biopsy (SLNB) in these patients. The recommendations are organized by location of melanoma on the body, and consider the thickness/depth of the melanoma. Outcomes of interest include recurrence rate, survival rate, morbidity, and rate of sentinel lymph node positivity.
This clinical practice guideline provides recommendations on the referral of patients with signs and/or symptoms of colorectal cancer (CRC) by family physicians and other primary care providers. The guideline reviews signs, symptoms, and other clinical features that may be indicative of CRC and that warrant additional investigation. Referral wait time recommendations are provided, along with recommendations to reduce diagnostic delay. Additionally, known risk factors that increase the likelihood of CRC in patients with signs and/or symptoms of CRC are reviewed.
This is a clinical practice guideline for women with average risk and high risk for ovarian cancer. The guideline examines the role of imaging during ovarian cancer screening, and its effectiveness in detecting ovarian cancer at an early stage, in order to potentially improve survival. Variations of procedures, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography using fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG-PET), are discussed, as is their appropriateness in different clinical situations.
This is a clinical practice guideline for men and adolescents with hematospermia or hemospermia. The guideline discusses imaging techniques such as transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI), and their use in the identification of hematospermia's etiology. The guideline examines the appropriateness of different imaging techniques based on patient age, severity of bleeding, and presence of other relevant symptoms.
This clinical practice guideline is an endorsement of the American Society for Radiation Oncology's 2017 guideline titled Radiation Therapy for Oropharyngeal Squamous Cell Carcinoma: Executive Summary of an Astro Evidence-Based Clinical Practice Guideline. The guideline examines the use of radiation therapy (RT) for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). The guideline discusses the indications for RT as both a primary method of treatment, and as post-operative adjuvant therapy. Appropriate dose, fractionation, and volume regimens for RT with and without systemic therapy are also discussed, in addition to an examination of induction chemotherapy in patients with OPSCC.
This is a clinical practice guideline for the management of localized prostate cancer. The guideline provides a clinical framework stratified by cancer severity to guide the care plan and reviews management options including active surveillance, observation/watchful waiting, prostatectomy, radiotherapy, cryosurgery, high intensity focused ultrasound (HIFU), and focal therapy. Shared decision making is highlighted, and guidance is provided on outcome expectations and management.
This is a clinical practice guideline for the management of patients with clinically localized small renal masses (SRM). The guideline examines management options for small renal masses, which includes biopsies, active surveillance for patients with significant comorbidities and limited life expectancy, partial nephrectomy (PN), percutaneous thermal ablation, radical nephrectomy, and referral to a nephrologist. Outcomes of interest include recurrence-free survival, disease-specific survival, and overall survival.
This is a provisional clinical opinion (PCO) for chemotherapy-naive men with castration-resistant prostate cancer (CRPC). This PCO examines second-line hormonal therapy and provides recommendations on staging, treatment, follow-up, and palliative care for men with CRPC. Outcomes of interest include overall survival, adverse events, quality of life, and treatment efficacy (defined as response in prostate-specific antigen values).
This is a clinical practice guideline for adult and pediatric patients who receive antineoplastic agents or radiation therapy for cancer. The guideline examines important developments in antiemetic management options for patients undergoing the above treatments. Comparisons are made between antiemetic management options on the basis of potential benefits, potential harms, and quality of evidence. Outcomes of interest include new evidence regarding antiemetic efficacy and new antiemetic management options.
This is a clinical practice guideline for the prevention and treatment of cancer-related infections in neutropenic and immunocompromised non-neutropenic patients with cancer. This guidelines aims to provide an overview of the risk categorization and recommended strategies for prevention of infections in high-risk patient populations, as well as monitoring in patients with signs and/or symptoms of infections. Outcomes of interest include a finding that advances in treatment further emphasize the need for multidisciplinary care.
This is a clinical practice guideline for patients with Waldenström's macroglobulinemia or lymphoplasmacytic lymphoma. The guideline examines the diagnosis, workup, primary treatment regimens, assessment of response to primary treatment, and follow-up after primary treatment. Regimens not toxic to stem cells and regimens with potential or unknown toxicity to stem cells are considered. Treatment of Immunoglobulin M (IgM) related peripheral neuropathy, maintenance therapy, and therapy for previously treated Waldenstrom's macroglobulinemia are also discussed.
This is a clinical practice guideline for patients with hairy cell leukemia. The guideline provides recommendations regarding diagnosis, initial treatment, response assessment and additional therapy, second-line therapy for relapsed/refractory or progressive disease, and supportive care. The impact of infections, such as hepatitis B (HBV) is also discussed.
This clinical practice guideline is an adaptation of Cancer Care Ontario’s 2016 guideline titled Interventions to Address Sexual Problems in People With Cancer. The guideline examines the effectiveness of pharmacological interventions, psychosocial counseling, or devices to manage sexual problems experienced after cancer treatment. Recommendations are based on patient gender, and condition. Specific topics discussed are sexual response, body image (women), intimacy/relationships, overall sexual functioning and satisfaction, vasomotor symptoms, genital symptoms (women) and genital changes (men).
This guideline provides recommendations on use of vertebroplasty or kyphoplasty as treatment options for cancer patients with vertebral compression fractures. The guideline outlines clinical criteria for when vertebroplasty, kyphoplasty, or focal tumour ablation (FTA) assisted vertebroplasty/kyphoplasty should be performed, and provides recommendations on selecting the most appropriate procedure. The role of radiation treatment, absolute contraindications, and service provider requirements are also discussed.
This clinical practice guideline is an endorsement of the American Thyroid Association's 2015 guideline titled Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The guideline provides recommendations on management of patients thyroid nodules and differentiated thyroid cancers. Topics include evaluation of thyroid nodules to determine the presence of malignancy, and management of differentiated thyroid cancer including surgery, radioactive iodine (RAI) therapy, hormonal therapy, external beam radiation therapy (EBRT), and systemic treatment.
This is a clinical practice guideline for adults who have completed treatment and have been cured of cancer. The guideline examines different models of follow-up care, organized both by clinical setting, and by which health professionals are responsible for the coordination of care. The appropriateness of different models of care for different types of cancer is discussed, with focuses on clinical outcomes (e.g. surveillance, recurrence) and quality of life outcomes (e.g. quality of life, patient satisfaction).
This is a clinical practice guideline for adult males with potentially curable prostate cancer. The guideline examines surgical procedures and outcomes for radical prostatectomy (RP), while specifically addressing the extent of resection, acceptable positive margins, nerve-sparing techniques, pelvic lymph node dissection (PLND), and the recommended procedures for handling and processing RP specimens. Incontinence, erectile dysfunction, rectal injury, and blood transfusion are discussed as surgical complications that need to be limited.
This is a clinical practice guideline for women and men of all ages who are experiencing nipple discharge. The guideline discusses different imaging modalities used to identify the causes of nipple discharge, such as mammography, digital breast tomosynthesis, ultrasound (US), magnetic resonance imaging (MRI) with or without intravenous (IV) contrast, fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission mammography (FDG-PEM), Tc-99m sestamibi molecular breast imaging (MBI), and ductography. In addition, image-guided core biopsy and image-guided fine needle aspiration are discussed as options for histologic diagnosis once suspicious lesions are identified. The guideline examines the appropriateness of these techniques for five clinical situations that are based on sex, age, and whether or not discharge is physiologic or pathologic.
This is a clinical practice guideline for patients with locally advanced invasive breast cancer who are being treated with, or considered for, neoadjuvant systemic therapy. The guideline examines imaging methods used to monitor responses to neoadjuvant systemic therapy, from pre-treatment to post-treatment. Digital mammography, digital breast tomosynthesis, ultrasound (US), and magnetic resonance imaging (MRI) are discussed as the key imaging modalities used.
This is a clinical practice guideline that examines the use of radiation therapy (RT) for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). The guideline discusses the indications for RT as both a primary method of treatment, and as post-operative adjuvant therapy. Appropriate dose, fractionation, and volume regimens for RT with and without systemic therapy are also discussed, in addition to an examination of induction chemotherapy in patients with OPSCC.
This is a clinical practice guideline for women with recurrent epithelial ovarian cancer (EOC), including fallopian tube and primary peritoneal cancers. The guideline examines the most up-to-date systemic therapy treatment recommendations for recurrent EOC in order to promote evidence-based practice in Ontario. Outcomes of interest include improvements in progression-free survival and symptom control.
This is a clinical practice guideline for patients with breast cancer. The guideline examines the use of integrative therapies for specific clinical indications during and after breast cancer treatment. The integrative therapies discussed in the guideline address anxiety/stress, depression/mood disorders, fatigue, quality of life/physical functioning, chemotherapy-induced nausea and vomiting, lymphedema, chemotherapy-induced peripheral neuropathy, pain, and sleep disturbance.
This is a clinical practice guideline for patients with multiple myeloma (MM). The guideline provides recommendations for the prevention and management of organ health-related toxicities, and gives best practice recommendations for optimal nursing care of this patient population. Specific outcomes examined include myeloma-induced renal impairment, gastrointestinal symptoms, and peripheral neuropathy.
This is a clinical practice guideline for adults who have been diagnosed with or are suspected of having basal cell carcinoma (BCC). The main focus of the guideline is on the most common approaches for the treatment of primary BCC, but it also includes recommendations on the treatment of recurrent tumours, appropriate biopsy techniques, staging, follow-up, and prevention of BCC.
This is a clinical practice guideline for asymptomatic Canadian men. The guideline provides recommendations on the current best practices for prostate cancer screening and early diagnosis, and provides information on new and emerging diagnostic modalities.
This is a clinical practice guideline for the prevention and management of constipation in pediatric cancer patients. Pharmacological and non-pharmacological treatment options (including dosing recommendations) are discussed. The management of refractory opioid-induced constipation is also examined.
This is a clinical practice guideline on the use of fecal immunochemical testing (FIT) in colorectal cancer screening. Guidance is provided on the application of FIT and FIT-based screening programs, including recommendations on the number of tests, screening intervals and cut-off values. The guideline also compares the effectiveness of FIT relative to other colorectal screening tests. Outcomes of interest include sensitivity, specificity and adherence rates.
This is a clinical practice guideline for the screening of colorectal cancer. Recommendations are provided for specific screening tests, and for the various approaches used to determine when and to whom screening should be offered. Screening tests discussed include colonoscopy, fecal immunochemical test, and computed tomography (CT) colonography. Cost issues, quality of screening, practical considerations, and family history are also discussed.
This is a clinical practice guideline for patients with leptomeningeal metastases from solid tumours. The guideline discusses the diagnosis, treatment, and follow-up of these patients, and a treatment algorithm is presented based on life expectancy. Treatment options examined include systemic pharmacotherapy, intra-cerebrospinal fluid pharmacotherapy, focal radiotherapy (RT), and whole brain radiotherapy (WBRT).
This is a clinical practice guideline for the management of urothelial carcinoma of the upper urinary tract (UTUC). The guideline provides recommendations on diagnosis, staging, treatment, and follow-up. Prognostic factors, predictors of survival and recurrence, as well as risk stratification are also discussed. Outcomes of interest include diagnostic accuracy, overall survival, recurrence rates, and adverse effects.
This is a clinical practice guideline for patients with myeloma. The guideline examines the screening and management of physical and psychosocial consequences in these patients following completion of treatment. Recommendations are provided for long-term physical consequences, including infection and immunity, renal and urogenital complications, bone, endocrine and metabolic disorders, neurological and eye complications, cardiovascular and respiratory complications, dental and oral hygiene, gastroenterological and nutritional problems, and second primary malignancies. Psychosocial and rehabilitation considerations such as frailty, patient concerns and information provision, psychological well-being, pain and fatigue, and physical fitness and functionality are also discussed.
This is a clinical practice guideline for adult patients with soft-tissue sarcoma who are being considered for chemotherapy. The guideline provides recommendations for staging procedures and classifications, as well as treatment options based on staging results and other risk factors. Treatment options including surgery, systemic therapy, radiation therapy, and chemotherapy are discussed. Outcomes of interest include adverse events, performance status, progression-free survival, and overall survival.
This is a clinical practice guideline for adult patients with head and neck cancer. The guideline examines oral and dental care assessment and management of patients before, during, and after cancer treatment. Topics addressed include pain, xerostomia, speech and swallowing disorders, oral hygiene, and functional capacity. The primary outcome of interest is quality of life.
Tailored to the unique needs and concerns of patients with all types of cancer, this clinical practice guideline provides standard-of-care recommendations, techniques, and strategies on smoking cessation. The guideline outlines different interventions, including pharmacotherapy options (e.g. nicotine replacement therapy, varenicline, bupropion, nortriptyline, clonidine), motivational strategies and behaviour techniques, and alternative treatment approaches such as electronic cigarettes and other electronic nicotine delivery systems.
This is a clinical practice guideline for the assessment of patients who are at high risk for colorectal cancer due to genetic or familial factors. The guideline provides recommendations for the management of patients with high-risk syndromes, including Lynch syndrome, familial adenomatous polyposis (FAP), Peutz-Jeghers syndrome (PJS), Juvenile Polyposis Syndrome (JPS), Serrated Polyposis Syndrome (SPS), and other high-risk syndromes associated with colorectal cancer risk.
This is a clinical practice guideline for adult patients with early stage colon cancer. The guideline discusses diagnostic work-up, staging, and treatment options. Recommendations for adjuvant chemotherapy are presented, based on cancer stage.
This is a clinical practice guideline for the prevention and treatment of cancer-related infections. The guideline examines external risk factors for infection, major host factors that predispose patients to infectious diseases, prevention of infectious complications (including the use of antimicrobial prophylaxis and preemptive therapy), management of neutropenic fever, and management of site-specific infections such as pneumonia, abdominal infections, and catheter-associated infections.
This is an update to the American Society for Radiation Oncology's evidence-based consensus statement on accelerated partial breast irradiation (APBI). The focus of the update centers on the selection criteria for APBI and intraoperative radiation therapy (IORT) for partial breast irradiation outside of a clinical trial.
This is a clinical practice guideline for squamous cell skin cancer. Basal cell and squamous cell skin cancers, collectively known as non-melanoma skin cancers (NMSCs), are the most common cancer in the United States. The guideline provides recommendations related to clinical presentation and workup, local treatment, recurrence and metastasis, and follow-up. The guideline also provides a discussion about risk stratification and common risk factors including age, degree of differentiation, and site of prior radiotherapy.
This is a clinical practice guideline for adults and children with cancer-induced anemia (CIA). The guideline discusses the etiology of CIA, and examines the screening, evaluation, and treatment methods for reducing CIA in affected patients. Red blood cell transfusion, erythropoietic therapy, and iron monitoring and supplementation are discussed as treatment options.
This is a clinical practice guideline for patients who may be at high-risk for developing breast and ovarian cancer due to genetic/familial predispositions. The guideline provides recommendations on genetic risk assessment and genetic counseling, and specifically discusses the management of individuals with hereditary breast or breast/ovarian syndromes, including BRCA-related breast/ovarian cancer syndrome, Li-Fraumeni syndrome, and Cowden syndrome.
This is a clinical practice guideline for women with cervical cancer. The guideline examines the initial diagnosis and workup, staging, primary and adjuvant treatment, surveillance, and therapy following relapse for these patients. Treatment for metastatic disease is also discussed, as are the topics of incidental cervical cancer and the occurrence of cervical cancer in pregnant women.
This is a clinical practice guideline for patients with AIDS-related Kaposi sarcoma. The guideline examines diagnosis, staging, treatment, and follow-up, while also providing recommendations on HIV screening and HIV therapy during cancer treatment. Antiretroviral therapy (ART), topical therapies, intralesional chemotherapy, local incisions, radiation therapy, and systemic therapy are all discussed as treatment options.
This is a clinical practice guideline for adults with melanoma. The guideline examines the use of sentinel lymph node (SLN) biopsy as a method for identifying nodal metastases, and provides recommendations on which patients should receive SLN biopsy based on the size and morphology of their melanoma. The guideline also discusses the appropriateness of completion lymph node dissection (CLND) as a method of treatment.
This is a clinical practice guideline for adults with Stage I to IV gastric cancer (specifically gastric adenocarcinoma) who are being considered for surgery. The guideline examines the optimal techniques to adequately stage gastric cancer, and the optimal techniques of gastric cancer surgery with curative intent. The guideline also considers indications for surgery for Stage IV gastric cancer in asymptomatic and symptomatic patients, and the relationship between surgical volumes and outcomes.
This recommendation report addresses "best practices" for prostate needle biopsies. Guidance is provided on the spectrum of prostate needle biopsy practices, including patient preparation, biopsy techniques, specimen submission to the laboratory, processing of the biopsy specimen, information to include on the requisition and pathology report, and operational issues. Facility requirements are also reviewed.
This is a clinical practice guideline for adult patients with clinical or pathological stage III non-small cell lung cancer (NSCLC). The guideline provides recommendations for the treatment of NSCLC by comparing treatment options such as chemotherapy, radiotherapy, and surgery. Outcomes of interest include adverse effects, overall survival, progression-free survival, quality of life, and local control.
This is a clinical practice guideline for screening women who may be at risk of having breast cancer. The guideline examines effective screening methods, particularly focusing on mammography, digital breast tomosynthesis (DBT), magnetic resonance imaging (MRI), and ultrasound (US). Outcomes of interest include disease progression, screening sensitivity, and screening accuracy.
This clinical practice guideline is an endorsement of the American Society for Radiation Oncology's 2017 guideline titled Evidence-Based Guideline for Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer. The endorsement examined new evidence and modified the guideline recommendations on the use of SBRT. Shared decision-making and implementation are discussed. Outcomes of interest include survival, quality of life, toxicity, pain and other adverse events.
This is a clinical practice guideline for the use of stereotactic body radiation therapy (SBRT) for patients with early-stage non-small cell lung cancer (NSCLC). The guideline examines the evidence for SBRT for early-stage NSCLC and offers guidance towards its use in challenging clinical scenarios. Outcomes of interest include survival, quality of life, toxicity, pain, and other adverse events.
A clinical practice guideline for asymptomatic, nonpregnant adult women. The guideline discusses pelvic examination as a screening method for gynecological conditions such as bacterial vaginosis, candidiasis, genital warts, genital herpes, trichomoniasis, pelvic inflammatory disease, cervical polyps, endometriosis, ovarian cysts, dysfunction of the pelvic wall and floor, and uterine fibroids, in addition to ovarian, uterine, and vaginal cancer. This guideline does not address the screening of cervical cancer, gonorrhea, or chlamydia.
This is a clinical practice guideline for patients with localized renal masses that are suspicious for renal cell carcinoma. The guideline discusses the evaluation, diagnosis, staging, and management of these renal masses. The management options discussed include partial nephrectomy, radical nephrectomy, thermal ablation, and active surveillance.
This is a clinical practice guideline discussing adjuvant therapy for adult patients with non-small cell lung cancer (NSCLC). The guideline specifically examines the appropriateness of adjuvant systemic therapy versus adjuvant radiation therapy in adults with completely resected stage I-IIIA NSCLC. Recommendations are made based on disease stage, as well as other factors such as tumour size, genetics, and histology.
This is a clinical practice guideline for patients with newly diagnosed prostate cancer who require or choose active treatment, and are not receiving active surveillance by choice or lack of suitability. The guideline examines the efficacy of brachytherapy, as compared to and combined with external beam radiation therapy (EBRT) and radical prostatectomy (RP). The guideline also considers which isotopes should be used for low-dose rate (LDR) brachytherapy to maximize clinical outcomes.
This is a clinical practice guideline for patients with early or locally advanced (nonmetastatic) breast cancer. The guideline examines the use of bisphosphonates and other bone-modifying agents as adjuvant therapy in patients with breast cancer. Outcomes of interest include recurrence and survival, with focus on the dependency of effectiveness on age or menopausal status.
This is a clinical practice guideline for oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. The guideline examines the core communication skills and tasks that apply across the continuum of cancer care. Topics include the discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills.
This is a clinical practice guideline for merkel cell carcinoma. Merkel cell carcinoma is a rare, aggressive cutaneous tumor that combines the local recurrence rates of infiltrative non-melanoma skin cancer along with the regional and distant metastatic rates of thick melanoma. This guideline provides recommendations for diagnosis and workup, staging, treatment, follow-up and recurrence. Treatment recommendations include surgery, sentinel lymph node biopsy, radiation therapy, and chemotherapy as possible options.
This is a clinical practice guideline for adults with myeloma. The guideline examines the use and technical application of the latest imaging modalities at diagnosis and in the follow-up of patients with myeloma and plasmacytoma. Plain X-rays, whole body low-dose computed tomography (WBLDCT), and whole body magnetic resonance imaging (WB-MRI) are imaging techniques that are focused on.
This is a clinical practice guideline for patients with thyroid cancer. The guideline examines the diagnosis, treatment, management, and follow-up of these patients. Topics of interest include a shift towards a standardized ultrasound/cytologic concordance system to guide investigation and management of thyroid nodules, acceptance of thyroid lobectomy as an option for many low risk thyroid cancers, acceptance of either no or lower dose radio-iodine treatment for many low risk thyroid cancers, and dynamic risk stratified follow-up for thyroid cancer.
This is a clinical practice guideline for adults with cancer-related fatigue. The guideline examines the appropriate screening, assessment, and management of these patients. Interventions discussed include pharmacological management, physical activity, functional and occupational therapy interventions, psychosocial and educational interventions, complementary therapies, nutrition, and management of anemia. Recommendations are provided based on the severity of fatigue.
This is a clinical practice guideline for the management of adult patients with adenocarcinoma of the pancreas. The guideline provides recommendations on diagnostic work-up, staging, and treatment options based on stage of cancer. Specific topics discussed include management recommendations for unresectable adenocarcinoma, and toxicity-associated dose modification. Outcomes of interest include adverse events, overall survival, and quality of life.
This is a clinical practice guideline for patients with actinic keratosis (AK). The guideline provides recommendations on treatment options such as topical therapies, cryosurgery, surgery, systemic therapy, photodynamic therapy, laser therapy, and combination treatment. Diagnosis and follow-up are also discussed.
This is a clinical practice guideline for adult patients with solid tumour malignancies. The guideline provides recommendations for administering influenza vaccines to these patients. The timing of vaccination, and for whom vaccination is appropriate, are both discussed.
This is a consensus statement providing recommendations to assist health care providers with the appropriate management of patients with biallelic mismatch repair deficiency (BMMRD) syndrome, also called constitutional mismatch repair deficiency syndrome. The guideline outlines what is known about BMMRD, the unique genetic and clinical aspects of the disease, and reviews the current management approaches taken.
This is a clinical practice guideline for patients with head and neck cancer. The guideline examines the optimal perioperative care for patients undergoing head and neck cancer surgery with free flap reconstruction. Specific topics discussed include preadmission education, perioperative nutritional care, preoperative nutritional status, nutritional formulae, prophylaxis against thromboembolism, and antibiotic prophylaxis.
This is a clinical practice guideline for lung cancer screening in adult patients. The guideline reviews risk factors for lung cancer and provides recommendations on selecting high-risk individuals for screening, guidance on choice of screening modalities with specific review of low dose computed tomography (LDCT), and recommendations on the evaluation and follow-up of nodules found during screening. Additionally, the benefits and risks of screening are discussed.
This is a clinical practice guideline for patients with epithelial occult primary cancer. The guideline provides recommendations for the evaluation, workup, management, and follow-up of two pathologic diagnoses in patients with epithelial occult primary cancer: adenocarcinoma, or carcinoma not otherwise specified (NOS), and squamous cell carcinoma (SCC). Management options considered include, chemotherapy, radiation therapy, locoregional therapeutic options, and specialized approaches, as well as supportive care and management of psychosocial distress.
This is a clinical practice guideline for patients with myeloproliferative neoplasms. The guideline specifically examines the diagnosis, risk-stratification, treatment, and supportive care for patients with polycythemia vera (PV), essential thrombocythemia (ET) and myelofibrosis (MF). Risk-stratified treatment algorithms are provided for each disorder.
This is a clinical practice guideline for patients with colorectal cancer, breast cancer, or cancers of the aerodigestive tract, who are being considered for treatment with fluoropyrimidines (5-fluorouracil and capecitabine). The guideline provides recommendations for the interpretation of clinical dihydropyrimidine dehydrogenase (DPYD) genotype tests so that the results can be used to guide fluoropyrimidine dosage. The primary outcome of interest is reduced toxicity among individuals with subnormal DPYD metabolism.
This is a clinical practice guideline for adults and children with hematologic malignancies, solid tumours, or hypoproliferative thrombocytopenia. The guideline examines when and how clinicians should use platelet transfusion to prevent or manage bleeding in these patients. Recommendations are made on topics such as the preparation of platelet products, the prevention of Rhesus (Rh) alloimmunization, and platelet transfusion thresholds for patients with different conditions.
This is a clinical practice guideline for the empirical management of fever and neutropenia (FN) in children with cancer, and those who have received hematopoietic stem-cell transplantation (HSCT). The guideline examines initial presentation, ongoing management, and empirical antifungal therapy. Topics of interest include risk stratification to define patients with high-risk invasive fungal disease (IFD), recommended biomarkers and radiologic investigations for the evaluation of IFD in prolonged FN, and empirical antifungal therapy in IFD low-risk patients with prolonged FN.
This is a clinical practice guideline for adult female patients diagnosed with advanced stage or recurrent endometrial cancer (excluding sarcomas and squamous cell carcinomas) or uterine papillary serous carcinoma. The guideline examines chemotherapeutic and hormonal therapy options for patients with these cancers. Outcomes of interest include improved response rates and survival.
This recommendations report provides guidance on the investigation and management of suspected or proven pelvic and extra-pelvic gynecologic sarcomas. Recommendations are made on the use of pathology during investigation, while recommendations pertaining to treatment focus on surgery and adjuvant therapy. The guidance document also provides recommendations on a number of quality assurance measures to assess gynecologic sarcoma services.
This clinical practice guideline is a focused update of the American Society of Clinical Oncology's 2016 guideline titled American Society of Clinical Oncology Clinical Practice Guideline Update: Recommendations on the Role of Bone-modifying Agents in Metastatic Breast Cancer. The guideline examines the role of bone-modifying agents (BMAs) in the treatment of patients with metastatic breast cancer, while specifically focusing on the intervals between doses of zoledronic acid, and the use of BMA's to control pain secondary to bone metastases. In addition to zolendronic acid, BMA's compared include denosumab, and pamidronate.
This is a clinical practice guideline for the assessment of liver metastases. The guideline provides recommendations regarding the appropriateness of imaging modalities and the optimization of imaging parameters for specific clinical scenarios, including diagnosis, staging, and surveillance. Outcomes of interest include accuracy in characterizing and detecting liver lesions, length of examination, and potential adverse health effects, as well as surveillance sensitivity, specificity, and reproducibility.
This is a clinical practice guideline for adult men with prostate cancer or clinically suspected prostate cancer. The guideline examines the various imaging modalities that can be effectively used to manage these patients, during initial diagnosis, staging, and active surveillance. Variations of imaging modalities such as transrectal ultrasound (TRUS), magnetic resonance imaging (MRI), and computed tomography (CT) are discussed, and the appropriateness of different techniques is examined for different clinical situations.
This is a clinical practice guideline for adults and children with pancreatic ductal adenocarcinoma. Different variations of imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) are discussed. The guideline examines the appropriateness of these techniques for two clinical situations: during initial staging before treatment, and following neoadjuvant therapy to evaluate tumour resectability for borderline resectable tumours.
This is a clinical practice guideline for the screening and treatment of thyroid cancer in asymptomatic adults. The guideline examines the accuracy of screening for thyroid cancer, and the harms of screening and/or treating thyroid cancer, such as overdiagnosis. Outcomes of interest include thyroid-specific morbidity and mortality, general mortality, and quality of life.
This clinical practice guideline is a focused update of the American Society of Clinical Oncology's 2016 guideline titled Potentially Curable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. The update focuses solely on new evidence that pertains to clinical question 4 of the guideline: What is the appropriate adjuvant regimen for patients with pancreatic cancer who have undergone an R0 or R1 resection of their primary tumour? Outcomes of interest include treatment efficacy, and improved survival.
This is a clinical practice guideline for patients with stage IV non-small-cell lung cancer (NSCLC). The guideline provides recommendations on systemic therapy options for NSCLC such as standard chemotherapy, immune checkpoint therapy, antibody therapy and other drug classes and treatment settings. Outcomes of interest include therapeutic efficacy, adverse effects, overall survival and quality of life. The guideline also discusses health disparities and multiple chronic conditions and provides recommendations on managing these barriers.
This is a clinical practice guideline for the management of non-metastatic muscle-invasive urothelial bladder cancer in adults. The guideline examines the initial evaluation, treatment, follow-up, and survivorship of affected patients, and discusses approaches to counseling and the role of patient preferences throughout. Specific treatment options considered include neoadjuvant and adjuvant chemotherapy, radical cystectomy, pelvic lymphadenectomy, and bladder preserving approaches such as maximal transurethral resection of bladder tumours, partial cystectomy, primary radiation therapy, and multi-modal bladder preserving therapy.
This is a clinical practice guideline for patients with renal cell carcinoma (RCC). The guideline examines the clinical management of RCC, including diagnosis, treatment, and follow up. The primary outcomes of interest are survival, recurrence, and quality of life.
This is a clinical practice guideline for adult patients with four or fewer brain metastases. The guideline examines the important prognostic factors for assessing and managing these patients, the role of surgery and radiotherapy in the management of oligometastatic disease, and the appropriate follow-up and surveillance strategy. Treatments considered include whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS), both alone and in conjunction.
This is a clinical practice guideline for patients diagnosed with colon cancer. The guideline examines the evaluation, staging, and treatment of these patients. Surgical treatment of the primary tumour is discussed, as well as treatment of tumour-related emergencies, management of stage 4 disease, management of locoregional recurrence, documentation, and adjuvant therapy.
This is a clinical practice guideline for patients with Lynch syndrome (LS). The guideline examines screening, prevention, and treatment of cancer in these patients. Specifically, screening tests for endometrial, ovarian, gastric, small intestinal, pancreatic, breast, and prostate cancers, as well as cancers of the urinary tract, are discussed. Prophylactic hysterectomy and oophorectomy, tumour testing, germline testing, and LS management are also examined.
This is a clinical practice guideline for adult patients with renal cell carcinoma (RCC). The guideline examines the staging, diagnosis, prognosis, treatment, and follow-up of these patients. Management recommendations are provided for treating localized RCC, locally advanced RCC, advanced/metastatic RCC, and recurrent RCC. The epidemiology, etiology, and pathology of RCC are also discussed.
This is a clinical practice guideline for the management of non-muscle-invasive bladder cancer. Recommendations are provided for diagnosis, staging, treatment, and follow-up. The guideline also discusses how to predict the short-term and long-term risks of disease recurrence and progression, as well as the stratification of patients into risk groups. Treatment options are presented based on these risk groups. Management of side effects is also discussed.
This clinical practice guideline is part three of a series focusing on the management of pancreatic cancer (PC). The guideline focuses on the neoadjuvant and induction therapies for PC and locally advanced pancreatic cancer (LAPC). Comparisons are made between the clinical effectiveness of neoadjuvant treatment with chemotherapy, radiotherapy or both.
This is a clinical practice guideline for patients with thyroid nodules. The guideline provides recommendations on molecular fine-needle aspiration (FNA) cytology diagnostics, and discusses topics such as the use of microarray gene expression classifier (GEC) tests, mutation panel assessments, and targeted next-generation sequencing (tNGS). Outcomes of interest include reductions in diagnostic lobectomies, and improved surgical decision-making.
This is a clinical practice guideline for the management of venous thromboembolism (VTE) and cardiovascular disease (CVD) in patients with multiple myeloma. The guideline provides recommendations on assessment, diagnosis, prevention, treatment, and follow-up for VTE and CVD. Risk factors and risk stratification for VTE and CVD are discussed. The guideline also highlights multiple myeloma treatments with side-effects related to VTE and CVD.
This is a clinical practice guideline for patients who have been diagnosed with breast cancer. The guideline examines breast reconstruction, specifically reconstruction with deep inferior epigastric perforator (DIEP) flap and pedicled transverse rectus abdominis musculocutaneous (TRAM) flap, to treat breast defects in these patients, which may be a result of mastectomy. Outcomes of interest include clinical complications and patient satisfaction.
This is a clinical practice guideline for patients with colorectal polyps. The guideline examines the use of polypectomy and endoscopic mucosal resection (EMR) in colonoscopy and for colorectal cancer (CRC) prevention. Polyp classification, polypectomy for polyps smaller than 20mm, EMR for polyps 20mm or larger, technical considerations, adverse events, and histopathology are discussed.
This is a clinical practice guideline for children with cancer who are receiving chemotherapy and/or radiation therapy. Recommendations are provided for the prevention of mucositis through oral care management, and various treatment options are considered for the management of mucositis in affected patients. The guideline also lists the risk factors for mucositis, and provides an oral assessment tool.
This is a clinical practice guideline for pediatric cancer patients who are receiving chemotherapy. Guidance is provided for the diagnosis and treatment of chemotherapy-induced diarrhea in these patients. Risk factors, grading of diarrhea, dietary modifications during diarrhea, and anti-diarrheal agents are also discussed.
This is a clinical practice guideline for adult patients with prostate cancer. The guideline examines the screening, diagnosis, staging, treatment, and follow-up of these patients. Treatment options considered include deferred treatment, radical prostatectomy, definitive radiotherapy, and hormonal therapy. Management of metastatic prostate cancer, prostate cancer in older men, prostate-specific antigen-only recurrence after treatment, and castration-resistant prostate cancer are also discussed, as well as the epidemiology and etiology of prostate cancer, and quality of life outcomes.
This is a clinical practice guideline for patients with primary urethral carcinoma (UC). The guideline provides recommendations on the diagnosis and treatment of UC. Staging and classification systems for UC are also discussed. Outcomes of interest include detection rate, overall survival, complications, and toxicity.
This clinical practice guideline is part two of a series focusing on the management of pancreatic cancer (PC). The guideline focuses on the diagnosis of pancreatic cancer, and provides recommendations regarding imaging tests such as endoscopic ultrasound (EUS), positron emission tomography (PET), and laparoscopy. The use of serum biomarkers during diagnostic work-up, and tests to assess curative resectability of pancreatic tumours, are also discussed.
A clinical practice guideline on the diagnosis, staging, treatment and management of adult patients who are suspected of having, or have been diagnosed with, chronic myelogenous leukemia (CML). Treatment options examined include the use of tyrosine kinase inhibitors (TKIs) such as imatinib, nilotinib, dasatinib, bosutinib, and ponatinib, as well as allogeneic stem cell transplant (SCT) and Interferon-a (IFNa). Special consideration is paid to the use of TKIs in the treatment of elderly patients with CML.
This is a clinical practice guideline for adolescents and young adults with cancer. The guideline discusses risk factors, screening, diagnosis, management, follow-up, supportive care, and palliative care for patients between 15 and 39 years of age. Unique issues discussed include adherence to treatment, the impact of cancer and its treatment on fertility, management of cancer during pregnancy, relationship management, and socioeconomic issues.
This is a clinical practice guideline for the evaluation of neck masses in adults. The guideline provides recommendations for the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes. Specific goals include reducing delays in the diagnosis of head and neck squamous cell carcinoma (HNSCC), promoting appropriate testing, reducing inappropriate testing, and promoting appropriate physical examination when cancer is suspected
This consensus guideline provides recommendations on safe handling of oral anti-cancer drugs (OACDs) in community pharmacies across the medication lifecycle, from manufacturer packaging to waste management and incident reporting. Specifically, the guideline addresses packaging, labeling, receiving and unpacking, storage, drug preparation and handling, verification and dispensing, transportation, personal protective equipment (PPE), disposal, waste management and cleaning, and incident reporting. Recommendations for training and education are also discussed, along with staffing considerations.
This is a clinical practice guideline for adults with non-resected limited stage and extensive stage small cell lung cancer who can safely receive definitive radiation. The guideline examines thoracic radiotherapy and first-line chemotherapy as treatment options for these patients. The recommendations are tailored to patients' stage of cancer, and consider optimal timing of each treatment option, whether treatment should be sequential or concurrent, and appropriate dose or treatment regimen.
This clinical practice guideline provides recommendations for breast reconstruction in women following mastectomy for the prevention or treatment of breast cancer. The guideline discusses patient education, eligibility for reconstruction, timing of reconstruction, factors that enhance recovery from reconstruction, post-reconstruction surveillance, and measuring outcomes of construction. The benefits and risks of implant-based, autologous flap, and combination reconstruction procedures are examined. The guideline also discusses the extent to appropriately perform mastectomy.
This is a clinical practice guideline for adults with inoperable locally advanced or metastatic renal cell cancer. The guideline provides recommendations on optimal targeted therapies and compares different drug treatments and combinations of treatments. Outcomes of interest include overall quality of life, overall survival, toxicity, fatigue, and other adverse events.
This clinical practice guideline is a focused update of the American Society of Clinical Oncology's 2016 guideline titled Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women with Early-stage Invasive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. The update discusses the use of MammaPrint to guide decisions on the use of adjuvant systemic therapy by examining both the publication of the phase III randomized MINDACT (Microarray in Node-Negative and 1 to 3 Positive Lymph Node Disease May Avoid Chemotherapy) study and other published literature on the MammaPrint assay for evidence of clinical utility. The guideline examines the contexts in which the MammaPrint assay will be beneficial for improving treatment decisions.
This clinical practice guideline focuses on molecular biomarker testing for patients with early and advanced colorectal cancer. The recommendations are intended to help establish standard molecular biomarker testing, guide decisions on whether or not to use epidermal growth factor receptor (EGFR)-targeted therapy, and to ensure that the most effective and advance personalized care is delivered to patients.
A clinical practice guideline for the treatment of small cell and non-small cell lung cancer. The guideline examines treatment options for multiple stages of these two cancer modalities, including surgical and non-surgical procedures. Palliative, supportive, and psychological care for lung cancer patients are also discussed. This guideline is wiki-based and is constantly updated as new evidence arises - this review pertains to the guideline as of April 23, 2018.
This is a clinical practice guideline for basal cell skin cancer. The guideline considers clinical presentation and workup, local treatment, recurrence and metastasis, and follow-up. The guideline also includes a discussion about risk stratification and explores different risk factors for basal cell skin cancer including location and size, age, and site of prior radiotherapy.
This is a clinical practice guideline for women with a history of breast cancer. The guideline examines the management of menopausal symptoms in these patients. Non-pharmacological, pharmacological, and hormonal therapies are considered for vasomotor symptoms, sleep disturbance, vulvovaginal symptoms, and sexual function. Depression and anxiety, mood and emotional well-being, mental health, global quality of life, and breast cancer recurrence are also discussed.
This is a clinical practice guideline for women with breast cancer who have chosen or been recommended for therapeutic mastectomy, and women who are at high risk for breast cancer who have chosen or been recommended prophylactic mastectomy. The guideline considers the suitability of patients for immediate or delayed breast cancer reconstruction surgery, appropriate timing of treatment, and optimal surgical techniques. Techniques examined include skin-sparing mastectomy (SSM), nipple-sparing mastectomy (NSM) and areola-sparing mastectomy, as well as autologous tissue and implant-based reconstruction.
This is a clinical practice guideline for women presenting with suspicious adnexal masses, either symptomatic or asymptomatic. The guideline examines the optimal strategies for preoperative identification of adnexal masses that are suspicious for ovarian cancer, and the most appropriate surgical procedures for those identified.
This is a clinical practice guideline for adult patients with cutaneous melanoma of the trunk or extremities. The guideline examines the optimal surgical management of patients with positive sentinel lymph nodes (SLNs) and biopsy-proven clinically palpable or biopsy-proven radiologically detected lymph nodes from cutaneous melanoma originating in the trunk or extremities. Outcomes of interest include local and regional recurrence, distant recurrence, overall survival (OS), and disease-free survival (DFS).
This is a clinical practice guideline on the diagnosis of prostate cancer. The guideline examines effective diagnostic methods and provides recommendations on testing and referrals. Outcomes of interest include diagnostic accuracy, sensitivity, and specificity. Other topics of discussion include factors associated with delayed referral and risk factors that are predictive of prostate cancer.
This is a clinical practice guideline for stem cell transplantation (SCT) in the treatment of acute lymphoblastic leukemia. The guideline establishes indications for allogeneic stem cell transplantation (allo-SCT) in the management of acute lymphoblastic leukemia (ALL) in adults. It identifies the role of reduced-intensity conditioning (RIC) regimens for SCT in the management of ALL adult patients, and the role of tyrosine-kinase inhibitors (TKIs) for patients undergoing allo-SCT for Philadelphia chromosome-positive ALL (Ph+ ALL). The guideline also discusses the role of alternative donor transplantation (haploidentical, cord blood) in the management of adult patients with ALL who lack a suitable donor. Outcomes of interest are relapse, disease-free survival, relapse-free survival, progression-free survival, and overall survival.
This is a clinical practice guideline for patients with gastroesophageal adenocarcinoma. The guideline provides recommendations for the assessment of HER2 (or erb-b2 receptor tyrosine kinase (ERBB2)) mutations, while addressing which patients and tumour specimens are appropriate. Outcomes of interest include increased accuracy of HER2 testing, and increased utility for clinician decision-making.
A clinical practice guideline for the management of adult onset sarcoma. The guideline examines the diagnosis, staging, treatment, and follow-up options for sarcoma. Imaging modalities for the purpose of diagnosis and staging are compared, while the importance of multidisciplinary care and the effects of delayed referrals to specialists are discussed. In addition, pre-operative and post-operative radiotherapy are compared, and the guideline also examines adjuvant and systemic chemotherapy, as well as surgical procedures. This guideline is wiki-based and is constantly updated as new evidence arises - this review pertains to the guideline as of April 23, 2018.
This is a clinical practice guideline to guide appropriate prescribing of filgrastim in adults. The guidelines looks at a variety of disease sites and is intended as a guide to facilitate a shared approach to the appropriate use of filgrastim. In order provide clarity surrounding the indications in which filgrastim should be used, the recommendations are presented by disease site.
This guideline covers diagnosing and managing non-Hodgkin's lymphoma in people aged 16 years and over. It aims to improve care for people with non-Hodgkin's lymphoma by promoting the best tests for diagnosis and staging and the most effective treatments for 6 of the subtypes: follicular lymphoma, MALT lymphoma, mantle cell lymphoma, diffuse large B-cell lymphoma, Burkitt lymphoma, and peripheral T-cell lymphoma. Tests and treatments covered include excision biopsy, radiotherapy, immunochemotherapy and stem cell transplantation.
This clinical practice guideline provides recommendations for the diagnosis, treatment, and follow-up of epithelial ovarian cancer. This guideline covers: carcinoma of the ovary, fallopian tube and primary peritoneal carcinoma; epithelial carcinoma, e.g. serious, mucinous, clear cell or endometrioid histology; borderline and invasive disease, diagnosis and first-line treatment; and follow-up after treatment. Recommendations consider patient values and preferences when treated for ovarian cancer.
This is a clinical practice guideline for adults (aged 18 and older) at any phase of the cancer care continuum regardless of cancer type, stage (including metastatic) or treatment plan, with some components of the guideline also applicable to the patient's family and/or caregivers. Recommendations are provided on implementation of the brief tobacco intervention using the evidence-based AAR Brief Tobacco Intervention Model which includes screening, education and assessment, treatment plan, and referral, monitoring, and follow-up. The 2015 guideline was revised in June 2016 to abbreviate the cessation intervention model to best support adoption across all CCA clinics and settings. Clinical considerations and contraindications of treatment options for cancer patients are discussed including nicotine replace therapy (NRT), bupropion, varenicline, and e-cigarettes, and the impact of tobacco use on cancer treatment is reviewed with a specific focus on erlotinib and irinotecan.
A clinical practice guideline for patients with gastrointestinal stromal tumours. The guideline examines appropriate imaging modalities, and treatment for newly diagnosed and metastatic tumours. Outcomes of interest include disease progression and recommended imaging.
A clinical practice guideline for adult patients with chronic lymphocytic leukemia. The guideline examines diagnosis, staging, and treatment of newly diagnosed, relapsed, and refractory leukemia. Outcomes of interest include progression-free survival, reduced adverse events, and treatment response.
This clinical practice guideline discusses specific issues related to the management of cancer in adults aged 65 years or older. Topics include screening and comprehensive geriatric assessment (CGA), assessing risks and benefits of treatment, preventing or decreasing complications from therapy, and managing disease-specific issues. Recommendations are also provided for management of patients deemed to be at high risk for toxicity from standard treatment.
This is a clinical practice guideline for the use of myeloid growth factors in adult patients with solid tumours and non-myeloid malignancies. Benefits and risks are reviewed, the role of biosimilars is discussed, and recommendations are provided for prophylactic and therapeutic uses of both granulocyte and granulocyte-macrophage colony stimulating factors (CSFs). Recommendations are also given regarding the use of CSFs in the hematopoietic cell transplant setting. Outcomes of interest include efficacy of CSFs, mortality, length of hospitalization, toxicity, and adverse effects.
This is a clinical practice guideline for Non-Hodgkin's Lymphomas (NHL). The guideline focuses on recommendations for diagnostic workup, treatment, and surveillance strategies for the most common subtypes of NHL, in addition to a general discussion on the classification systems used in NHL and supportive care considerations. The most common NHL subtypes that are covered in the guideline are: Mature B-cell lymphomas, Mature T-cell and NK-cell lymphomas, Post Transplant Lymphoproliferative Disorders (PTLD), and Castleman's Disease.
This is a clinical practice guideline for multiple myeloma. The guideline addresses diagnosis, treatment, and follow-up care. It offers specific recommendations for primary therapy, surveillance and follow-up tests for solitary plasmacytoma, smoldering (asymptomatic) myeloma, active (symptomatic) multiple myeloma, as well as for transplant and non-transplant candidates.
This clinical practice guideline reviews workup and treatment of bone cancer, with specific recommendations provided for chondrosarcoma, chordoma, Ewing's sarcoma family of tumors, and osteosarcoma. Surveillance and relapse is also reviewed. An overview of systemic therapy agents is provided, and principles of radiation therapy are discussed.
This clinical practice guideline provides recommendations for the diagnosis and treatment of acute myeloid leukemia (AML). Induction therapy and post-remission (consolidation) therapy are reviewed with recommendations stratified by risk and age. Specific recommendations are provided for the management of acute promyelocytic leukemia (APL). The guideline also discusses therapy for relapse, evaluation and treatment of CNS leukemia, and supportive care.
This is a clinical practice guideline for adult patients with non-small cell lung cancer. The guideline provides updated recommendations around prevention and screening, evaluation and staging, treatment, and follow up care. Areas of focus are discussed with recognition that much progress has been made in regards to screening, minimally invasive techniques for diagnosis and treatment, advances in radiation therapy (RT) including stereotactic ablative radiotherapy (SABR), and targeted therapies.
This clinical practice guideline reviews diagnostic assessment and management of prostate cancer. The guideline discusses risk stratification, molecular testing, and imaging for clinical assessment and staging workup. Management options reviewed include observation, active surveillance, radical prostatectomy, radiation therapy, androgen deprivation therapy, chemotherapy, and immunotherapy, with treatment recommendations stratified by risk. Outcomes of interest include survival and adverse effects of treatment.
This is an update to the 2009 US Preventive Services Task Force (USPSTF) recommendation on screening for skin cancer. The guideline specifically addresses evidence on the effectiveness of screening for skin cancer with a clinical visual skin examination in reducing skin cancer morbidity and mortality and death from any cause; its potential harms, including any harms resulting from associated diagnostic follow-up; its test characteristics when performed by a primary care clinician vs a dermatologist; and whether its use leads to earlier detection of skin cancer compared with usual care.
This is an update to the 2008 US Preventive Services Task Force (USPSTF) recommendation on screening for colorectal cancer. The USPSTF reviewed the evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test, and the methylated SEPT9 DNA test in reducing the incidence of and mortality from colorectal cancer or all-cause mortality. Other topics discussed in the guideline include: the harms of these screening tests; and the test performance characteristics of these tests for detecting adenomatous polyps; as well as information on optimal starting and stopping ages and screening intervals across the different available screening methods.
This clinical practice guideline reviews the use of sentinel node biopsy (SLNB) as a diagnostic tool for adult patients with malignant melanoma. Topics of discussion include indications and contraindications of SLNB, pathological examination of the sentinel nodes, and indications for therapeutic node dissection and recommended extent of dissection. The use of ultrasound-guided fine-needle aspiration is also discussed. Outcomes of interest include test sensitivity, specificity, and positive and negative predictive value, as well as rate of nodal recurrence and survival.
A clinical practice guideline for patients with primary cutaneous melanoma. The guideline examines diagnosis, treatment, and follow-up including preventive excision and body mapping. Outcomes of interest include melanoma-specific survival and morbidity.
This is a clinical practice guideline for magnetic resonance imaging (MRI) for pre-treatment local staging of prostate cancer. The use of MRI for pre-treatment local staging is juxtaposed with the ways in which prostate cancer is conventionally detected which includes prostate-specific antigen (PSA) screening, digital rectal examination (DRE), and biopsy-confirmed diagnosis by transrectal ultrasonography (TRUS). The guideline therefore explores the performance and diagnostic accuracy of MRI, as well as the impact of pre-treatment local staging by MRI on patient on patient outcomes, biochemical recurrence, changes in treatment planning (including nerve- sparing surgery), changes in stage classification, and surgical margin status in men with newly diagnosed biopsy-confirmed prostate cancer who are under consideration for radical treatment.
A clinical practice guideline for women with stage I ovarian cancer. The guideline examines adjuvant therapy, primarily systemic therapies, in relation to surgical staging. Outcomes of interest include overall and disease-free survival.
This clinical practice guideline provides recommendations on the diagnosis and treatment of locally advanced and borderline resectable pancreatic cancer. Radiotherapy alone is compared to chemoradiation for treatment of locally advanced disease, and preoperative therapy for borderline resectable disease is discussed. The guideline reviews neoadjuvant systemic therapy followed by local treatment and provides recommendations on chemotherapy regimes. Outcomes of interest include progression-free survival, median survival, 1-year survival, and local control.
This is a clinical practice guideline for breast cancer screening. The guideline provides recommendations based on three different variants: 1. high-risk women (women with a BRCA mutation and their untested, first-degree relatives, women with a history of chest irradiation between the ages of 10-30, women with 20% or greater lifetime risk of breast cancer); 2. intermediate-risk women (women with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15-20% lifetime risk of breast cancer); 3. average-risk women (women with <15% lifetime risk of breast cancer, breasts not dense). Recommendations consider the appropriateness of mammography, digital breast tomosynthesis (DBT), magnetic resonance imaging (MRI), ultrasound, as well as other imaging modalities.
This clinical practice guideline provides recommendations on the investigation, treatment, and follow-up care of patients aged 16 years and older with cancer of the upper aerodigestive tract. HPV-related disease and less common upper aerodigestive tract cancers including carcinoma of the nasopharynx or paranasal sinuses, unknown primary of presumed upper aerodigestive tract origin, and mucosal melanoma, are also reviewed. Additionally, recommendations are provided on optimizing rehabilitation and function. Outcomes of interest include prevalence, predictive value, sensitivity, specificity, local control, survival (overall, progression-free), treatment-related morbidity and mortality, and resource use, among others.
A clinical practice guideline for middle-aged and older men at risk for prostate cancer who are considering, or have decided to have, a PSA test. The guideline examines supporting informed decision making for PSA testing, recommended protocols, and diagnosis and management for abnormal results. Outcomes of interest include reducing over-diagnosis and improved cumulative mortality.
This is a clinical practice guideline for women with early-stage invasive breast cancer. The guideline provides recommendations on use of breast tumour biomarker assay results to inform decisions on adjuvant therapy. Several markers are reviewed including 21 gene recurrence score (Oncotype DX), 12 gene risk score (EndoPredict), 70 gene assay (MammaPrint), 50 gene subtype predictor (PAM50 Risk of Recurrence), Breast Cancer Index (BCI), 5 protein panel risk specification (Mammostrat), immunohistochemistry 4 (IHC-4), urokinase plasminogen activator and plasminogen activator inhibitor type 1 (uPA and PAI-1), circulating tumour cells (CTCs), tumour-infiltrating lymphocytes (TILs), and protein encoded by the MKI67 gene. Additionally, the guideline provides recommendations on the use of specific biomarkers to guide choice of specific drugs and regimes. Outcomes of interest include overall survival and disease-free or recurrence-free survival.
This is a clinical practice guideline aiming to standardize the basic components of a synoptic report template for the bone marrow samples of patients with hematological neoplasms, such as acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), myelodysplastic syndromes (MDSs), myeloproliferative neoplasms (MPNs), plasma cell disorders, Hodgkin lymphoma, and non-Hodgkin lymphoma (NHL). Reports would address the following domains: bone marrow morphologic descriptors, possible tests (by category) to be performed on the primary sample, relevant clinical and laboratory information, necessary components (regulatory, legal, financial, among others), and layout.
This is a clinical practice guideline for adults diagnosed with incurable gastroenteropancreatic neuroendocrine tumours. The guideline examines treatment options for pancreatic neuroendocrine tumours and non-pancreatic neuroendocrine tumours, including chemotherapy, targeted therapy, somatostatin analogues and interferon, and combination therapy. Outcomes of interest include progression-free and overall survival, adverse events, and quality of life.
This is a clinical practice guideline for women diagnosed with invasive early-stage breast cancer. The guideline discusses the use of different multigene profiling assays for determining risk profiles (high-risk vs low-risk) in patients with estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative tumours. The validity and clinical utility of different assays are examined, including Oncotype DX, Prosigna, MammaPrint, EndoPredict, and EPclin. In addition, assays are specifically compared to Oncotype DX, the only assay that was publicly funded and part of standard practice in Ontario at the time of publication.
This clinical practice guideline is an adoption of the American College of Physicians' 2014 guideline title Screening Pelvic Examination in Adult Women: A Clinical Practice Guideline from the American College of Physicians. The guideline examines the use of pelvic examinations to screen for noncervical cancer, pelvic inflammatory disease, or other benign gynecologic conditions in asymptomatic, non-pregnant adult women. Speculum or bimanual examinations are specifically discussed; the use of Pap tests for cervical cancer screening is not addressed in this guideline.
This is a clinical practice guideline for patients with testicular germ cell tumours (GCTs). The guideline examines appropriate management and follow-up strategies for different stages of the two main histological types of testicular GCTs: seminomas and nonseminomas. Outcomes of interest include recurrence and overall survival.
This is a clinical practice guideline for the treatment of adult patients with metastatic colorectal cancer. The guideline examines different management options, including treatment via clinical trials, treatment chemotherapy, palliative chemotherapy, EGFR inhibitors, and regorafenib (as a fourth-line therapy). The guideline also discusses the need to test for Ras mutations before treatment. Outcomes of interest include treatment efficacy and improved survival outcomes.
This is a clinical practice guideline for patients with neoplasms causing biliary obstruction. The guideline examines the management of malignant biliary obstructions, including diagnostic work-up and treatment options. Recommendations are provided based on factors such as the resectability and location of the obstruction. Outcomes of interest include improved quality of life (QOL) and prolonged survival.
This is a clinical practice guideline for adult patients in primary care settings or emergency departments who have signs and symptoms suggestive of colorectal cancer (CRC). The guideline examines how to define expectations for primary care providers (PCPs), endoscopists, and radiologists regarding the appropriate work up of patients who have symptoms suggestive of colorectal cancer, and outlines the communication expectations between PCPs, endoscopists, radiologists, and other health care providers and patients. Outcomes of interest include effective communication, as well as early and accurate diagnoses.
This is a clinical practice guideline for patients undergoing major head and neck cancer surgery with free flap reconstruction. The guideline provides recommendations for the optimal perioperative care of these patients, focusing on topics such as preadmission education, preoperative nutritional status, perioperative nutritional care, prophylaxis against thromboembolism, antibiotic prophylaxis, postoperative nausea and vomiting prophylaxis, standard anesthetic protocol, pain management, postoperative wound care, postoperative pulmonary physical therapy, and more.
This is a considerations document for personalizing busulfan-based conditioning. The document examines a list of the most frequently asked questions (FAQs) regarding personalized busulfan dosing, and provides recommendations addressing topics of practical relevance to clinicians involved with hematopoietic cell transplantation.
This is a clinical practice guideline for patients with chronic lymphocytic leukemia (CLL). The guideline examines the role of allogeneic hematopoietic cell transplantation (allo-HCT) for patients with CLL in an era of highly active targeted therapies. The recommendations emerge from comparing allo-HCT against novel therapies for treatment of CLL, at various disease stages.
This is a clinical practice guideline for adults with low-grade gliomas (LGGs). The guideline examines the diagnosis, prognosis, and treatment of these patients. Treatment modalities discussed include surgery, radiation therapy, and chemotherapy.
This is a clinical practice guideline for the clinical management of malignant melanoma with the aim of improving the standard of care received by this patient population. The guideline provides recommendations on referral to surgeons and associated wait times, procedures (e.g., biopsy), tumour markers, and adjuvant therapies.
This is a clinical practice guideline for patients with non-muscle invasive bladder cancer. Recommendations are provided on diagnostic procedure, risk stratification, variant histologies, urine markers, and treatment options including TURBT/Repeat resection, intravesical therapy, BCG/maintenance, and chemotherapy BCG combinations. BCG relapse and salvage regimens are reviewed as is the role of cystectomy and cystoscopy. Additionally, recommendations are provided for risk adjusted surveillance and follow-up strategies.
A clinical practice guideline for the prevention of chemotherapy and radiotherapy-induced nausea and vomiting in advanced cancer patients. The guideline examines the emetogenic potential of antineoplastic agents and recommended pharmacological treatments. Outcomes of interest include antiemetic prophylaxis, efficacy, and optimal dosing.
This is a clinical practice guideline for recurrent Hodgkin lymphoma. The guideline provides recommendations for the treatment of patients with early relapsed or progressive disease. Areas of focus include: stem cell transplantation, the role of radiation therapy, and chemotherapy.
A clinical practice guideline for patients with prostate cancer. The guideline examines permanent source brachytherapy in low and high risk patients combined with external-beam radiation therapy and/or androgen deprivation therapy. Outcomes of interest include quality of life, quality of life, complication rates, and biochemical outcomes.
A clinical practice guideline for women who may be at risk for breast cancer or who qualify for breast cancer screening. The guideline examines screening for average and increased risk, and diagnostic evaluation including mammography, MRI, ultrasound, and tissue biopsy. Outcomes of interest include adverse events, delayed diagnosis, and probability of malignancy.
This is a clinical practice guideline for soft tissue sarcoma. The guideline examines diagnosis, treatment and follow up. Various stages are addressed, as well as a various treatment options and disease progression. Guidance is presented for specific issues (e.g., gastrointestinal stromal tumors).
This is a clinical practice guideline for chronic lymphocytic leukemia/ small lymphocytic lymphoma. This guideline provides recommendations relating to diagnosis, prognostic factors, workup, staging, and response criteria. It also provides recommendations as they pertain to treatment options, which include discussions about first-line therapy, relapsed or refractory therapy, as well as assessment of functional status and comorbidity.
This is a clinical practice guideline for patients (children/adolescents and adults) who are experiencing cancer-related fatigue. The guideline discusses evaluation and intervention for patients on active treatment, post-treatment, and at end of life. Education and counselling, nonpharmacologic interventions, and pharmacologic interventions are all discussed along with general strategies for management of fatigue.
This clinical practice guideline provides recommendations on assessment and management of cancer pain in adult patients, including pain in adult cancer survivors. Pathophysiologic classification of cancer pain syndromes is reviewed, and recommendations are provided for pain assessment, management/intervention, and reassessment. Both pharmacologic and non-pharmacologic interventions are discussed.
This is a clinical practice guideline for gastric cancer. The guideline provides an evidence- and consensus-based treatment approach for the management of patients with gastric cancer. Topic areas discussed within the guideline include: staging, principles of pathology, surgery, endoscopic therapies, radiation therapy, combined modality therapy, chemotherapy, and follow-up.
This is a clinical practice guideline for the investigation and diagnosis of suspected lung cancer and referral for treatment, particularly for patients residing in Nova Scotia. The guideline reviews the investigation process from initial presentation to treatment referral. Topics include principles of communication between patient-provider and among providers throughout the diagnostic process, standards for initial investigation, appropriate use of imaging (CT, MRI, PET, bone scan) and biopsy and laboratory testing, as well as recommendations regarding treatment referral upon diagnosis. Referrals to diagnostic specialists (thoracic surgery or respirology) and to psychosocial and supportive care are also reviewed.
This is a clinical practice guideline for individuals at risk of or having genetic mutations that increase their risk of breast or ovarian cancer. The guideline reviews hereditary breast or breast/ovarian cancer syndrome, Li-Fraumeni syndrome, Cowden syndrome/PTEN Hamartoma tumor syndrome, and other genetic mutations associated with breast/ovarian cancer. Recommendations are provided for initial risk assessment, formal risk assessment and genetic counselling, and management options for individuals with a clinical diagnosis following genetic testing.
This is a clinical practice guideline for patients with colon cancer. The guideline reviews risk assessment, TNM staging, and pathology, and provides recommendations on the clinical presentation and treatment of nonmetastatic disease as well as recommendations on management of metastatic disease. Treatment for locally recurrent disease and survivorship are also discussed, as is the role of vitamin D in colorectal cancer.
This is a clinical practice guideline for the management of chronic pain in survivors of adult cancers. Whereas other guidelines have largely focused on relieving acute pain or pain associated with advanced disease, this guideline focuses on the care required when pain persists months or years after the completed cancer treatment. Areas addressed in the guideline include: screening and comprehensive assessment; treatment and care options; nonpharmacologic interventions; pharmacologic interventions; as well as risk assessment, mitigation, and universal precautions with opioid use.
This is a clinical practice guideline for patients with resectable pancreatic cancer. The guideline reviews biomarkers, specifically carbohydrate antigen 19-9 (CA19-9), and SMAD4 (DPC4), as well as other prognostic factors such as resection margin status and lymph node involvement. Adjuvant therapy, neoadjuvant therapy, and radiotherapy are discussed as treatment options, taking patient risk factors for local recurrence into consideration.
A clinical practice guideline for adult patients with recurrent endometrial cancer. The guideline examines management, including re-staging workups, and treatment through salvage radiotherapy and surgical intervention. Outcomes of interest include improved local control and 5-year survival rates through external beam radiation and brachytherapy.
A clinical practice guideline for adults with locally advanced, high-risk prostate cancer. The guideline examines aggressive approaches to prostate cancer treatment, focusing on intensive local therapy through external beam radiation. Outcomes of interest include improved local control resulting in improved outcomes via combination therapy.
A clinical practice guideline for patients with favorable-prognosis stage I and II Hodgkin lymphoma. The guideline examines the use of combined modalities therapy to treat Hodgkin lymphoma, including a focus on optimization of duration and volume. Outcomes of interest include improved tumour control rate and reduced number of cycles in appropriate cases.
This clinical practice guideline discusses evaluation, treatment (primary and secondary) options, and follow-up care for patients with bladder cancer. Specific workup and treatment recommendations are provided for non-muscle invasive disease, muscle invasive disease, upper genitourinary tract (GU) tumours, urothelial carcinomas of the prostate, primary carcinoma of the urethra. Non-urothelial carcinomas of the bladder are also discussed.
A clinical practice guideline for lung cancer screening of adults at high risk. The guideline examines computed tomography screening and screening intervals, and criteria for high risk screening. Outcomes of interest include reduction in harms from chest radiography and improved screening economy.
This clinical practice guideline discusses the evaluation and treatment of patients with suspected solid pancreatic neoplasia. The guideline reviews presentation and clinical evaluation of pancreatic neoplasia, and provides an overview of radiologic and endoscopic modalities for adenocarcinoma of the pancreas, neuroendocrine tumours (NETS) of the pancreas, solid pseudopapillary tumours (SPTs), metastatic disease, and lymphoma. Screening for pancreatic cancer is also discussed. Outcomes of interest include sensitivity and specificity, as well as adverse events.
This is a clinical practice guideline for the treatment of advanced non-small cell lung cancer (NSCLC). The guideline examines the efficacy of different therapies including chemotherapy and immune checkpoint inhibitors. Outcomes of interest include overall survival, progression-free survival, quality of life, toxicity, and response rate.
This clinical practice guideline is an endorsement of the American Society for Radiation Oncology's 2016 guideline on radiation therapy (RT) for glioblastoma not originating from the brainstem. This guideline provides recommendations on whether and how RT should be applied, and examines dose-fractionation, target volume design, and the effects of concurrent and adjuvant systemic therapies. Outcomes included overall and progression-free survival, recurrence rates, toxicity, and quality of life (QOL).
This is a clinical practice guideline for the screening of skin cancer in asymptomatic adults. The recommendations do not apply to patients with suspicious skin lesions, family history of skin cancer, or personal history of pre-malignant or malignant skin lesions. Outcomes of interest include reductions in morbidity and mortality from skin cancers.
This is a clinical practice guideline for patients with glioblastoma. The guideline examines radiation therapy as treatment for these patients, and the ways in which systemic therapies modify its effects. The guideline also reviews ideal dose-fractionation, target volume design, and reirradiation for recurrent glioblastoma. Tumour-specific and patient-specific factors are considered in the recommendations.
A clinical practice guideline for patients with lymphoma, including small lymphocytic leukemia (SLL)/chronic lymphocytic leukemia (CLL), Waldenstroms, marginal zone lymphoma, and cutaneous lymphoma. The guideline examine the use of PET/CT, primarily for staging and response assessment. Outcomes of interest include survival, quality of life, and appropriate use.
This clinical practice guideline provides recommendations on influenza vaccinations for children and adults with solid tumours or hematologic malignancies. Recommendations are provided for vaccine type (live versus inactivated) and administration in relation to the therapy cycle, and are stratified by patient age (adult versus pediatric). Topics of discussion include the effects of age, duration, and type of systemic therapy in regards to response of patients to the influenza vaccine, as well as contraindications and precautions for immunization.
This is a clinical practice guideline for palliative oncology patients 18 years of age or older with low grade/ low volume/ malignancy-associated urogenital or gastrointestinal bleeding, or with malignant gastrointestinal obstruction, compression or invasion. External beam radiotherapy (EBRT) with or without , brachytherapy, stent placement, and surgical bypass are discussed as therapeutic options. Outcomes of interest include clinical improvement of symptoms, quality of life, and survival.
This is a clinical practice guideline for the screening, diagnosis, staging, and treatment of neuroendocrine tumors. This guideline provides recommendations on issues including: multiple endocrine neoplasia, surveillance of resected neuroendocrine tumors of the gastrointestinal tract, lung, and thymus, and genetic counseling/testing in pheochromocytomas/paragangliomas. Most of the guideline sections pertain to well-differentiated, low- to intermediate-grade tumors, although poorly differentiated/high-grade/large or small cell carcinomas are also addressed.
This is a clinical practice guideline for the diagnosis and management of systemic light chain amyloidosis. Primary systemic light chain amyloidosis is typically characterized by decreased numbers of monoclonal plasma cells in the bone marrow compared to multiple myeloma, however, the protein produced by these plasma cells has an affinity for visceral organs (such as kidney, heart, liver, and spleen), and this protein causes related end-organ dysfunction. Recommendations include a discussion of the management options such as transplant and chemotherapy.
This is a clinical practice guideline on the identification and treatment of psychosocial problems in patients with cancer. The guideline discuss screening tools for distress, initial evaluation and treatment by the oncology team, psychological/psychiatric treatment by mental health professionals, social work and counselling services, and spiritual and chaplaincy care. Psychological/psychiatric treatment guidelines are reviewed. Special topics of interest include oncologist burnout.
This is a clinical practice guideline for patients with renal cell carcinoma (RCC). The guideline provides recommendations for the initial evaluation and staging, treatment, and follow-up for adults with various stages of kidney cancer. Topic areas discussed in the guideline include: imaging, surgery, lymph node dissection, targeted therapy, and supportive care.
This clinical practice guideline discusses evaluation, treatment (primary and secondary) options, and follow-up care for patients with bladder cancer. Specific workup and treatment recommendations are provided for non-muscle invasive disease, muscle invasive disease, upper genitourinary tract (GU) tumours, urothelial carcinomas of the prostate, and primary carcinoma of the urethra. Non-urothelial carcinomas of the bladder are also discussed.
This is a clinical practice guideline for the treatment of patients with metastatic pancreatic cancer. This clinical practice guideline addresses six overarching clinical questions: After a histopathologic confirmation of pancreatic adenocarcinoma diagnosis, what initial assessment is recommended before initiating any therapy for metastatic pancreatic cancer? What is the appropriate first-line treatment of patients with metastatic pancreatic cancer? What is the appropriate therapy for patients with metastatic pancreatic cancer who experience either disease progression or intolerable toxicity with prior regimens for metastatic pancreatic cancer? When should the concept of palliative care be introduced? For patients with metastatic pancreatic cancer, what are the recommended strategies for relief of pain and symptoms? What is the recommended frequency of follow-up care/surveillance for patients with metastatic pancreatic cancer?
This guideline discusses the clinical standards of care for the treatment of rectal cancer in Nova Scotia with all aspects of rectal cancer care covered, from diagnosis to survivorship and/or palliation. This includes recommended standards for professionals involved in care, pretreatment investigations, and surgical, neo-adjuvant, and adjuvant treatments. Other topics covered include lynch syndrome screening and referral to medical genetics. Psychosocial health services and supportive care recommendations are also reviewed.
This is a clinical practice guideline for small cell lung cancer and lung neuroendocrine tumours. Diagnosis, staging, prognostic factors, treatment and surveillance are reviewed. Treatment options include chemotherapy, with special topics of discussion including elderly patients and second- and third-line therapies, radiotherapy (thoracic radiotherapy, prophylactic cranial irradiation, and palliative radiotherapy), and surgery. Outcomes of interest include survival (disease free, overall, progression-free), response rates, and treatment toxicity.
This is a clinical practice guideline for patients with colon cancer or adenocarcinomas of the small bowel and appendix. The guideline reviews staging, pathology, clinical presentation and treatment of nonmetastatic disease, management of metastatic disease, post-treatment surveillance, and survivorship. The role of vitamin D in colorectal cancer is also discussed.
This clinical practice guideline reviews workup, staging, and treatment for both noninvasive and invasive breast cancer. Special considerations include phyllodes tumor, Paget's disease, breast cancer during pregnancy, and inflammatory breast cancer. Treatment recommendations for invasive cancer are stratified by tumor receptor status and stage. Fertility and birth control is also discussed.
The guideline provides recommendations for management and treatment of patients 18 years of age and older who have malignant superior vena cava obstruction (SVCO) or airway obstruction, compression, or invasion, or those experiencing hemoptysis. The course of management is dependent on symptoms, primary histology, urgency of histology, previous treatment, and access to resources. External beam radiotherapy (EBRT), endobronchial brachytherapy, chemotherapy, radiotherapy, bronchoscopic debulking, surgical resection, photodynamic therapy, and Neodymium-doped yttrium aluminum garnet (Nd:YAG) are discussed as treatment options. For superior vena cava obstruction, external beam radiation EBRT, RT dose fractionation, SVC stent insertion, steroids, and palliative intent chemotherapy are discussed.
A clinical practice guideline for patients with locally advanced breast cancer. The guideline examines appropriate screening to determine extent and node involvement, and treatment through systemic therapies and radiotherapies. Outcomes of interest include improved breast conservation in select populations and improved outcomes through trimodal therapy.
A clinical practice guideline for patients with newly diagnosed stage III or IV Hodgkin lymphoma. The guideline examines diagnosis, primarily through biopsy, and treatment options focusing primarily on chemotherapy. Outcomes of interest include increased toxicity using both mechlorethamine, vincristine, procarbazine, and prednisone and doxorubicin, bleomycin, and vinblastine hybrid treatment.
A clinical practice guideline for patients with localized prostate cancer undergoing external beam radiation. The guideline examines treatment planning and delivery, with specific intervention details for multiple clinical variants. Outcomes of interest include improved clinical outcomes and reduced GI toxicity.
This is a clinical practice guideline for teleoncology models of care. Teleoncology seeks to offer solutions to some of the access issues faced by patients and health professionals from regional, rural and remote communities around the world. The focus of the guideline is shaped by a number of clinical questions that include: what teleoncology models of care are available to health services in Australia and overseas; what models of care for teleoncology are available to nursing services; what models of care for teleoncology are available to allied health services; is teleoncology as effective as standard oncology care for the screening of cancer; is teleoncology as effective as standard oncology care for the diagnosis of cancer; is teleoncology as effective as standard oncology care for the treatment of cancer; and is teleoncology as effective as standard oncology care for the palliative care of cancer patients.
This is a clinical practice guideline for patients with rectal cancer. The guideline provides recommendations on use of MRI for staging, optimal surgical techniques for patients with T1-T2 anal cancer with comparisons made between local resection or transanal endoscopic microsurgical resection and radical resection, and the use of adjuvant chemotherapy for patients who have received neoadjuvant radiotherapy (RT). Outcomes of interest include survival (overall, disease free, metastasis-free, local recurrence free), and quality of life.
A clinical practice guideline for patients with chronic lymphocytic leukemia (CLL), monoclonal B cell lymphocytosis (MBL) and small lymphocytic lymphoma (SLL). The guideline examines clinical assessment, staging, and treatment including supportive therapy and potential complications. Outcomes of interest include long-term remission, increases in secondary malignancies, and disease progression.
This is a clinical practice guidelines on the use of psoralen-ultraviolet A (PUVA) photochemotherapy as a therapeutic modality for conditions including cutaneous T-cell lymphoma (CTCL). Topics of discussion that are specific to CTCL include a comparison between PUVA and other types of phototherapy such as narrowband ultraviolet B (TL-01) for treatment of patch-stage CTCL, as well as use of PUVA in early stage CTCL of the MF type. Adverse reactions are reviewed along with risk reduction measures and methods to manage treatment side-effects. Outcomes of interest for PUVA treatment of CTCL include response rates, remission duration, and survival.
This guideline aims to described the role of esophageal stents in patients with malignant or benign esophageal disease and makes recommendations on circumstances that warrant their use. Questions addressed in this guideline include: what are the results for palliative stent placement compared to other treatment modalities; what are the short-term and long-term adverse events of stent placement; and can stents be used to treat benign esophageal leaks and perforations.
The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. The guideline provides recommendations for management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment.
A clinical practice guideline for patients with early stage endometrial cancer. The guideline examined adjuvant therapy, including brachytherapy, radiation, chemotherapy, as well as observation in patients with low-grade/low-risk endometrial adenocarcinoma. Outcomes of interest include recurrence, local control, and overall survival.
This is a clinical practice guideline for antiemesis. The guideline examines emesis, types of nausea/vomiting (e.g., chemotherapy induced), antiemetic therapies, and treatment issues associated with antiemetic therapies.
This is a clinical practice guideline for patients with squamous cell carcinoma (SCC) of the penis. The guideline reviews risk factors and clinical presentation, and provides recommendations for clinical staging, management of primary legions, management of regional lymph nodes, surveillance, and management of metastatic disease. Surgery, radiotherapy, and chemotherapy are reviewed as treatment options.
This is a clinical practice guideline for patients with epithelial ovarian cancer including fallopian tube cancer and primary peritoneal cancer. Less common histopathologies including ovarian low malignant potential (LMP) tumor, malignant germ cell neoplasms, carcinosarcomas (malignant mixed Müllerian tumors [MMMTs] of the ovary), and malignant sex cord-stromal tumors, are also discussed. The guideline provides recommendations on diagnosis, treatment, follow-up, and relapse. Primary treatment options for ovarian cancer include surgery (risk-reducing or cytoreductive), chemotherapy (neoadjuvant and adjuvant), incomplete surgery and/or staging, anti-angiogenesis agents, and radiation therapy. The number of chemotherapy cycles and agents are reviewed, along with drug reactions.
This is a clinical practice guideline for myelodysplastic syndromes (MDS). The guideline provides an update to recommendations on standard approaches to the diagnosis and treatment of MDS in both children and adults. The guideline discusses evaluation and prognostic stratification, Topics of interest include prognostic stratification, evaluation of related anemia and treatment of symptomatic anemia, and supportive care. Molecular abnormalities in MDS and comorbidity indices are also discussed.
This is a clinical practice guideline for patients with anal carcinoma. Risk factors are discussed and recommendations are provided on risk reduction including HIV immunization, work up, management, and follow-up care. Treatment options are reviewed, with specific recommendations provided for primary treatment of: non-metastatic anal carcinoma, anal canal cancer, and anal margin cancer, as well as treatment for metastatic cancer and for locally progressive or recurrent anal carcinoma. Special considerations are made regarding treatment of anal cancer in patients with HIV/AIDS.
This clinical practice guideline provides evidence-based recommendations to oncologists and others for treatment of patients with locally advanced, unresectable pancreatic cancer (LAPC). The guideline addresses a number of key clinical questions including: what initial assessment is recommended before initiating therapy for LAPC; what is the appropriate initial treatment approach for people diagnosed with LAPC; and for people with LAPC, what are the recommended strategies for relief of pain and symptom burden.
This guideline applies to patients with ductal carcinoma in situ (DCIS) treated with whole-breast radiation therapy (WBRT). The primary question addressed in this guideline is "what margin width minimizes the risk of ipsi-lateral breast tumor recurrence (IBTR) in patients with DCIS receiving breast-conserving surgery?" The guideline developed from a consensus panel is intended to assist treating physicians and patients in the clinical decision-making process based on the best available evidence.
These clinical practice guidelines for survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment to aid health care professionals who work with survivors of adult-onset cancer in the post-treatment period, including those in specialty cancer survivor clinics and primary care practices. The guidelines focus on the vast and persistent impact both the diagnosis and treatment of cancer can have on the adult survivor’s health, physical and mental states, health behaviors, professional and personal identity, sexuality, and financial standing.
This is a clinical practice guideline for healthy male patients who have elected to participate in early screening of prostate cancer. The guideline reviews types of early detection testing, mainly PSA and DRE, provides recommendations on baseline evaluation, risk assessment, and early detection evaluation, provides guidance on indications for biopsy and direction for management of biopsy results. Special topics of interest include biomarker testing and biopsy technique.
A clinical practice guideline for patients with a history of breast cancer. The guideline examine the use of biopsies and retesting of estrogen receptor (ER), progesterone receptor (PR) and HER2-neu receptor (HER2) to determine recurrence or metastases. Outcomes of interest include progression-free and overall survival.
This is a clinical practice guideline for patients at average or increased risk of developing sporadic colorectal cancer (patients with high risk colorectal cancer syndromes are not discussed). The guideline discusses risk assessment and provides recommendations for screening modality and schedule stratified by risk. Patients with increased risk include those with a personal history of adenomatous or sessile serrated polyps, colorectal cancer, inflammatory bowel disease, and/or positive family history of colorectal cancer. Screening tests include colonoscopy, flexible sigmoidoscopy computed tomographic colonography, and fecal-based screening.
This is a clinical practice guideline for patients with cervical cancer including squamous cell carcinoma, adenosquamous carcinoma, and adenocarcinoma of the cervix. The guideline discusses diagnosis and workup, principles of staging and surgery, primary treatment, adjuvant treatment, surveillance, and therapy for relapse. Special topics of consideration include incidental cervical cancer, radiation therapy, and cervical cancer and pregnancy.
This guideline outlines the screening, diagnosis, treatment, and follow-up of human papillomavirus related cancers. The guideline examines appropriate vaccination strategies, screening (including care controversies), and treatment including chemotherapy and surgical options. Outcomes of interest include fertility sparing and reduction of unnecessary Pap testing. Provincial resources are provided.
A clinical practice guideline for patients with bone metastases and spinal compression as common causes of cancer-related pain. The guideline examines radiotherapy and prophylactic steroids to reduce pain and pain flares. Outcomes of interest include improved neurological outcomes, survival, and reduced functional interference.
This is a clinical practice guideline for patients with, or suspected of having, upper urinary tract urothelial carcinomas (UTUCs). The guideline reviews diagnostic assessment, staging, treatment, and follow-up. Treatment recommendations are provided based on whether the disease is localized or advanced and include radical nephroureterectomy, conservative surgery, adjuvant topical agents, chemotherapy, and radiotherapy. Outcomes of interest include risk factors, sensitivity and specificity of diagnostic tests, survival (recurrence-free, disease-free, and overall), disease progression, morbidity, and mortality.
This is a clinical practice guideline for the staging and treatment of colorectal cancer. The guideline focuses on surgical and pathological considerations for the resection of colorectal cancer and provides recommendations on the technique and extent of resection, as well as the reporting of resection results. Outcomes of interest include overall survival, disease-free survival, recurrence rates, and margin status.
This is a clinical practice guideline for patients with locally advanced nonmetastatic (stages III-IVB) squamous cell carcinoma of the head and neck (LASCCHN). The guideline examines the use of systemically administered drugs in combination or in sequence with radiation (RT), surgery, or both. Outcomes of interest include tumour response rate, survival rate, and organ preservation.
This is a clinical practice guideline for the screening of colorectal cancer in asymptomatic adults. The guideline discusses colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multitargeted stool DNA test, and the methylated SEPT9 DNA test as methods of screening. Outcomes of interest include reductions in all-cause mortality, mortality from colorectal cancer, and incidence of colorectal cancer. Screening intervals, age of initiation, and age of termination are determined for different screening methods, via a modeling approach.
This is a clinical practice guideline for men with prostate cancer who are receiving androgen deprivation therapy (ADT). The guideline examines the effectiveness of therapies that target bone, which can mitigate the effects of ADT on bone health. Outcomes of interest include fracture, bone mineral density (BMD), osteoporosis, skeletal-related events (SREs), bone metastasis, pain, patient-reported quality of life (QOL), and overall survival.
This is a clinical practice guideline for women diagnosed with invasive cervical cancer. The guideline examines the most effective antitumour and palliative care interventions for clinicians and planners. Treatment options that are discussed include cone biopsy, extrafascial hysterectomy, modified radical or radical hysterectomy, and combinations of surgery, chemotherapy, and radiation therapy.
This guideline reviews clinical presentation and patient evaluation, prognostic factors, principles of management, and treatment outcomes for patients with nasal cavity and paranasal sinus cancers. Surgery, radiotherapy, and chemotherapy are discussed as treatment options. Special topics of interest include the management of cervical lymph nodes and the management of unusual pathologies of nasal cavity cancers, namely esthesioneuroblastoma and sinonasal undifferentiated carcinoma.
This is a clinical practice guideline for the staging of testicular malignancy. Recommendations are made with consideration of the following variant: staging testis tumour, diagnosed by orchiectomy. The guideline also discusses tumour markers and provides an overview of imaging modalities.
This is a clinical practice guideline for stage I breast cancer, and focuses specifically on the initial workup and surveillance for local recurrence and distant metastases in asymptomatic women. Recommendations are made with different variants in mind, including newly diagnosed cases, surveillance, and ruling out brain metastases, liver metastases, and thoracic metastases. The guideline also considers the appropriateness of different imaging procedures to detect or rule out metastasis.
This is a clinical practice guideline for breast pain. Recommendations are made with consideration of the two main types of breast pain: 1. cyclical breast pain (diffuse unilateral or bilateral pain and/or tenderness, often accompanied by swelling, that waxes and wanes with the menstrual cycle); 2. noncyclical breast pain (predominantly inflammatory in nature, rather than hormonal in origin. It is usually unilateral, and tends to be more focal than cyclical breast pain). The guideline provides guidance on the examination of breast pain with recommendations considering different types of imaging options.
This is an update of the 2009 recommendation on screening for breast cancer. The recommendations apply to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as BRCA1 or BRCA2 gene mutation or other familial cancer syndrome) or a history of chest radiation at a young age. The recommendations consider the benefits of screening mammography and digital breast tomosynthesis (DBT) as well as the potential harms.
A guideline for the management of fluorouracil for treating solid tumours. The guideline examines the safe management of fluorouracil in medication pumps, and recommendations for treating and monitoring patients who have overdosed. Important aspects include specific dosing regimens, fluid administration calculations, and outpatient management.
This is a clinical practice guideline for adults and children who are receiving hematopoietic stem cell transplantation (HSCT) or are undergoing treatment for hematological malignancies. The guideline provides recommendations for the diagnosis, prevention, and management of common respiratory viral infections in these patients. Diseases discussed include influenza, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza virus (HPIV), and human rhinovirus (HRV).
This is a clinical practice guideline for children aged 1 month to 18 years who are receiving chemotherapy. The guideline examines the management of chemotherapy-induced nausea and vomiting (CINV), including the treatment of breakthrough CINV and the prevention of refractory CINV. The primary outcome of interest is a decrease in the incidence of CINV.
This is a clinical practice guideline for patients with stage 1-3 cutaneous melanoma who have received curative resection. The guideline examines the appropriateness of adjuvant radiation therapy (RT) for these patients, narrowing the focus on those patients with primary melanoma, in-transit primary melanoma, recurrent melanoma, and those at high risk for regional recurrence of melanoma. The guideline also considers whether equivalent disease control is provided with a standard fractionation schedule and a hypofractionated schedule. Outcomes of interest include control rate, survival rate and adverse event rates.
This is a clinical practice guideline for adult men and women that have sexual function side effects as a result of cancer diagnoses and/or treatment. The guideline examines strategies/interventions to manage sexual function side effects with the aim of decreasing distress, and improving quality of life for cancer survivors and their partners. Both pharmacologic and non-pharmacologic interventions are discussed.
A clinical practice guideline for the use of palliative radiation therapy (RT) in adults with bone metastases. The guideline discusses the appropriateness of different fractionation schemes depending on clinical context, and examines the risks of experiencing long-term side-effects associated with single fractionation. The efficacy of advanced RT techniques for initial treatment and retreatment is also discussed, and the guideline examines the potential impacts that surgery, radionuclides, bisphosphonates, and kyphoplasty/vertebroplasty have on the appropriateness of palliative RT. Outcomes of interest include reductions in pain, spinal cord compression, hypercalcemia, and pathologic fracture.
This clinical practice guideline examines the impact of fertility drugs on the risk of cancer in women. The guideline looks at the association between use of fertility drugs and increased risk of developing invasive ovarian, breast, endometrial, colon and thyroid cancers as well as non-Hodgkin lymphoma and malignant melanoma. The association between fertility drugs and borderline ovarian tumours is also examined.
This is a clinical practice guideline for patients with early-stage breast cancer. The guideline provides recommendations regarding the use of sentinel node biopsy (SNB) for determining the extent to which patients' breast cancer has spread. Outcomes of interest include when to use SNB, and potential benefits and harms associated with SNB.
This is a clinical practice guideline for adults with cancer who may be considering cardiotoxic anticancer therapies. The guideline examines surveillance and monitoring approaches for cardiac dysfunction in survivors of adult-onset cancers, both during and after treatment. Determining which patients are at risk for developing cardiac dysfunction, and identifying strategies to minimize risk before and during the administration of potentially cardiotoxic therapy, are also discussed.
This is a clinical practice guideline for patients with advanced cancer and their caregivers. The guideline examines the integration of palliative care into standard oncology care, including the most practical models of palliative care, when and to who this care should be provided, and which palliative care interventions are helpful to caregivers. Outcomes of interest include quality of life, symptom relief, psychological outcomes, survival, and satisfaction.
This guideline provides recommendations on fecal immunochemical testing (FIT) in screening for colorectal neoplasia. The guideline summarizes current evidence for FIT in colorectal neoplasia detection and the comparative effectiveness of FIT relative to other common screening modalities. Guidance statements on FIT application are developed and quality metrics for program implementation are proposed.
This clinical practice guideline examines adjuvant systemic therapy for early stage breast cancer. The guideline provides a systematic method for treatment decision-making for patients with lymph node negative breast cancer and lymph node positive breast cancer, based on level of risk and hormone receptor status. The guideline further explores chemotherapy options for these patients and considers the influence of menopausal status on treatment decisions.
This is a clinical practice guideline for the identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The specific objectives of this guideline are to improve early detection and treatment of malnutrition and metabolic derangements in cancer patients and cancer survivors; to provide guidance to health care workers and patients on the most appropriate and effective management of nutritional and metabolic problems in cancer patients; and, by this, to lower the incidence and impact of malnutrition and metabolic derangements in cancer patients and survivors. Topics considered include: effects of nutritional intervention during cytostatic and targeted therapies on treatment tolerance, response to treatment and overall survival, as well as effect of artificial nutrition on treatment tolerance, treatment completion, relapse rate and overall survival.
This is a clinical practice guideline for the diagnosis and management of melanoma. The purpose of these guidelines is to achieve early diagnosis whenever possible, make doctors and patients aware of the most effective treatment options, and minimize the financial burden on the health system by documenting investigations and therapies that are inappropriate. Topics discussed include: features of melanoma, biopsy, sentinel node biopsy, and excision margins.
This guideline addresses diagnostic and therapeutic aspects of thyroid nodular disease; thyroid cancer management is not addressed. The guideline provides recommendations on clinical evaluation and diagnosis, thyroid ultrasonography and other imaging studies, thyroid biopsy, laboratory evaluation, radionuclide scanning, and management and therapy of nodules. Special topics of consideration are thyroid nodules during pregnancy and management of thyroid nodules in children.
This guideline covers integrated diagnostic reporting for diagnosing hematological cancer in adults, young people and children. It also covers staffing, facilities (levels of care) and multidisciplinary teams needed for adults and young people. It aims to improve care for people with suspected or diagnosed cancer by promoting best practice on the organization of hematological cancer services.
This is a clinical practice guideline for the management of diffuse large B-cell lymphoma. Recommendations include consideration of: prognostic factors, early stage disease, advanced stage disease, relapsed/refractory disease in the transplant-eligible patient, HIV-associated DLBCL, management of the elderly, frail or unfit patient with DLBCL, and follow-up.
A clinical practice guideline for patients with palpable breast masses. The guideline examines imaging modalities, including mammography, digital breast tomosynthesis, and ultrasound, based on clinical variants. Outcomes of interest include sensitivity and accuracy.
A clinical practice guideline for adult and pediatric patients with cancer, including hematological cancers and solid tumours. The guideline examines pneumococcal immunization in order to prevent secondary infections. Outcomes of interest include reduced pneumonial mortality and improved immunization scheduling.
This is a clinical practice guideline addressing lymphoma in the adult population. The guideline focuses on diagnosis and pathology, staging, and treatment of Non-Hodgkin Lymphomas, Hodgkin Lymphoma, HDCT and hematopoietic stem cell transplantation for lymphoma. Supportive and follow-up care is also addressed. The guideline updates the 2015 guideline of the same title.
A clinical practice guideline for the diagnosis and treatment of acute lymphoblastic leukemia in adult and pediatric patients. The guideline examines diagnostic methods, treatment by age group, and special considerations including allogeneic stem cell transplantation and the role of cranial radiation. Outcomes of interest include probability of survival and incidence of hematological relapse.
A clinical practice guideline for patients with suspected uterine neoplasms. The guideline examines surveillance, diagnostic assessment, and treatment focusing primarily on surgical interventions and systemic therapy. Outcomes of interest include long-term survival and reproductive sparing.
This is a clinical practice guideline for the evaluation, treatment, and management of thymomas and thymic carcinomas. The guideline considers surgical resection, systemic therapies, and radiation therapies for both mediastinal and thymic masses.
This clinical practice guideline is for adolescents and young adults (AYAs), defined as individuals aged 15 to 39 years, who have been diagnosed with cancer. The guideline discusses issues specific to AYAs and recommends interventions unique to these patients. Topics include an overview of risk factors, screening, diagnosis, and special considerations for management of AYA patients such as adherence to treatment and fertility preservation, contraception for women during and after cancer treatment, and management of cancer during pregnancy. Psychosocial and behavioural issues, survivorship issues, and palliative and end-of-life care are also discussed.
This is a clinical practice guideline for smoking cessation in patients with cancer. The guideline emphasizes the importance of smoking cessation in all patients with cancer and seeks to establish evidence-based, standard of care recommendations tailored to the unique needs and concerns of patients with cancer. Treatment plans are provided that include recommendations that evaluate the merits of pharmacotherapy, behaviour therapy, and follow-up. The guideline developers acknowledge that smoking and nicotine addiction is a chronic relapsing disorder and as a result, the guideline also provides recommendations around retreatment and the management of relapse.
This is a clinical practice guideline for adult patients with cancer-induced anemia, with an emphasis on patients with anemia who are receiving concomitant chemotherapy. The guideline reviews etiology and provides recommendations on screening, follow-up risk assessment, and management. Red blood cell transfusion, erythropoietic therapy (ESA), and iron monitoring and supplementation are reviewed as treatment options.
This is a clinical practice guideline for the diagnosis, staging, and treatment of thyroid carcinoma. Recommendations are stratified by histologic type, namely papillary, follicular, Hürthle cell, medullary, and anaplastic. Primary treatment options and assessment and management after initial treatment is reviewed. Recurrent or persistent disease is also discussed.
This clinical practice guideline reviews diagnosis and management of adenocarcinomas of the exocrine pancreas. Risk factors and genetic predisposition are discussed, and the guideline provides recommendations on screening, diagnosis and staging, and treatment options including systemic therapy, chemoradiation, and surgical management. Palliative and supportive care are also reviewed. Topics of interest include an overview of biomarkers, and suggestions for management of premalignant tumours of the pancreas.
This clinical practice guideline provides recommendations for evaluation, workup, management, and follow-up of 2 pathologic diagnoses in patients with epithelial occult primary cancer: adenocarcinoma or carcinoma not otherwise specified (NOS), and squamous cell carcinoma (SCC). Diagnostic tests are recommended based on disease location and patient gender. Treatment options for disseminated or localized disease for adenocarcinoma and site-specific SCC are also discussed.
This is a clinical practice guideline for Hodgkin lymphoma. The guideline discusses the clinical management of patients with classical Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), focusing exclusively on patients from post adolescence through the seventh decade of life who do not have serious intercurrent disease. Areas considered and discussed within the guideline include: staging and prognosis, the role of PET scans, treatment, principles of radiation therapy, and follow-up after completion of treatment.
This clinical practice guideline provides recommendations on esophageal and esophagogastric junction (EGJ) cancers, including: a review of hereditary cancer predisposition syndromes associated with increased risk for esophageal and EGJ cancers, staging and pathology, imaging, and treatment including surgery, radiation therapy, combined modality therapy, chemotherapy, and targeted therapies. Surveillance, management of metastatic, or recurrent cancer, and best supportive care are also discussed. Special topics of interest include treatment and surveillance options for patients with Barrett's esophagus, and suggested strategies to help alleviate the current problems associated with leucovorin shortage.
This is a clinical practice guideline for patients aged 15 or older with acute lymphoblastic leukemia (ALL). The guideline reviews diagnosis, workup and risk stratification, treatment and consolidation therapy stratified by age and Philadelphia chromosome presence/absence, surveillance, treatment for relapse/refractory disease, and supportive care. The guideline discusses typical immunophenotyping panels for all major subtypes, and minimal residual disease assessment. Evaluation and treatment of extra medullary involvement is also reviewed.
This is a clinical practice guideline for women with newly diagnosed or suspected stage IIIC or IV epithelial ovarian cancer, fallopian tub cancer, or primary peritoneal cancer. More specifically, the guideline provides guidance to clinicians and patients regarding the use of neoadjuvant chemotherapy (NACT) and interval cytoreduction. The guideline addresses a number of clinical questions including: what clinical evaluations should be performed in all women with suspected or newly diagnosed stage IIIC or IV epithelial ovarian cancer; what is the preferred chemotherapy regimen for women with stage IIIC or IV epithelial ovarian cancer who will receive NACT; and what are the treatment options for patients with progressive disease on NACT.
This is a clinical practice guideline provides evidence-based recommendations to oncologists and others on potentially curative therapy for patients with localized pancreatic cancer. Key recommendations are guided by questions including: what initial assessment is recommended before initiating any therapy for potentially curable pancreatic cancer; what is the appropriate adjuvant regimen for patients with pancreatic cancer who have undergone a resection of their primary tumor; and when should palliative care services be initiated for people with pancreatic cancer that is potentially curable by surgery.
The American Society of Clinical Oncology (ASCO) guideline for the use of postmastectomy radiotherapy (PMRT) was published in 2001. This update of that guideline, completed in collaboration with the American Society for Radiation Oncology (ASTRO) and the Society of Surgical Oncology (SSO), focuses on key areas of ongoing controversy, including the use of PMRT for patients with one to three positive lymph nodes, use of PMRT for patients undergoing neoadjuvant systemic therapy (NAST), and selected technical aspects of PMRT, particularly the extent of regional nodal irradiation (RNI). The question of whether PMRT is indicated in women with T1-2 tumours and a positive sentinel node biopsy (SNB) who do not undergo completion axillary lymph node dissection (ALND) is also discussed.
This a clinical practice guideline for women with hormone receptor (HR) -positive metastatic breast cancer (MBC). The guideline provides treatment recommendations for HR-positive MBC patients who are being considered for endocrine therapy. Recommendations are based on the answers to a number of different of questions including: Is there an optimal first-line endocrine therapy regimen for hormone receptor (HR) –positive metastatic breast cancer (MBC); is there an optimal second- or later-line endocrine therapy for HR-positive MBC; and how does adjuvant treatment affect recommendations for treatment in the metastatic or advanced setting.
This clinical practice guideline provides recommendations on colorectal screening for patients with high-risk syndromes of inherited colon cancer. Recommendations are provided for management of Lynch syndrome, FAP, MAP, Peutz-Jeghers syndrome, juvenile polyposis syndrome (JPS), SPS, and other high-risk syndromes associated with CRC risk (Li-Fraumeni syndrome [LFS] and Cowden syndrome/PTEN hamartoma tumor syndrome [PHTS]). Topics of discussion include risk assessment and genetic counselling, diagnosis, and preventative treatment options.
This is a clinical practice guideline for adult patients with potentially curable, early stage (Stage I or II) NSCLC (without nodal involvement or metastases), and who are deemed medically inoperable or refuse surgery. The guideline provides discusses the use of stereotactic body radiation therapy (SBRT)/stereotactic ablative radiation therapy with curative intent and provides recommendations on fractionation schemes. Outcomes of interest include tumour control and survival as well as toxicity.
This is a clinical practice guideline for adult patients with clinically resectable or resected stage II or III rectal cancer. The guideline reviews the use of pre- and post-operative therapy including chemotherapy and radiotherapy as treatment options. Outcomes of interest include survival (overall, cause-specific), quality of life, acute and late toxicities, and postoperative morbidity (within 30 days of surgery).
This clinical practice guideline provides recommendations for follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer. The guideline addresses the following questions which include: what evaluations (e.g., colonoscopy, computed tomography [CT], carcinoembryonic antigen [CEA], liver function, complete blood count [CBC], chest x-ray, history, physical exam) should be performed for surveillance for recurrence of cancer? What is a reasonable frequency of these evaluations for surveillance? Which symptoms and/or signs potentially signify a recurrence of CRC and warrant investigation?
This is a clinical practice guideline for the pretreatment staging of colorectal cancer. Recommendations are made with consideration of two different variants of colorectal cancer: 1. rectal cancer, locoregional staging, and 2. colorectal cancer, staging for distant metastases. The guideline provides recommendations as to the appropriate imaging modalities to be used in the initial staging of colorectal cancer.
This is an update to the 2009 recommendation on aspirin use to prevent cardiovascular disease (CVD) events and the 2007 recommendation on aspirin and nonsteroidal anti-inflammatory drug use to prevent colorectal cancer (CRC). The recommendations apply to adults aged 40 years or older without known CVD and without increased bleeding risk. Recommendations include consideration of the aspirin dosage as well as the benefits and harms of initiating aspirin use.
This guideline is for adult patients over 16 years of age with suspected, newly diagnosed, or relapsed myeloma. The guideline provides recommendations on laboratory and imaging investigations, management of newly diagnosed myeloma, managing acute renal disease caused by myeloma, preventing and managing complications, disease monitoring, and managing relapsed myeloma. Recommendations are also provided on service organization. Outcomes of interest include time to biochemical and/or clinical progression, overall survival, adverse events, quality of life and resource use.
This is a clinical practice guideline for male patients diagnosed with or suspected of having prostate cancer. The guideline reviews classification and staging, diagnostic evaluation, disease management, and follow-up care. Side effects of local treatment and health-related quality of life in prostate cancer survivors are also discussed. Outcomes of interest include overall survival, cancer-specific survival, development of metastatic disease, sensitivity and specificity of diagnostic procedures, and side effects of treatment.
This is a clinical practice guideline for adult patients with acute myeloid leukemia (AML), excluding acute promyelocytic leukemia, who are deemed suitable for intensive treatment. The guideline includes consideration of the most effective systemic post-remission treatment - consolidation and/or maintenance - for adults with previously untreated AML. The guideline also considers which patient characteristics are most important when making treatment decisions.
A clinical practice guideline for adult, adolescent, and child patients with nodular lymphocyte predominant Hodgkin lymphoma. The guideline examines investigation and management for multiple treatment stages, including disease transformations and fertility preservation options. Outcomes of interest include improved outcomes through combination chemotherapy, and improved end of treatment scans.
This is a clinical practice guideline for asymptomatic adults aged 50 years and older who are not at high risk for colorectal cancer. The guideline provides screening recommendations stratified by age group (aged 50-74, and 74 and older). Various screening procedures are discussed and compared including fecal occult blood testing (gFOBT), fecal immunochemical testing, flexible sigmoidoscopy, and colonoscopy. Outcomes of interest include mortality and morbidity, adverse outcomes of screening procedures, test sensitivity and specificity, and positive and negative predictive values.
This is a clinical practice guideline for adult patients with thyroid nodules and differentiated thyroid cancer (DTC). The guideline provides recommendations on initial management of thyroid cancer including screening, staging, risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine, as well as long-term management including surveillance techniques, management of recurrent and metastatic disease, and consideration for clinical trials and targeted therapy. The evaluation and diagnostic approach for thyroid nodules is also discussed, including a review of indications for fine-needle aspiration biopsy and interpretation of results, as well as use of molecular markers and management of benign thyroid nodules. Outcomes of interest include survival, recurrence, sensitivity and specificity.
This is a clinical practice guideline for premenopausal women with Stage I to III hormone receptor-positive breast cancer. The guideline reviews the use of ovarian suppression in addition to standard adjuvant or standard therapy, with recommendations stratified by risk. Outcomes of interest included survival (overall, disease free), freedom from breast cancer at 5 years, freedom from distant recurrence at 5 years, adverse events, quality of life, patient-reported outcomes, and cognitive impairment.
This is a clinical practice guideline for the surveillance of patients after colorectal cancer (CRC) resection with curative intent. This guideline focuses on the role of colonoscopy in patients after CRC resection. It also considers the possible adjunctive roles of fecal testing and CTC. Overall, the goal of the guideline is to provide recommendations regarding the role of colonoscopy, flexible sigmoidoscopy, EUS, fecal testing, and CTC in surveillance after surgical resection of CRC.
This is a clinical practice guideline for women who are at increased risk of developing breast cancer. The guideline provides an overview on risk assessment, risk-reduction interventions including lifestyle interventions, risk-reduction surgery, and risk-reduction agents (tamoxifen, raloxifene, aromatase inhibitors). Recommendations are also provided for managing side effects of risk-reduction agents and monitoring for complications. Risk-reduction counselling is also discussed.
This is a clinical practice guideline for patients over 18 years of age with esophageal cancer, including both squamous cell and adenocarcinoma. The guideline provides recommendations on diagnostic work-up, staging, treatment options for potentially curable cancer stratified by stage, and management options for incurable cancer. Esophagectomy, endoscopic therapy, primary chemoradiotherapy, radiotherapy, pre-operative chemoradiotherapy followed by esophagectomy and pre-operative chemotherapy are discussed, as well as supportive care. Outcomes of interest include survival (overall, progression-free, 5-year), morbidity, toxicity, and rate of sudden death.
This is a clinical practice guideline for patients with a variety of cancers, including lung, liver, and kidney tumours, with a specific focus on patients with hepatocellular carcinoma (HCC) or liver metastases. The guideline examines the effectiveness of thermal ablation, which encompasses radiofrequency ablation (RFA) and microwave ablation, as well as transcatheter arterial chemoembolization (TACE), alone or in combination with other strategies. The guideline outlines patient clinical criteria, criteria for service providers, and system-level criteria.
This is a clinical practice guideline for women with vulvar carcinoma. The guideline examines the appropriate use of adjuvant therapy in these patients, following primary surgical treatment. Adjuvant radiation, including dose, fields, and technique, as well as adjuvant chemotherapy, were discussed as potential treatment options. In addition, the guideline examines the appropriateness of different imaging techniques, such as magnetic resonance imaging (MRI), fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), and computed tomography (CT), for the staging of vulvar carcinoma.
A clinical practice guideline for adult patients with potentially curable esophageal carcinoma. The guideline examines diagnosis with FDG-PET/CT, staging, and treatment options including chemoradiotherapy and brachytherapy. Outcomes of interest include staging accuracy and treatment response.
This is a clinical practice guideline for the second line treatment of metastatic melanoma. The guideline facilitates the safe and effective clinical use of the systemic therapy ipilimumab. The treatment intent of this guideline is non-curative and to improve overall survival, as well as progression free survival.
This is a clinical practice guideline for the treatment of mutated metastatic melanoma. The guideline facilitates the safe and effective clinical use of the systemic therapy vemurafenib. The treatment intent of this guideline is non-curative and to improve overall survival, as well as progression free survival.
This is a clinical practice guideline for the treatment of relapsed/refractory anaplastic large cell lymphoma. The guideline facilitates the safe and effective clinical use of brentuximab vedotin. The treatment intent is non-curative and to improve progression-free survival and overall survival.
This is a clinical practice guideline for the evaluation, diagnosis and management of a suspicious lateral neck mass in adults. Use of history and physical exam, X-ray, CT scan, and fine needle aspiration biopsy (FNAB) are discussed along with urgency of referral depending on results. Additionally, the guideline addresses the diagnosis or suspicion of lymphoma, as well as appropriate use of open biopsy.
This is a clinical practice guideline for the adjuvant treatment of completely resected stages I-IV uterine leiomyosarcoma. The guideline is intended to guide the safe and effective clinical use of fixed-dose rates of gemcitabine and docetaxel. Treatment outcomes are potentially curative and to improve progression-free survival, as well as overall survival.
This is a clinical practice guideline for the use of GI endoscopy in the evaluation and treatment of pancreatic neoplasms. Diagnosis by endoscopic ultrasound (EUS) is discussed, as is use of EUS-guided-fine needle aspiration (FNA) to determine cytology, chemistries and tumour markers such as CEA, as well as cyst fluid DNA and molecular analysis. Other topics of discussion include emerging techniques for cyst evaluation, adverse events fro EUS, diagnosis by ERCP (Endoscopic Retrograde Cholangio-Pancreatography), and endoscopic treatment of cystic lesions.
A clinical practice guideline for patients for have undergone surgery for breast cancer, or have metastatic breast cancer. The guideline examines the utility of radiotherapy in breast-conserving surgery, post-mastectomy, and metastasis. Outcomes of interest include recurrence, death risk, and overall survival.
A clinical practice guideline for adult patients with newly diagnosed WHO grade 2 astrocytoma, oligo-astroctyoma, or oligodendroglioma. The guideline examines the role of immunotherapy and tumour vaccines. nutrition, and alternative therapies for treatment. Outcomes of interest include adverse outcomes and self-reported use, however evidence is limited.
This is a clinical practice guideline for the diagnosis and management of patients with diffuse low grade glioma. More specifically, the guideline addresses a number of questions related to the diagnosis and management of patients with diffuse low grade glioma including: what are the optimal neuropathological techniques to diagnose low-grade glioma in the adult; and, in adult patients with histologically-proven WHO grade II diffuse glioma, is MGMT promoter methylation testing warranted? If so, is there a preferred method? In addition to providing recommendations in response to questions like those stated above, the guideline also identifies key issues for future investigation such as the identification of distinct molecular characteristics.
This is a clinical practice guideline for the management of renal cell carcinoma. The guideline examines the diagnosis, staging, treatment, and follow-up of renal cell carcinoma, with treatment recommendations stratified by disease stage. Therapeutic strategies are also discussed. Outcomes of interest include overall survival, cancer-specific survival, recurrence-free survival, and quality of life.
This clinical practice guideline provides recommendations for urothelial carcinomas of the upper urinary tract. The guideline covers epidemiology, etiology, and pathology, staging, diagnosis, prognosis, disease management, and follow-up. Issues addressed in the guideline include: risk factors, symptoms, imaging, preoperative factors, predictive tools, and management for both localized and advanced disease.
This is a clinical practice guideline for non-muscle-invasive bladder cancer (Ta, T1 and CIS). The guideline covers staging and classification systems, diagnosis, disease recurrence, management, and follow-up. Issues addressed include: imaging, chemotherapy, and biopsy.
A clinical practice guideline for female patients who have received potentially curative primary treatment for cervical cancer. The guideline examines appropriate follow-up strategies including minimum levels of screening and follow-up intervals. Outcomes of interest include recurrences detected during screening and survival rates.
This is a clinical practice guideline for immunocompetent adults with primary CNS lymphoma. The guideline provides consensus considerations and recommendations for diagnosis, assessment, staging, and treatment of primary CNS lymphoma. Specifically, the guideline addresses aspects of care related to surgery, systemic and intrathecal chemotherapy, intensive chemotherapy with autologous stem-cell transplantation, radiotherapy, intraocular manifestations, and management of elderly patients.
An organizational guideline for the provisions of gynecologic oncology services by multidisciplinary professionals. The guideline examines the efficacy of specialist treatment, resource allocation, and the organization of work and services. Important aspects include the role of gynecologic oncologist, annual surgical case volumes, and minimum treatment standards.
A clinical practice guideline for prostate cancer survivors. The guideline examines health promotion, screening for second primary cancers, and assessment of physical and psychosocial effects. Outcomes of interest include effective referral, minimized psychological harm, and reduced recurrence.
This is a clinical practice guideline for the evaluation of liver disease severity and prognosis. The guideline considers the value of liver biopsy for fibrosis evaluation and compares it to other non-invasive tests. The guideline developers considered a number of different questions including: what are the currently available non-invasive tests; how do serum biomarkers perform for staging liver fibrosis; and what are the indications for non-invasive tests for staging liver disease in viral hepatitis.
A clinical practice guideline for the management of complications in patients with multiple myeloma. The guideline examines treatment and supportive care for common complications, including pain management, anemia, renal impairment, peripheral neuropathy, infections, and venous thromboembolisms. Outcomes of interest include renal failure, fracture, and reduced impairment.
This clinical practice guideline provides recommendations on the diagnosis of Lynch syndrome in patients without a personal history of colorectal or another cancer but with a family history suggestive of Lynch syndrome, as well as for patients with colorectal cancer with IHC absent for MLH1. Management of the risk of colorectal cancer for patients with Lynch syndrome is also discussed with a review of surveillance colonoscopy and recommendations on the use of aspirin as a preventative measure for cancer. Outcomes of interest include sensitivity, specificity, false-positive and false-negative rates of diagnostic tests, as well as psychological distress/quality of life, colorectal cancer incidence, staging, and mortality, Lynch-syndrome associated cancer incidence and mortality, surgical complications from colonoscopy, and costs.
A clinical practice guideline for radiologic management of thoracic nodules and masses. The guideline examines radiologic imaging and lung cancer screening, focusing primarily on CT scans and biopsy for a number of variant conditions. Outcomes of interest include diagnostic accuracy, reduced thoracotomies, and reduced complications.
This is a clinical practice guideline for patients with resectable oropharyngeal (OP) carcinomas. The guideline reviews optimal radiation therapy treatment intensification, optimal concurrent chemotherapy including use of altered fractionation, the role of cetuximab, induction chemotherapy, organ-preserving surgery, and nonsurgical deintensification therapy. Special topics of consideration include the therapeutic implications of OP carcinomas in Human Papillomavirus–Positive (HPV) patients.
This is a clinical practice guideline for the follow up of malignant or aggressive musculoskeletal tumours. The guideline discusses the timing of surveillance and the type of imaging used, with a focus on FDG-PET/CT and MRI, as well as ultrasound, X-ray, and Tc-99m bone scan. Sensitivity, specificity, recurrence rate, and survival (overall and progression-free) are all considered as outcomes.
This is a clinical practice guideline for the diagnosis, staging, and treatment of oropharyngeal cancer. The guidelines provide recommendations on staging for primary tumour, regional lymph nodes, and distant metastases; management of invasive carcinoma of oropharynx, locally advanced resectable disease; post-operative adjuvant therapy options, post chemoradiation or post radiation evaluation; salvage therapy; radiation therapy; concurrent chemotherapy; and management of residual disease, loco-regional recurrent or distant metastases.
This is a clinical practice guideline for the assessment and management of patients with nasopharyngeal carcinoma. The guideline explores the etiology of nasopharyngeal carcinoma as well as the pathologic classification and staging. Recommendations are provided for assessment and include discussions of imaging and specimen collection. Additionally, the guideline explores appropriate management options and provides guidance on how to proceed in cases of suspected recurrent disease.
This is a clinical practice guideline for the treatment of patients with laryngeal cancer. The guideline provides different treatment options by the following laryngeal divisions: glottic, supraglottic, and subglottic. The role of surgery, radiotherapy and chemotherapy are explored in this guideline.
This is a clinical practice guideline for postoperative care in gynecologic/oncology surgery. The guideline reviewed existing evidence to make recommendations for elements of postoperative care. Postoperative care elements considered in the guideline include: preoperative medical optimization, bowel preparation, carbohydrate loading, thromboembolism prophylaxis, skin preparation, standard anesthetic protocol and intraoperative fluid management. This guideline is part 2 of 2 in the Enhanced Recovery After Surgery (ERAS®) Society Recommendations guidelines.
A clinical practice guideline for the diagnosis, treatment, and follow-up of oropharyngeal, hypopharyngeal and laryngeal cancers. The guideline examines preferred locoregional staging methods and treatment options including an emphasis on interprofessional care. Outcomes of interest include limited evidence for the benefits of surgical treatment in some cases and some evidence that primary chemotherapy may provide some benefit over radiotherapy.
These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with differentiated thyroid cancer (DTC) are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided.
A clinical practice guideline for screening mammography in women at average risk for breast cancer. The guideline examines screening regularity and the relative benefits and harms of screening modalities, focusing primarily on mammography. Outcomes of interest include reduced harm through false-positives and improved breast cancer mortality.
A clinical practice guideline for the primary prevention of non-melanoma skin cancer, including basal and squamous cell carcinoma. The guideline examines modifiable risk factors for developing skin cancer, focusing primarily on photoprotection at an individual and public health level. Outcomes of interest include reduced actinic keratoses through daily sunscreen use and clarification of labelling standards. This guideline is Chapter 2 of 5 of the Non-melanoma Skin Cancer in Canada guideline series.
This clinical practice guideline provides recommendations on management of prostate cancer, including diagnosis and screening, management stratified by risk, and follow up care. Active surveillance, surgery (radical prostatectomy), external beam radiotherapy (EBRT), low dose rate (LDR) brachytherapy, cryosurgery, High Intensity Focused Ultrasound (HIFU), Androgen Deprivation Therapy (ADT), and systemic therapies are discussed as treatment options. Bone health is also reviewed. Outcomes of interest include survival and recurrence.
This is a guideline for management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem cell transplantation. The guideline reviews patient evaluation and provides recommendations on initial management, with considerations made to patient condition and whether or not they are already receiving empiric antibiotics. Recommendations are also provided for continued management of inpatients, management based on culture results, and management of fever in hematology/oncology patients who have completed therapy or are on therapy but are not neutropenic.
This clinical practice guideline provides an update to a key recommendation for the use of antiemetics for patients receiving cancer therapy. More specifically, the update focuses on recommendations regarding the use of netupitant and palonosetron (NEPA), a drug used for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of chemotherapy. Areas addressed in the guideline include: dosing information for NEPA and other antiemetics summarized in a table, as well as cost consideration for the use of NEPA.
A clinical practice guideline for the management of female patients with cervical cancer. The guideline examines diagnosis, staging, treatment including surgery and adjuvant therapy, and follow up. Outcomes of interest include fertility preservations and improved quality of life through hormonal replacement therapy during follow up.
This clinical practice guideline provides recommendations on the use of colony-stimulating factors (CSFs) in adults or children with a solid tumour or lymphoma who are being treated with chemotherapy. The guideline reviews indications for use of CSFs as primary or secondary prophylaxis, as well as initiation, duration, dosing, and administration. Other topics covered include the use of CSFs to increase chemotherapy dose density, and the role of CSFs as: adjuncts to progenitor-cell transplantation; in the setting of acute leukemia or myelodysplastic syndromes; and in the treatment of radiation injury. Outcomes of interest include neutropenia- and infection-related outcomes, survival (progression-free and overall survival), and outcomes related to stem-cell mobilization or transplantation.
A clinical practice guideline for adult patients with renal cancer. The guideline examines treatment through surgery and ablative therapy, diagnosis, and follow-up. Outcomes of interest include improved prediction of cancer-specific survival through Karakiewicz nomograms and improved evidence for microwave ablation.
This guideline outlines the screening, diagnosis, treatment, and follow-up of human papillomavirus related cancers. The guideline examines appropriate vaccination strategies, screening (including care controversies), and treatment including chemotherapy and surgical options. Outcomes of interest include fertility sparing and reduction of unnecessary Pap testing.
This is a clinical practice guideline on the identification and treatment of psychosocial problems in patients with cancer. The guideline discusses screening tools for distress, initial evaluation and treatment by the oncology team, psychological/psychiatric treatment by mental health professionals, social work and counselling services, and spiritual and chaplaincy care. Psychological/psychiatric treatment guidelines are reviewed. Special topics of interest include oncologist burnout.
This is a clinical practice guideline for patients (children/adolescents and adults) who are experiencing cancer-related fatigue. The guideline discusses evaluation and intervention for patients on active treatment, post-treatment, and at end of life. Education and counselling, nonpharmacologic interventions, and pharmacologic interventions are all discussed along with general strategies for management of fatigue.
This clinical practice guideline reviews diagnosis and management of adenocarcinomas of the exocrine pancreas. Risk factors and genetic predisposition are discussed, and the guideline provides recommendations on screening, diagnosis and staging, and treatment options including systemic therapy, chemoradiation, and surgical management. Palliative and supportive care are also reviewed. Topics of interest include an overview of biomarkers, and suggestions for management of premalignant tumours of the pancreas.
This clinical practice guideline provides recommendations for evaluation, workup, management, and follow-up of 2 pathologic diagnoses in patients with epithelial occult primary cancer: adenocarcinoma or carcinoma not otherwise specified (NOS), and squamous cell carcinoma (SCC). Diagnostic tests are recommended based on disease location and patient gender. Treatment options for disseminated or localized disease for adenocarcinoma and site-specific SCC are also discussed.
This is a clinical practice guideline for multiple myeloma. The guideline addresses diagnosis, treatment, and follow-up for patients with multiple myeloma. It offers specific recommendations for primary therapy, surveillance and follow-up tests for solitary plasmacytoma, smoldering (asymptomatic) myeloma, active (symptomatic) multiple myeloma, as well as for transplant and non-transplant candidates.
This is a clinical practice guideline for patients with colon cancer or adenocarcinomas of the small bowel and appendix. The guideline reviews staging, pathology, clinical presentation and treatment of nonmetastatic disease, management of metastatic disease, post-treatment surveillance, and survivorship. The role of vitamin D in colorectal cancer is also discussed.
This is a clinical practice guideline for women with endometrial cancer, including uterine carcinosarcoma. The guideline provides recommendations on lynch syndrome screening, surgery, adjuvant treatment for completely surgically staged endometrioid carcinoma, and adjuvant treatment for surgically staged high risk histotypes including endometrial serous, clear cell, dedifferentiated/undifferentiated carcinomas and carcinosarcomas. The guideline also reviews therapy for relapsed patients, and follow-up and surveillance of women without evidence of disease after primary potentially curative treatment for any stage of endometrial cancer.
An organizational guideline for the processing and administration of chemotherapy to cancer patients. This guideline is an update to the 2013 guideline of the same title. The guideline examines the different stages and stakeholders in the chemotherapy treatment process, and the roles and responsibilities therein. Important aspects include accountability checks and staff safety procedures.
This clinical practice guideline is for patients diagnosed with or suspected of having melanoma. The guideline provides recommendations on diagnostic assessment, staging, and management. Follow-up care is also discussed, including topics such as management of suboptimal Vitamin D levels and concurrent drug therapies. Outcomes of interest include survival (overall, disease free, melanoma specific), and adverse events (acute toxicity, wound/sensory complications).
This clinical practice guideline is for the treatment of patients with stage II and III colon cancer who have undergone complete resection with curative intent. The guideline examines the impact of different adjuvant chemotherapy regimens. Outcomes of interest include overall survival, disease-free survival, adverse events, and quality of life.
This is a clinical practice guideline for women with the noninvasive breast cancer known as ductal carcinoma in situ (DCIS; intraductal carcinoma). The guideline examines the management options for DCIS, which commonly involves excision, radiotherapy, and hormonal therapy. Outcomes of interest include improvements in relapse-free survival and overall survival.
This is a clinical practice guideline for women with stage 1 and 2 breast cancer. The guideline discusses conservative surgery and radiation therapy, while specifically examining the National Institutes of Health (NIH) Consensus Conference statement, results of prospective randomized clinical trials, patient selection and evaluation, radiation therapy (RT) following conservative surgery, treatment techniques, the role of accelerated partial-breast irradiation (PBI), the integration of radiation and adjuvant systemic therapy, and follow-up care. The guideline discusses the appropriateness of different techniques for four unique clinical situations.
A clinical practice guideline for patients with any type of cancer. The guideline examines the benefits of smoking cessation, and education for quitting once a patient has been diagnosed with cancer. Outcomes of interest include quality of life and treatment-related toxicity.
This is a clinical practice guideline for the treatment of metastatic non-small cell lung cancer. The guideline facilitates the safe and effective clinical use of pemetrexed for this population. The treatment intent is non-curative and meant to prolong overall survival and progression-free survival, as well as improve quality of life.
This is a clinical practice guideline for the systemic first- or second-line treatment of metastatic or locally advanced uterine leiomyosarcoma. The guide facilitates the safe and effective clinical use of fixed-dose rate gemcitabine and docetaxel. Treatment outcomes are non-curative and look to prolong progression-free survival and overall survival.
This is a systemic therapy summary for the use of dose-dense paclitaxel combined with carboplatintherapy to treat adults with stage 2-4 ovarian/fallopian/peritoneal cancer (with curative intent or to prolong survival). Treatment regimen, drug dose, and administration are reviewed, along with pre-medications, supportive care, suggested outpatient prescriptions, and recommendations for clinical monitoring and follow-up care. The guideline also addresses adverse events, precautions, dose modifications, and drug interactions.
This is a clinical practice guideline for patients with advanced or metastatic renal cell carcinoma (both clear cell and non-clear cell histology) with poor prognosis. The guideline provides recommendations for treatment with temsirolimus, including treatment regimen and recommendations for clinical monitoring and follow-up care. Pre-medication and supportive care is discussed along with adverse events, precautions, and drug interactions.
This clinical practice guideline provides recommendations on the diagnosis and treatment of rectal cancer in adult patients. Imaging procedures for staging are discussed with comparisons made between ultrasound, MRI, and CT scan. Treatment options include neoadjuvant and adjuvant chemotherapy as well as rectal cancer surgery, specifically total mesorectal excision (TME). Surgical management of recurrent rectal adenocarcinoma is also discussed.
A clinical practice guideline for patients with advanced or metastatic pancreatic cancer. The guideline examines the use of oxaliplatin, fluorouracil and leucovorin in patients who had received, or were intolerant to, gemcitabine-based therapy. Outcomes of interest include progression-free and overall survival.
This is a clinical practice guideline on the management and admission to intensive care of critically ill adult patients with hematological malignancy. This guideline is intended to be of use to hematologists and intensivists practicing in the UK, and outlines some of the major considerations in the management of the critically ill patient with hematological malignancy.
A clinical practice guideline for the pathological diagnosis of breast cancer in adults. The guideline examines diagnostic procedures based on routine clinical practice and treatment modalities. Outcomes of interest include diagnostic accuracy, concordance rates, and margin negativity.
This is a clinical practice guideline for patients with, or suspected of having, primary urethral carcinoma. The guideline reviews diagnostic assessment, staging, and treatment. Treatment options include penile-preserving and urethral-sparing surgery, urethrectomy, radiotherapy, cisplatinum-based chemotherapy, chemoradiotherapy, transurethral resection (TUR), Bacille-Calmette-Guérin (BCG), and cystoprostatectomy with extended pelvic lymphadenectomy. Outcomes of interest include survival, sensitivity of diagnostic tests, local cure rate, local recurrence rate, and local tumour control rate.
This clinical practice guideline provides recommendations on use of systemic treatment in the care of advanced, stage IIIB/IV patients who have non-small cell lung cancer (NSCLC) that has not progressed (i.e., complete response, partial response or stable disease) following four to six cycles of platinum-based chemotherapy and who have maintained an Eastern Cooperative Oncology Group performance status of 0 to 2. The guideline discusses use of pemetrexed, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), and use of maintenance chemotherapies, namely docetaxel and gemcitabine. Overall survival and quality of life were critical outcomes for the development of recommendations within this guideline.
A clinical practice guideline for the diagnostic assessment of clinically significant prostate cancer. The guideline examines Multiparametric magnetic resonance imaging as an alternative to traditional transrectal ultrasound–guided systematic biopsy in order to reduce over- or under-diagnosis of clinical results. Outcomes of interest include detection rate of clinically significant prostate cancer, improved survival, and improved predictive value.
An organizational guideline for the provision of colonoscopies to patients with abnormal cervical screening results. The guideline examines the provision of consistent quality in colonoscopies, including training and competence, practices, and quality indicators. Important aspects include training program availability, referral criteria, and group vs. individual practice requirements.
This clinical practice guideline provides recommendations on prevention, diagnosis, and treatment of hepatocellular carcinoma. Treatment options are discussed including surgical resection, transplantation, local ablation, transarterial chemoembolization, external-beam radiation therapy, systemic therapies, preemptive antiviral therapy, and drug treatment for cancer pain. Assessment of tumour response and post-treatment follow-up are also reviewed.
This is a clinical practice guideline for colorectal cancer (CRC) survivors. The guideline reviews methods to identify and manage any physical and psychosocial long-term and late effects of CRC and its treatment, recommendations on surveillance for recurrence and screening for second primary cancers, and health promotion recommendations with detailed discussion about obesity, physical activity, nutrition, and smoking cessation. The guideline also discusses coordination of care among specialists and primary care providers.
A clinical practice guideline for the use of plerixafor for autologous hematopoietic stem cell mobilization and transplantation in patients with hematologic cancers. The guideline examines administration with granulocyte-colony stimulating factor in patients who have or have not been mobilized before. Outcomes of interest include successful apheresis harvest, number of CD34+ cells collected, and survival rate.
A clinical practice guideline for the management of patients with non-small cell lung cancer. The guideline examines screening for at-risk populations, diagnostic work-up, treatment, and follow-up. Outcomes of interest include clarified current standard of care through lobectomy and mediastina lymph node dissection, with additional treatment selections based on patient population.
A clinical practice guideline for the surveillance of patients following treatment for uveal melanoma and the use of new and systemic treatments. The guideline examines the effectiveness of new surveillance technologies, staging, and treatment including special consideration for patients with hepatic recurrence. Outcomes of interest include local tumour control, preservation of eye function, and progression free survival.
A clinical practice guideline for patients with non-muscle invasive bladder cancer. The guideline examines management, emphasizing intravesical therapy and prognostic factors. Outcomes of interest include lower recurrence and longer disease-free intervals with transurethral resection of bladder tumours.
A clinical practice guideline for the treatment of actinic keratosis and cheilitis as precursors to invasive squamous cell carcinomas. The guideline examines treatment options including surgical and topical removal, and considers the use of combined modalities. There is also specific information for the monitoring and treatment of long-term immunosuppressed patients. Outcomes of interest include improved cosmetic results through the use of topical methods. This guideline is Chapter 3 of 5 of the Non-melanoma Skin Cancer in Canada guideline series.
This is an update to the 2013 clinical practice guideline for the management of multiple myeloma in adult patients. The guideline examines diagnosis and treatment for multiple myeloma, monoclonal gammopathy, smoldering myeloma, and amyloidosis, including prognostic criteria. Outcomes of interest include improved survival outcomes through triple drug based induction regimens and improved dose reduction options for elderly patients.
This is a clinical practice guideline addressing lymphoma in the adult population. The guideline focuses on the following areas: Diagnosis and Pathologic Classification, Staging, Treatment of Non-Hodgkin Lymphomas, Hodgkin Lymphoma, HDCT and hematopoietic stem cell transplantation for lymphoma, supportive care in the treatment of lymphoma, and follow-up care in the treatment of lymphoma. Additionally, it seeks to provide recommendations to the following questions: what are the diagnostic criteria for the most common lymphomas; what are the staging and re-staging procedures for Hodgkin and non-Hodgkin lymphomas; what are the recommended treatment and management options for Hodgkin and non-Hodgkin lymphomas; and what are the recommended follow-up procedures for patients with malignant Hodgkin and non-Hodgkin lymphoma.
A clinical practice guideline for adult patients with metastatic colorectal cancer. The guideline examines treatment, primarily though palliative chemotherapy regimens. Outcomes of interest include delayed disease progression through monoclonal antibodies and improved treatment planning through the identification of RAS testing.
This is a clinical practice guideline for female patients with metastatic breast cancer. The guideline examines whether biomarkers should be used to guide decisions on systemic therapy. Topics of interest include the clinical utility of sampling metastatic tumours to test for changes from the primary tumour with respect to endocrine receptor (ER/PR) or HER2 status, and whether additional clinical biomarkers beyond ER/PR/HER2 have shown clinical utility in initiating or directing clinical therapy, or guiding decisions on switching to a different regime or discontinuing treatment. Outcomes of interest include survival (overall, progression-free), quality of life, and cost effectiveness. The guideline examines whether changes to systemic therapy based on biomarker status improves health outcomes, quality of life and/or cost effectiveness. Specifically, the guideline reviews the testing of metastatic tumour for changes from primary tumour with respect to ER, PR, and HER2 status, whether there is evidence of additional tumour markers that have demonstrated clinical utility to initiate or direct selection of systemic therapy, or to switch or discontinue a specific drug regime.
This is a clinical practice guideline for patients with stage IV non-small-cell lung cancer. The guideline reviews systemic therapies as first-, second-, and third-line treatment options, with considerations made to patient performance status and tumour characteristics such as EGFR/ALK status. The guideline provides recommendations on therapy type and dosage as well as interval and duration. Topics of interest include treatment considerations for older adults (65 years or older) and a discussion on palliative care. Outcomes of interest include survival (overall, progression-free), and adverse events.
This is a guideline for the treatment and staging of small-cell lung cancer. The guideline examines treatment through chemotherapy, radiotherapy, and surgery with a focus on potential toxicity. Outcomes of interest include clarified duration of chemotherapy as a first-line treatment and increased use of PET scans for staging.
This clinical practice guideline discusses specific issues related to the management of cancer in adults aged 65 years or older. Topics include screening and comprehensive geriatric assessment (CGA), assessing risks and benefits of treatment, preventing or decreasing complications from therapy, and managing disease-specific issues. Recommendations are also provided for management of patients deemed to be at high risk for toxicity from standard treatment.
This clinical practice guideline is for adolescents and young adults (AYAs), defined as individuals aged 15 to 39 years, who have been diagnosed with cancer. The guideline discusses issues specific to AYAs and recommends interventions unique to these patients. Topics include an overview of risk factors, screening, diagnosis, and special considerations for management of AYA patients such as adherence to treatment and fertility preservation, contraception for women during and after cancer treatment, and management of cancer during pregnancy. Psychosocial and behavioural issues, survivorship issues, and palliative and end-of-life care are also discussed.
This is a clinical practice guideline for adult patients with cancer-induced anemia, with an emphasis on patients with anemia who are receiving concomitant chemotherapy. The guideline reviews etiology and provides recommendations on screening, follow-up risk assessment, and management. Red blood cell transfusion, erythropoietic therapy (ESA), and iron monitoring and supplementation are reviewed as treatment options.
This is a clinical practice guideline for small cell lung cancer and lung neuroendocrine tumours. Diagnosis, staging, prognostic factors, treatment and surveillance are reviewed. Treatment options include chemotherapy, with special topics of discussion including elderly patients and second-line and third-line therapies, radiotherapy (thoracic radiotherapy, prophylactic cranial irradiation, and palliative radiotherapy), and surgery. Outcomes of interest include survival (disease free, overall, progression-free) and response rates, and treatment toxicity.
This is a clinical practice guideline for patients with epithelial ovarian cancer including fallopian tube cancer and primary peritoneal cancer. Less common histopathologies including ovarian low malignant potential (LMP) tumour, malignant germ cell neoplasms, carcinosarcomas (malignant mixed Müllerian tumours [MMMTs] of the ovary), and malignant sex cord-stromal tumours, are also discussed. The guideline provides recommendations on diagnosis, treatment, follow-up, and relapse. Primary treatment options for ovarian cancer include surgery (risk-reducing or cytoreductive), chemotherapy (neoadjuvant and adjuvant), incomplete surgery and/or staging, anti-angiogenesis agents, and radiation therapy. The number of chemotherapy cycles and agents are reviewed, along with drug reactions.
This is a clinical practice guideline for dermatofibrosarcoma protuberans (DFSP). The NCCN Non-Melanoma Skin Cancer Panel has developed these guidelines outlining the treatment of DFSP to supplement their guidelines for basal cell and squamous cell skin cancers and merkel cell carcinoma. Topic areas discussed in this guideline as they relate to DFSP include: biopsy, surgery, chemotherapy, and radiotherapy.
This is a clinical practice guideline for Waldenström's Macroglobulinemia (WM) / Lymphoplasmacytic Lymphoma (LPL). The guideline provides recommendations for the diagnosis, work up, and treatment of WM / LPL. Topic areas discussed in the guideline include: primary treatment regimens (both regimens not toxic to stems cells as well as regimens with potential or unknown toxicity to stem cells), assessment of response to treatment, follow-up after primary treatment, treatment of IgM-related peripheral neuropathy, maintenance therapy, and management of patients who are intolerant to rituximab.
This is a clinical practice guideline for Hodgkin lymphoma. The guideline discusses the clinical management of patients with classical Hodgkin lymphoma (CHL) and nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), focusing exclusively on patients from post adolescence through the seventh decade of life who do not have serious intercurrent disease. Areas considered and discussed within the guideline include: staging and prognosis, the role of PET scans, treatment, principles of radiation therapy, and follow-up after completion of treatment.
This is a clinical practice guideline for patients with colon cancer. The guideline reviews risk assessment, TNM staging, and pathology, and provides recommendations on the clinical presentation and treatment of nonmetastatic disease as well as recommendations on management of metastatic disease. Treatment for locally recurrent disease and survivorship are also discussed, as is the role of vitamin D in colorectal cancer.
This clinical practice guideline discusses evaluation, treatment (primary and secondary) options, and follow-up care for patients with bladder cancer. Specific workup and treatment recommendations are provided for non-muscle invasive disease, muscle invasive disease, upper genitourinary tract (GU) tumours, urothelial carcinomas of the prostate, primary carcinoma of the urethra. Non-urothelial carcinomas of the bladder are also discussed.
This clinical practice guideline provides recommendations for the diagnosis and treatment of acute myeloid leukemia (AML). Induction therapy and post-remission (consolidation) therapy are reviewed with recommendations stratified by risk and age. Specific recommendations are provided for the management of acute promyelocytic leukemia (APL). The guideline also discusses therapy for relapse, evaluation and treatment of CNS leukemia, and supportive care.
This is a clinical practice guideline for adults age 18 years and older who are suspected of having or are newly diagnosed with bladder cancer or cancer of the urethra, or diagnosed with recurring bladder cancer or cancer of the urethra. The guideline provides recommendations on diagnosis, staging, and management of muscle-invasive, non-muscle invasive, locally advanced, and metastatic bladder cancers. Management of treatment side effects and follow-up care is also discussed. Outcomes of interest include survival (overall, disease-free), disease-related morbidity and mortality, treatment-related morbidity and mortality, psychological well-being, quality of life, admissions to hospital after diagnosis, adverse events, and cost-effectiveness.
This is a clinical practice guideline for the investigation and management of pulmonary nodules. The guideline highlights new research evidence which has led to significant changes in recommendations for the management of pulmonary nodules. The guideline provides clarity in the use of imaging as well as clarity about the place of biopsy in the investigation and management of pulmonary nodules.
This is a clinical practice guideline for the management of patients with tumour lysis syndrome (TLS). The guideline provides recommendations for the management of TLS in both adults and children with haematological malignancies. Topics of interest include: the use of uricosuric drugs for the prevention and management of clinical TLS; management of hyperuricaemia; and the use of prophylaxis.
This is a clinical practice guideline for the prevention and management of venous thromboembolism (VTE) in patients with cancer. The guideline also provides guidance on an approach to screening for cancer in patients with unprovoked VTE in whom cancer was not initially suspected based on clinical grounds. The guideline probes the association between cancer and thrombosis, with areas of interest including the prevention of catheter-related thrombosis, treatment of symptomatic cancer-associated VTE, and screening for cancer in patients with apparently unprovoked VTE.
This is a clinical practice guideline for patients with early rectal cancer. The guideline provides recommendations on diagnosis, staging, and treatment. Local excision, rectal resection, and total mesorectal excision are discussed as surgical options, and laparoscopic and open approaches to abdominal surgery are compared. The use of neoadjuvant (chemo) radiation therapy is also discussed. Outcomes of interest include diagnostic accuracy, sensitivity, and specificity of diagnostic and staging procedures, local recurrence, survival (5-year, overall, disease free), distant metastases rate, morbidity, and quality of life.
This is a clinical practice guideline for children receiving chemotherapy or undergoing hematopoietic stem call transplantation (HSCT) for cancer. The guideline examines the effectiveness of prophylactic interventions for preventing or reducing the severity of oral and oropharyngeal mucositis in these patients. Interventions considered include cryotherapy, low-level light therapy and the use of keratinocyte growth factor (KGF).
This is a clinical practice guideline for patients with resectable gastric cancer. The guideline discusses treatment options such as chemotherapy, radiation therapy, and combined modality treatments such as definitive chemoradiotherapy, preoperative chemoradiotherapy, and postoperative chemoradiotherapy. The guideline also provides an overview of radiation therapy techniques.
This is a clinical practice guideline for cancer patients with non-spine bone metastases. The guideline examines treatment options for these patients, which include radiotherapy, systemic therapies, and surgical stabilization, and the appropriateness of different techniques is examined for different clinical situations. Outcomes of interest include reductions in pain, and improved palliative care.
This is a clinical practice guideline for the treatment of mutated advanced melanoma. The guideline facilitates the safe and effective clinical use of the systemic therapy trametinib. The treatment intent is to improve quality of life and decrease symptom burden.
A clinical practice guideline for patients with relapsed/refractory Hodgkin's lymphoma. The guideline examines treatment with brentuximab vedotin. Outcomes of interest include progression-free and overall survival.
A clinical practice guideline for patients with chronic lymphocytic leukemia. The guideline examines treatment with pentostatin, cyclophosphamide and rituximab (PCR) for patients who have undergone prior treatments including allogeneic stem cell transplant and fludarabine-based therapy. Outcomes of interest include minimized myelosupression and infection risk.
This is a clinical practice guideline for patients with metastatic castrate-resistant prostate cancer who have been previously treated with docetaxel. The guideline provides recommendations on treatment with abiraterone and prednisone including treatment regimen and recommendations for pre-medications, supportive care, clinical monitoring and follow-up care. Additionally, adverse effects, precautions, dose modifications, and drug interactions are discussed.
This clinical practice guideline discusses the use of oral sunitinib as first-line treatment in patients with advanced/metastatic renal cell carcinoma of clear-cell histology who have an Eastern Cooperative Oncology Group (ECOG) performance status of less than or equal to 2 and who are of low to intermediate risk as defined by Memorial Sloan Kettering Cancer Centre (MSKCC) risk status. The guideline provides a treatment regimen and recommendations for clinical monitoring and follow-up care. Clinical toxicity assessment is discussed along with common or clinically important adverse events and drug interactions.
A clinical practice guideline for patients with human epidermal growth factor receptor 2 (HER2)/neu positive locally advanced, recurrent or metastatic adenocarcinoma of the stomach or gastroesophageal junction. The guideline examines the use of trastuzumab in conjunction with cisplatin and fluorouracil or capecitabine as a first-line treatment. Outcomes of interest include progression-free and overall survival.
This is a clinical practice guideline for the use of endoscopic approaches in the evaluation and treatment of ampullary adenomas. The guideline discusses evaluation of ampullary lesions before endoscopic therapy, the role of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) in assessment, and endoscopic resection. The role of EUS in management of duodenal adenomas is also examined. Adverse events and post-procedural care and surveillance are also addressed.
A clinical practice guideline for adult patients with newly diagnosed low grade gliomas. The guideline examines the role of chemotherapy as adjuvant therapy of choice in treatment, tumour markets to predict benefit, optimal treatment timing and chemotherapy agents, and additional adjuvant therapies. Outcomes of interest include overall survival and progression free survival.
This is a clinical practice guideline for adults with newly diagnosed diffuse low grade glioma (LGG). Recommendations are drawn from the following three questions: what is the optimal role of external beam radiotherapy in the management of adult patients with newly diagnosed low-grade glioma (LGG) in terms of improving outcome (i.e. survival, complications, seizure control or other reported outcomes of interest); which radiation strategies (dose, timing, fractionation, stereotactic radiation, brachytherapy, chemotherapy) improve outcomes compared to standard external beam radiation therapy in the initial management of low grade gliomas in adults; and Do specific factors (e.g. age, volume, extent of resection, genetic subtype) identify subgroups with better outcomes following radiation therapy than the general population of adults with newly diagnosed low-grade gliomas. In addition to providing recommendations in response to these questions, the guideline also provides a discussion about key issues for future investigation. These issues include the development of novel molecular or genetic markers in low-grade gliomas, and utilizing imaging alternatives to standard MRI to assess tumor response.
This is a clinical practice guideline for patients with diffuse low grade glioma (LGG). More specifically, these guideline recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma). The central issue addressed in this guideline pertains to whether patients with imaging suggestive of LGG should undergo observation versus treatment involving a surgical procedure.
This guideline addresses person-centred care for adults 18 years and older in Ontario using oncology services. The guideline discusses the importance of treating patients as individuals and provides recommendations on putting patients first and ensuring that essential requirements of care such as respect for the patient, patient concerns, nutrition, pain management and personal needs, patient independence, and consent and capacity, are met. Additionally, the guideline provides recommendations on tailoring healthcare service for each patient and enabling patients to actively participate in their care.
This is a clinical practice guideline on muscle-invasive and metastatic bladder cancer. This is an update to the European Association of Urology's 2000 guidelines on bladder cancer and provides recommendations related to staging, diagnostic evaluation, management, and follow-up. Issues addressed include: imaging, surgery, chemotherapy, radiotherapy, and recurrence.
A clinical practice guideline for laparoscopic liver resection. The guideline examines best practices for major and minor resections, including approaches, surgical safety, and potential adverse events. Outcomes of interest include operative mortality, postoperative complications, length of stay, and overall survival.
A clinical practice guideline for treatment of uterine cervical cancer. The guideline examines updated evidence on primary treatments, treatment for recurrent cancers, and additional presentations, focusing primarily of lymphadenectomy and hysterectomy. Outcomes of interest include recurrence and fertility preservation.
This is a clinical practice guideline for patients with upper tract urothelial carcinoma (UTUC). The guideline provides recommendations on diagnosis and treatment, with discussions on surgery, radiotherapy, chemotherapy and other anticancer drug therapies. Topics include surgical techniques, the use of neoadjuvant versus adjuvant chemotherapy, postoperative follow-up care, the use of ureteroscopic kidney-sparing surgery, instillation of BCG or other anticancer drugs into the upper urinary tract, treatment of metastatic or recurrent UTUC, and use of radiotherapy alone as treatment. Epidemiology is also discussed.
This is a clinical practice guideline for hematopoietic stem cell transplantation for multiple myeloma. In acknowledging the fact that therapeutic strategies for multiple myeloma have changed significantly over the past decade, the guideline developers provide recommendations on the role of hematopoietic stem cell transplantation (HCT), including how to incorporate HCT and when HCT is indicated.
This is a clinical practice guideline for adult patients with cancer who are receiving chemotherapy and experiencing fever, including patients with a solid tumour, lymphoma/myeloma/chronic lymphocytic leukemia, living at home, and/or with an unknown neutrophil count. This excludes hospital inpatients, patients in the emergency department, patients already diagnosed with febrile neutropenia, or with hematopoietic stem cell transplantation, acute leukemia, or myelodysplastic syndrome. The guideline provides recommendations on assessment of fever and provision of patient education. The guideline focuses on unfavourable outcomes including febrile neutropenia, infection, and death.
This is a clinical practice guideline for the treatment of unknown primary head and neck cancer. An unknown or 'occult' primary is one where a primary tumour cannot be identified after appropriate investigation, in a patient with no prior history of head and neck cancer. The guideline provides recommendations on the initial workup of all patients with a neck mass, as well as recommendations for staging, management, and cases of recurrent disease.
A clinical practice guideline for patients with solid and hematological malignancies undergoing antineoplastic treatment. The guideline examines risk-adapted approaches to viral infections, including reactivated viruses and seasonal viruses. Outcomes of interest include secondary complications, including bacterial pneumonia, and increased risk of contracting infections.
A clinical practice guideline for adult and pediatric patients with Hodgkin's lymphoma. The guideline examines the use of autologous stem cell transplant and allogeneic HCT and their appropriateness for patient populations depending on staging. Outcomes of interest include progression-free survival and the use of risk-adapted therapy to improve outcomes.
This is a clinical practice guideline for patients undergoing gynecologic/oncology surgery. The guideline examines supporting pre- and intra-operative management of surgery, including counselling, pre-operative bowel preparations, and the importance of minimally invasive surgery. Outcomes of interest include improving surgical outcomes with readmission optimization and reducing length of hospital stay. This guideline is part 1 of 2 in the Enhanced Recovery After Surgery (ERAS®) Society Recommendations guidelines.
This clinical practice guideline reviews the use of imatinib in the treatment of adult patients with unresectable or metastatic gastrointestinal stromal tumours (GIST) expressing KIT (CD117+). Recommendations are provided on dosage and schedule. Outcomes of interest include overall and progression free survival, and quality of life.
This clinical practice guideline provides recommendations on management of early-stage Hodgkin lymphoma. Chemotherapy alone, radiation therapy alone, and chemoradiation therapy are all reviewed as potential treatment options and provides recommendations on strategy, optimum radiation doses and schedule, and chemotherapy regimes. Outcomes of interest include overall survival, other measures of disease control (e.g. event-free survival or failure-free survival), and long-term adverse events, among others.
This is a clinical practice guideline for patients with castration-resistant prostate cancer (CRPC). The guideline provides recommendations on different patient types, with consideration to whether patient is symptomatic/asymptomatic, if cancer is metastatic, poor vs good performance status, and whether or not patient has previously received docetaxel chemotherapy. Outcomes of interest include survival (overall survival, progression-free, metastasis-free) PSA PFS, PSA decline, measurable disease response, adverse events/side-effects of treatment, quality of life (QOL), skeletal-related events (SREs), pain-free survival, and pain response.
This is a clinical practice guideline for adult and pediatric patients with solid tumours or hematologic cancers. The guideline provides recommendations on influenza immunization including immunization interval and dosage, type of vaccine (activated versus inactive), and timing of administration in relation to the cancer treatment cycle. Special topics of interest include immunization of patients undergoing blood and marrow transplant (BMT, autologous and allogeneic), as well as immunization of family members and hospital or clinic staff who are in contact with cancer patients.
This is a clinical practice guideline for the management of chronic myeloid leukemia (CML) in adult patients over 18 years of age. The 2015 update incorporates new evidence from research involving tyrosine kinase inhibitors for the treatment of CML. Guideline recommendations stem from the following three questions: what diagnostic and baseline investigations are recommended for adult patients with suspected or confirmed CML; what are the recommended treatment options for CML; and what are the criteria for monitoring response to treatment?
This is a clinical practice guideline for the diagnosis and management of acute promyelocytic leukemia (APL) in adult patients over the age of 18 years. As a unique subtype of acute myeloid leukemia (AML), APL has distinct clinical features and management when compared to other forms of AML and therefore, these guidelines serve as a supplement to the AML guidelines. The guideline recommendations are drawn from the following questions: what are the diagnostic criteria for APL; what is the recommended management for adult patients in Alberta with APL; and what is the recommended follow-up for adult patients in Alberta with APL.
A clinical practice guideline for the diagnosis, treatment, and follow-up of oropharyngeal cancer. The guideline examines baseline assessment and imaging, and treatment options based on patient staging. Important aspects include patient treatment preference and prioritization of treatment options based on risk features.
This is a clinical practice guideline for patients who have completed active medical or radiation oncology treatment for early-stage breast cancer and who have been discharged by the cancer care centre for care by the referring physician. The guideline provides recommendations on responsibilities regarding follow-up care, follow-up investigations and surveillance, and signs and symptoms indicative of a breast cancer recurrence. Potential complications from cancer treatment and common survivorship concerns and challenges are also reviewed.
A clinical practice guideline for the treatment of non-muscle invasive bladder cancer. The guideline examines care pathways for nursing in the administration of instravesical instillation, including chemotherapy and immunotherapy. Important aspects of this guideline include safety and exposure procedures and patient management during the administration of the instillation medication.
This clinical practice guideline provides recommendations on colorectal screening for patients with high-risk syndromes of inherited colon cancer. Recommendations are provided for management of Lynch syndrome, FAP, MAP, Peutz-Jeghers syndrome, juvenile polyposis syndrome (JPS), SPS, and other high-risk syndromes associated with CRC risk (Li-Fraumeni syndrome [LFS] and Cowden syndrome/PTEN hamartoma tumour syndrome [PHTS]). Topics of discussion include risk assessment and genetic counselling, diagnosis, and preventative treatment options.
This is a clinical practice guideline for women who are at increased risk of developing breast cancer. The guideline provides an overview on risk assessment, risk-reduction interventions including lifestyle interventions, risk-reduction surgery, and risk-reduction agents (tamoxifen, raloxifene, aromatase inhibitors). Recommendations are also provided for managing side effects of risk-reduction agents and monitoring for complications. Risk-reduction counselling is also discussed.
This is a clinical practice guideline for patients with squamous cell carcinoma (SCC) of the penis. The guideline reviews risk factors and clinical presentation, and provides recommendations for clinical staging, management of primary legions, management of regional lymph nodes, surveillance, and management of metastatic disease. Surgery, radiotherapy, and chemotherapy are reviewed as treatment options.
This is a clinical practice guideline for gastric cancer. The guideline provides an evidence- and consensus-based treatment approach for the management of patients with gastric cancer. Topic areas discussed within the guideline include: staging, principles of pathology, surgery, endoscopic therapies, radiation therapy, combined modality therapy, chemotherapy, and follow-up.
This is a clinical practice guideline on treatment of chronic myelogenous leukemia (CML). The guideline reviews tyrosine kinase inhibitor therapy and provides recommendations on workup and treatment of chronic and advanced phase CML. Allogeneic hematopoietic stem cell transplant (HCT) is discussed including a review of prognostic factors, discussion on the effect of prior TKI therapy, indications for allogeneic HCT, monitoring response after allogeneic HCT, and management of post-transplant relapse.
This clinical practice guideline reviews workup, staging, and treatment for both noninvasive and invasive breast cancer. Special considerations include phyllodes tumour, Paget's disease, breast cancer during pregnancy, and inflammatory breast cancer. Treatment recommendations for invasive cancer are stratified by tumour receptor status and stage. Fertility and birth control are also discussed.
This is a clinical practice guideline for patients with anal carcinoma. Risk factors are discussed and recommendations are provided on risk reduction including HIV immunization, work up, management, and follow-up care. Treatment options are reviewed, with specific recommendations provided for primary treatment of: non-metastatic anal carcinoma, anal canal cancer, and anal margin cancer, as well as treatment for metastatic cancer and for locally progressive or recurrent anal carcinoma. Special considerations are made regarding treatment of anal cancer in patients with HIV/AIDS.
This is a clinical practice guideline for patients aged 15 or older with acute lymphoblastic leukemia (ALL). The guideline reviews diagnosis, workup and risk stratification, treatment and consolidation therapy stratified by age and Philadelphia chromosome presence/absence, surveillance, treatment for relapse/refractory disease, and supportive care. The guideline discusses typical immunophenotyping panels for all major subtypes, and minimal residual disease assessment. Evaluation and treatment of extra medullary involvement is also reviewed.
This clinical practice guideline provides recommendations on the assessment and management of uterine leiomyomas. Treatment options reviewed include medical management, surgical therapies, uterine artery embolization, focused energy delivery systems, MR-guided focused ultrasound, and radiofrequency myolysis. Special considerations are given towards concerns about malignancy and acute uterine bleeding.
This clinical practice guideline discusses the use of combined endobronchial ultrasound (EBUS) and esophageal ultrasound (EUS-(B) for mediastinal nodal staging of lung cancer. The use of EBUS/EUS for the analysis of the primary lung tumour and the left adrenal gland is also discussed. Other topics of consideration include training issues. Outcomes of interest include sensitivity, specificity, diagnostic accuracy, complication rate, and positive and negative predictive values.
This is a clinical practice guideline for the management of castration-resistant prostate cancer (CRPC). The guideline considers the role of bone supportive agents and palliative radiation in the overall management of CRPC. Due to the fact CRPC includes a wide range of disease types, different management options are considered including for those with rising PSA non metastatic CRPC, metastatic CRPC without symptoms or minimally symptomatic, metastatic CRPC with symptoms, and for patients with CRPC and bone metastases.
This is a clinical practice guideline for the screening, assessment and management of cancer-related fatigue in adults. The guideline examines the efficacy of interventions (pharmacological, non-pharmacological, and/or combinations) for reducing cancer-related fatigue in adults and comparisons are made to usual care and attention control. Outcomes of interest include clinically significant improvement in fatigue or clinically significant reduction in cancer-related fatigue (measured by severity) or differences in fatigue severity between intervention group and controls using self-reported outcome measures.
This is a clinical practice guideline for patients with castration-resistant prostate cancer. The guideline examines treatment through chemotherapy agents in common clinical scenarios. Outcomes of interest include reduced skeletal-related events (SRE), and reduced adverse outcomes.
A clinical practice guideline for the surveillance and management of patients with dysplasia in inflammatory bowel disease at risk of developing colorectal cancer. The guideline examines appropriate colonoscopy procedures, predominantly chromoendoscopy, and management through the resection of lesions. Outcomes of interest include increased surveillance and detection through high definition colonoscopies.
A clinical practice guideline for the screening, diagnosis, and management of colon ischemia associated with colorectal cancer. The guideline examines appropriate CT or MRI imaging, colonoscopic diagnosis, and severity-based treatments including surgical intervention and antimicrobials. Outcomes of interest include decreased bacterial translocations and improved assessment of surgical risk.
This is a clinical practice guideline for patients with advanced colorectal cancer. The guideline reviews the safe administration of Panitumumab or Cetuximab (anti-EGFR therapy). Monitoring and treatment of adverse treatment effects are reviewed, including cutaneous toxicities, diarrhea, hypomagnesemia, fatigue, asthenia, lethargy, or malaise, hypersensitivity reactions, and interstitial lung disease.
This guideline is for pediatric oncology patients presenting with febrile neutropenia. The guideline treatment options stratified by risk. Treatment options for patients with penicillin allergy are also discussed.
A clinical practice guideline for patients with stage IV or advanced, unresectable colorectal carcinoma. The guideline examines the use of cetuximab as a third-line therapy once other therapies, including fluoropyrimidines, oxaliplatin, or irinotecan, had been tried or when patients are intolerant to other options. Outcomes of interest include progression-free and overall survival.
A clinical practice guideline for women who may be at risk for breast cancer. The guideline examines effective screening and diagnosis methods, focusing on mammography with comparisons made to imaging techniques. Outcomes of interest include breast cancer outcomes, screening sensitivity, and accuracy.
This is a clinical practice guideline for follicular lymphoma (FL). More specifically, this guideline is for the primary treatment of adult patients with FL. Guideline recommendations are guided by the following four questions: what treatment options should be considered for localized FL; how should asymptomatic advanced-stage FL be managed; what treatment options should be considered for symptomatic advanced-stage FL; and in which patients should additional treatment be considered (i.e., maintenance, consolidation, SCT).
An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative radiation therapy (RT) for retroperitoneal sarcoma (RPS). Many of the recommendations are based on expert opinion because of the absence of higher level evidence and thus, are best regarded as preliminary. At the time of publication, the guideline developers were awaiting data from the European Organization for Research and Treatment of Cancer (EORTC) study of pre- operative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, the guidelines can be used to establish treatment uniformity to aid future assessments of efficacy and toxicity.
This clinical practice guideline is for adult patients with imaging suggestive of low-grade glioma. The guideline discusses the optimal role of biopsy in the initial management of presumptive low-grade glioma, and provides recommendations on the best technique for biopsy. Primary outcomes of interest include diagnostic accuracy, morbidity and mortality. Advanced imaging for tumor targeting is also discussed.
This is a clinical practice guideline for the treatment of adult patients with unresectable or metastatic gastrointestinal stromal tumours. The guideline states that unresectable or metastatic gastrointestinal stromal tumours are often resistant to traditional methods of treatment like conventional chemotherapy. As such, the guideline focuses on the benefits and harms of imatinib mesylate as a form of treatment. The guideline therefore considers whether treatment with imatinib mesylate has a benefit in terms of tumour response, disease progression, survival or quality of life.
A clinical practice guideline for patients of any age with localized Ewing's sarcoma of bone. The guideline examines surgery, radiation therapy, and combination therapy for treatment and appropriate surgical imaging. Outcomes of interest include survival and local control.
This is a clinical practice guideline for men with prostate cancer who have received treatment with curative intent. The frequency by which prostate-specific antigen (PSA) levels should be tested in these patients is discussed, and the guideline also examines appropriate diagnostic testing techniques for instances in which biochemical (BC) recurrence occurs. The guideline also discusses psychosocial issues, sexual health, fatigue, urinary health, and bowel heath outcomes associated with prostate cancer treatment.
This guideline provides recommendations on the use of advanced practice nurses (APNs) to optimize patient, provider, and health system outcomes across the cancer care continuum. Specifically, the guideline reviews patient populations and situations (types of needs, practice settings, phase of the cancer care continuum) for which APN roles have demonstrated equivalent or improved outcomes, or reduced harms in cancer care. Outcomes of interest include quality of life, physical, functional, psychosocial, and mental health, as well as morbidity, mortality, symptom management, patient and provider satisfaction, health care utilization, costs, and quality of care.
This is a clinical practice guideline on the hyperinflammatory syndrome hemophagocytic lymphohistiocytosis (HLH). As the developers state, HLH can occur in the context of malignancies and malignancy-triggered HLH should be regarded separately from HLH during chemotherapeutic treatment, which is frequently associated with an infectious trigger. Because the overlap between the features of HLH and the features of neoplasms makes it difficult to identify HLH when it occurs in malignant conditions, the guideline developers focus their recommendations on the recognition and diagnostic workup, as well as the treatment of malignancy-associated HLH.
A clinical practice guideline for patients with pulmonary neuroendocrine (carcinoid) tumours, including typical and atypical presentations. The guideline examines diagnosis and staging, primarily through pathology and contract CT, and treatment focusing on surgical management.
A clinical practice guideline for patients with primary cutaneous melanoma. The guideline examines the use of dermoscopy for diagnosis, and treatment including appropriate surgical margins. Outcomes of interest include prognostic improvement, aesthetic impairment, and cure rates.
This is a clinical practice guideline offers best practice advice on the care of men with lower urinary tract symptoms (LUTS). The guideline provides recommendations on the effective evidence-based management of LUTS. Areas covered in the guideline include discussion of: initial assessment, conservative management, surgery, and drug treatment. The guideline also provides recommendations on how to best ensure men with LUTS have access to care that addresses their psychosocial issues.
A clinical practice guideline for renal cell carcinoma staging. The guideline examines staging through multiple imaging modalities, including CT, MRI, PET, bone scans, chest radiography, ultrasound, and arteriography. Outcomes of interest include diagnostic accuracy, reduced cost, and detection of metastasis.
This is a clinical practice guideline for patients diagnosed with or suspected of having small cell lung cancer. The guideline reviews screening, work-up, and treatment for limited stage and extensive stage cancer. Recommendations are also provided on follow up care.
This is a clinical practice guideline for the treatment of oral cavity cancer. The guideline addresses staging, pre-treatment investigations. management with recommendations given by cancer stage (stage I and II, advanced (T3) and very advanced (T4B) and by site (anterior tongue, buccal mucosa, floor of mouth, retromolar trigone, and hard palate and alveolar ridge). Follow up care is also reviewed.
A clinical practice guideline for the use of long-term central venous catheters in pediatric hemato-oncological disorders. The guideline examines thrombosis prevention and secondary prophylaxis, and evaluation of removal. Outcomes of interest include reduced circulatory impairment, efficacy of treatment, and bleeding.
This is a clinical practice guideline for adult patients with multiple myeloma. The guideline reviews the use of lenalidomide as a treatment option for previously untreated or relapsed/refractory multiple myeloma as compared to non-lenalidomide treatments. Use of lenalidomide as a maintenance or consolidation treatment (following transplant and non-transplant treatments) is examined and strategies for managing toxicity are discussed. Outcomes of interest include disease progression, adverse events, safety, and overall survival.
A clinical practice guideline for the diagnosis and management of primary sclerosing cholangitis and possible development of bile duct and colon cancers. The guideline examines diagnosis through biochemical tests, autoantibodies and imaging as well as the lack of established medical treatments. Outcomes of interest include improved jaundice, reduced hospitalizations, and improved recommendations for reducing colonic malignancy risks.
This is a clinical practice guideline for the diagnosis and management of Barrett's Esophagus (BE). The purpose of this guideline is to review the definition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. These 2015 guidelines differ markedly from their 2008 predecessor in several areas including: the expanded use of endoscopic ablative therapy, further refinement of screening recommendations, and a better understanding of the impact of gender and anthropomorphics on risk.
This is a clinical practice guideline for adults (aged 18 and older) at any phase of the cancer care continuum regardless of cancer type, stage (including metastatic) or treatment plan, with some components of the guideline also applicable to the patient's family and/or caregivers. The guideline provides recommendations on implementation of the brief tobacco intervention, using the evidence-based 5 A’s model (ASK, ADVISE, ASSESS, ASSIST, ARRANGE) which includes screening, education and assessment, treatment plan, and referral, monitoring, and follow-up. Clinical considerations and contraindications of treatment options for cancer patients are discussed including nicotine replace therapy (NRT), bupropion, varenicline, and e-cigarettes. The impact of tobacco use on cancer treatment is also reviewed with a specific focus on erlotinib and irinotecan.
This is a clinical practice guideline for the organization and delivery of health-care services for head and neck cancer patients in Alberta. The recommendations centre around responses to a number of guideline questions including: what does the health-care team treating head and neck cancer patients look like; what are the minimum qualifications required by core team members; what are the minimum cancer centre and team member volumes that optimize clinical outcomes; and what are the unique infrastructure requirements of team members.
This is a clinical practice guideline for smoking cessation in patients with cancer. These guidelines emphasize the importance of smoking cessation in all patients with cancer and seek to establish evidence-based, standard of care recommendations tailored to the unique needs and concerns of patients with cancer. These guidelines provide treatment plans that include recommendations that evaluate the merits of pharmacotherapy, behaviour therapy, and follow-up. The guideline developers acknowledge that smoking and nicotine addiction is a chronic relapsing disorder and as a result, the guideline also provides recommendations around retreatment and the management of relapse.
This is a clinical practice guideline for the use of myeloid growth factors in adult patients with solid tumours and non-myeloid malignancies. Benefits and risks are reviewed, the role of biosimilars is discussed, and recommendations are provided for prophylactic and therapeutic uses of both granulocyte and granulocyte-macrophage colony stimulating factors (CSFs). Recommendations are also given regarding the use of CSFs in the hematopoietic cell transplant setting. Outcomes of interest include efficacy of CSFs, mortality, length of hospitalization,, toxicity, and adverse effects.
This clinical practice guideline provides recommendations on assessment and management of cancer pain in adult patients, including pain in adult cancer survivors. Pathophysiologic classification of cancer pain syndromes is reviewed, and recommendations are provided for pain assessment, management/intervention, and reassessment. Both pharmacologic and non-pharmacologic interventions are discussed.
This is a clinical practice guideline for healthy male patients who have elected to participate in early screening of prostate cancer. The guideline reviews types of early detection testing, mainly PSA and DRE, provides recommendations on baseline evaluation, risk assessment, and early detection evaluation, provides guidance on indications for biopsy and direction for management of biopsy results. Special topics of interest include biomarker testing and biopsy technique.
This is a clinical practice guideline for the diagnosis, staging, and treatment of thyroid carcinoma. Recommendations are stratified by histologic type, namely papillary, follicular, Hürthle cell, medullary, and anaplastic. Primary treatment options and assessment and management after initial treatment is reviewed. Recurrent or persistent disease is also discussed.
This clinical practice guideline reviews diagnostic assessment and management of prostate cancer. The guideline discusses risk stratification, molecular testing, and imaging for clinical assessment and staging workup. Management options reviewed include observation, active surveillance, radical prostatectomy, radiation therapy, androgen deprivation therapy, chemotherapy, and immunotherapy, with treatment recommendations stratified by risk. Outcomes of interest include survival and adverse effects of treatment.
This is a clinical practice guideline for adult patients with non-small cell lung cancer. The guideline provides updated recommendations around prevention and screening, evaluation and staging, treatment, and follow up. Areas of focus are discussed with recognition that much progress has been made in regards to screening, minimally invasive techniques for diagnosis and treatment, advances in radiation therapy (RT) including stereotactic ablative radiotherapy (SABR), and targeted therapies.
This is a clinical practice guideline for Non-Hodgkin's Lymphomas (NHL). The guideline focuses on recommendations for diagnostic workup, treatment, and surveillance strategies for the most common subtypes of NHL, in addition to a general discussion on the classification systems used in NHL and supportive care considerations. The most common NHL subtypes that are covered in the guideline are: Mature B-cell lymphomas, Mature T-cell and NK-cell lymphomas, Post Transplant Lymphoproliferative Disorders (PTLD), and Castleman's Disease.
This is a clinical practice guideline for myelodysplastic syndromes (MDS). The guideline provides an update to recommendations on standard approaches to the diagnosis and treatment of MDS in adults. These recommendations are based on a review of recent clinical evidence that has led to important advances in treatment or has yielded new information on biological factors that may have prognostic significance in MDS.
This is a clinical practice guideline for kidney cancer. The guideline provides recommendations for the initial evaluation and staging, treatment, and follow-up for adults with various stages of kidney cancer. Topic areas discussed in the guideline include: imaging, surgery, lymph node dissection, targeted therapy, and supportive care.
This clinical practice guideline provides recommendations on esophageal and esophagogastric junction (EGJ) cancers, including: a review of hereditary cancer predisposition syndromes associated with increased risk for esophageal and EGJ cancers, staging and pathology, imaging, and treatment including surgery, radiation therapy, combined modality therapy, chemotherapy, and targeted therapies. Surveillance, management of metastatic, or recurrent cancer, and best supportive care are also discussed. Special topics of interest include treatment and surveillance options for patients with Barrett's esophagus, and suggested strategies to help alleviate the current problems associated with leucovorin shortage.
This is a clinical practice guideline for patients with cervical cancer including squamous cell carcinoma, adenosquamous carcinoma, and adenocarcinoma of the cervix. The guideline discusses diagnosis and workup, principles of staging and surgery, primary treatment, adjuvant treatment, surveillance, and therapy for relapse. Special topics of consideration include incidental cervical cancer, radiation therapy, and cervical cancer and pregnancy.
This clinical practice guideline provides recommendations on exercise for adult patients living with cancer (including those on active treatment and who have completed treatment). Benefits of specific types of exercise are considered along with safety concerns, and recommendations are provided for delivery models and exercise regimens for patients living with cancer at different points in the cancer journey, as well as pre-screening requirements for new referrals. Outcomes of interest include quality of life, safety, and muscular and aerobic fitness.
This is a clinical practice guideline for hematopoietic cell transplant (HCT) donors and recipients. The guideline provides recommendations on the diagnosis and management of hepatitis C virus (HCV) infection in these patients, and examines the treatment of HCV-infected donors before HCT, as well as the treatment of HCV-infected long-term HCT survivors.
This clinical practice guideline looks at the use of somatostatin analogues in management of neuroendocrine tumours. Topics reviewed include the use of somatostatin analogues for management of secretory syndromes as a result of tumours, the effectiveness in use for delaying tumour progression, and effectiveness in use for management of carcinoid heart disease. Otreotide is looked at for effectiveness in management of symptoms secondary to elevated calcitonin in medullary thyroid carcinoma. Outcomes of interest include treatment response, survival, and adverse events.
This is a clinical practice guideline for adult women (18 years and older) either without breast cancer or with a recent diagnosis of breast cancer, who have a family history of breast, ovarian or a related cancer; the guideline also provides recommendations for men affected by male breast cancer. The guideline discusses oncogenetic testing aspects of breast cancer and ovarian, specifically hereditary breast cancer, the Li-Fraumeni syndrome, and the Cowden syndrome. Topics include criteria and indications for genetic testing, tests for which genes have clinical utility, and appropriate follow-up depending on results and family history.
This is a clinical practice guideline for patients at risk of Birt-Hogge-Dubé Syndrome, the familial atypical multiple mole melanoma syndrome and neurofibromatosis 1&2, either based on clinical suspicion or family history. The guideline reviews indications for genetic testing, clinical utility of specific genetic tests, and follow-up depending on test results and family history. Impact of genetic counselling and test on patient behaviour and distress levels is also reviewed.
This guideline is an update to "Venous Thromboembolism Prophylaxis and Treatment in Patients with Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update" (2013). The guideline is for cancer patients who may be at risk for venous thromboembolism (VTE), and provides recommendations on prophylaxis and the treatment of VTE in the outpatient, inpatient, and perioperative settings. Interventions considered include mechanical and pharmacologic thromboprophylaxis and patient education. The role of inferior vena cava (IVC) filters is also discussed. Outcomes of interest include symptomatic and asymptomatic thrombotic events found on screening, major and minor bleeding, mortality (early and overall), sudden death, and adverse events.
This clinical practice guideline discusses the use of endoscopy in patients with malignant and premalignant conditions of the stomach including gastric polyps, gastric intestinal metaplasia (GIM), pernicious anemia, gastric carcinoid tumours, adenocarcinoma, mucosa-associated lymphoid tissue (MALT) lymphoma, and GI stromal tumours (GISTs). Surveillance endoscopy, staging ultrasound, biopsy, polypectomy, resection (surgical and endoscopic), and open gastrojejunostomy are discussed. Outcomes of interest include risk factors for dysplasia and gastric cancer, as well as survival rate, accuracy of staging techniques, and treatment complication rate.
This is a clinical practice guideline for the management of endometrial cancer. Treatment recommendations are stratified by risk and include radiotherapy, chemotherapy, and surgery. Multidisciplinary care and pre-operative investigations are also discussed. Outcomes of interest include sensitivity, specificity and accuracy of pre-operative procedures, surgical adverse events (intra-operative and postoperative), quality of life, length of hospital stay, financial costs and cost effectiveness, disease-free and overall survival, loco regional recurrence rates, toxicity from adjuvant therapy, and risk of relapse.
This is a clinical practice guideline for the treatment of lung cancer. Recommendations are provided by stage, type (non-small cell and small cell) and whether cancer is operable, and treatment options for review include surgery, radiotherapy, chemotherapy and targeted therapy. Recommendations on palliative and supportive care are also provided. Outcomes of interest include survival (progression free, overall), post-operative complication rates, toxicity, and quality of life.
This is a clinical practice guideline for patients with Barrett's esophagus (BE) without dysplasia and BE with dysplasia and/or early esophageal adenocarcinoma (EAC). Topics of discussion include: endoscopic and histological definitions of BE and early EAC; prevalence, incidence, natural history, and risk factors for BE and early EAC; and management of BE and early EAC, including modification of lifestyle factors, screening, surveillance, and medical, endoscopic, and surgical interventions.
This is a clinical practice guideline for patients with cutaneous melanoma after treatment with curative intent. The guideline provides recommendations on follow-up schedules, involving appropriate evaluations and timing for early detection of local-regional recurrence, distant metastases, and new primary melanomas. Diagnostic imaging modalities such as ultrasound (US), computed tomography (CT), positron emission tomography (PET), and PET/CT, laboratory tests such as LDH and S100B, skin self-examinations, and dermoscopy/dermatoscopy are discussed.
This is a clinical practice guideline for patients with recurrent spinal metastasis resulting in metastatic epidural spinal cord compression. The guideline examines the appropriateness of various treatment options including systemic therapy, surgical intervention, radiation therapy, osteoclast inhibitors and hospice care. The appropriateness of different techniques for unique clinical situations is discussed. Outcomes of interest include neurologic status, performance status, extent of disease, spine stability and life expectancy.
This is a clinical practice guideline for the diagnosis and management of acute myeloid leukaemia in pregnancy. The guideline considers the unique challenges pregnancy poses as it relates to diagnosing and managing acute myeloid leukaemia in patients. Important topics discussed in this guideline include: issues of management in the first trimester versus that of the second and third trimesters, chemotherapy and complications, teratogenic risk, as well as supportive therapies in pregnancy.
This is a clinical practice guideline for the surveillance of patients after curative treatment of colon and rectal cancer. The guideline outlines different surveillance schedules, and offers recommendations for surveillance based on factors including: underlying risk for recurrence, patient comorbidity, and the ability to tolerate major surgery to resect recurrent disease or palliative chemotherapy, performance status, physiologic age, preference, and compliance.
This clinical practice guideline discusses the use of endoscopy for the evaluation and management of inflammatory bowel disease (IBD), with a review of endoscopic approaches for general management of IBD and recommendations for screening and surveillance of colorectal cancer. Timing of screening colonoscopy and surveillance intervals are reviewed, and surveillance procedures are discussed with comparisons made between random biopsies, white light biopsy, and surface chromoendoscopy. The guideline also provides recommendations on the management of abnormal findings including endoscopically visible lesions and dysplasia. Additional topics of interest include pouch surveillance and stricture evaluation and dilation.
This guideline provides recommendations on adjuvant radiotherapy for adult patients with ductal carcinoma in situ (DCIS) who have undergone breast conserving surgery (BCS) or mastectomy. The handling of close radial margin of excision after BCS is considered. Dose/fractionation schedule and acute toxicity are discussed, as are the side effects of radiotherapy.
This is a clinical practice guideline for patients diagnosed with well or moderately differentiated (grade 1 or 2) pancreatic neuroendocrine tumours (PNETs). The guideline reviews the use of targeted therapies for PNETs including sunitinib malate, everolimus, and combination treatment with capecitabine/temozolomide. Recommendations are provided on use, dose, and schedule. Outcomes of interest include progression free survival (versus placebo) and toxicity.
This is a clinical practice guideline for adult patients with adenocarcinoma of the pancreas. The guideline discusses diagnostic workup, treatment options for potentially curable adenocarcinoma of the pancreas, and management of unresectable adenocarcinoma of the pancreas including locally advanced and metastatic disease. Surgical and first and second line systemic treatment options are discussed. Toxicity of systemic therapy regimes is also reviewed.
This is a clinical practice guideline for adult patients with invasive breast cancer who have had breast conserving surgery (BCS) or a mastectomy. The guideline reviews radiotherapy treatment according to lymph node status (positive or negative). Additionally, recommendations are provided for radiotherapy treatment with neoadjuvant chemotherapy, and the guideline discusses the risk of cardiac dose for patients with left-sided breast cancer and how this risk might be minimized.
This is a clinical practice guideline for adult patients over the age of 18 years with acute myeloid leukemia. The guideline reviews diagnosis, classification, ancillary tests, response criteria, prognosis/risk stratification, risk groups as per cytogenetic or molecular status, and management options. Treatments reviewed include chemotherapy, hematopoietic stem cell transplantation, and palliation. Follow up care is also discussed.
This clinical practice guideline discusses genetic testing for patients diagnosed with or suspected of having hereditary endocrine cancer syndromes, specifically multiple endocrine neoplasia type 2 (MEN2), multiple endocrine neoplasia type 1 (MEN1), Von Hippel-Lindau (VHL) syndrome, and paraganglioma and phaeochromocytoma. Indications for genetic testing of relatives of patients is also reviewed. Genetic testing for Succinate Dehydrogenase B, C and D (SDHB, SDHC, SDHD), menin, VHL and RET mutations are discussed. Outcomes of interest include diagnostic accuracy, health outcomes, and psychosocial outcomes.
This is a clinical practice guideline for patients with locally advanced non-small cell lung cancer (LA NSCLC). The guideline discusses the use of external beam radiation therapy (RT) including dose in conventionally fractionated radiotherapy, dose and scheduling in altered fractionation therapy, radiotherapy versus no treatment, hyperfractionated radiotherapy, and hyper- and hypofractionated accelerated radiotherapy. Outcomes of interest include overall survival, local control, surgical resectability, treatment toxicity, compliance rates, hospitalization rates, and quality of life, among others.
This is a clinical practice guideline for patients diagnosed with or at risk of hereditary gastrointestinal cancer syndromes including lynch syndrome, familial adenomatous polyposis (FAP), attenuated familial adenomatous polyposis (AFAP), MUTYH-associated polyposis (MAP), Peutz–Jeghers syndrome, juvenile polyposis syndrome, Cowden syndrome, serrated (hyperplastic) polyposis syndrome, hereditary pancreatic cancer, and hereditary gastric cancer. The guideline reviews initial assessment, genetic testing for a germline mutation when indicated, pre- and post-test genetic counselling, and management of patients who meet clinical criteria for a syndrome as well as those with identified pathogenic germline mutations. Outcomes of interest include cancer risk, quality of life, and survival benefit from surveillance.
This is a systemic therapy summary for the use of bevacizumab, paclitaxel and carboplatin as therapy options for adults with recurrent, persistent or metastatic cervical cancer. Treatment regimen, drug dose, and administration are reviewed, and recommendations provided for clinical monitoring and follow-up care. The guideline also addresses adverse events, precautions, dose modifications, and drug interactions.
A clinical practice guideline for patients with metastatic pancreatic adenocarcinoma. The guideline examines the use of folfirinox - a combination of fluorouracil, oxaliplatin, leucovorin and irinotecan - as a first-line treatment. Outcomes of interest include progression-free and overall survival.
This clinical practice guideline discusses the use of deep enteroscopy (DE) in the management of small-bowel disorders including diagnosis and therapeutic intervention of small-bowel tumours. The guideline compares different DE techniques including double-balloon enteroscope (DBE) single-balloon enteroscope (SBE), and the Endo-Ease Discovery SB (SE). Safety and efficacy are the primary outcomes of interest.
This is a clinical practice guideline for the surgical treatment of breast cancer. The guideline provides recommendations as they relate to breast-conserving therapy for ductal carcinoma in situ (DCIS), repeat lumpectomy after breast-conserving therapy, endoscopic surgery, breast reconstruction, and pharmacological therapy effective for postmastectomy pain syndrome (PMPS).
This is a clinical practice guideline for systemic treatment of breast cancer. The guideline provides recommendations as they relate to preoperative endocrine therapy, preoperative chemotherapy, and, among others, aromatase inhibitor monotherapy. The guideline also provides recommendations as they relate to postoperative therapy options, recommendations for metastatic or recurrent breast cancer, and HER2-positive primary breast cancer.
This is a clinical practice guideline for referral of patients with suspected prostate cancer by family physicians and other primary care providers. More specifically, the guidelines provide recommendations for referral based on digital rectal examination (DRE) findings and prostate-specific antigen (PSA) test results. The research questions that guided the development of recommendations included: what signs, symptoms, and other clinical features that present in primary care are predictive of prostate cancer; what is the diagnostic accuracy of investigations commonly considered for patients presenting with signs and/or symptoms of prostate cancer; and what major, known risk factors increase the likelihood of prostate cancer in patients presenting with signs and/or symptoms of prostate cancer.
This is a clinical practice guideline for management of colorectal polyps. In recognizing an increase in the morbidity of colorectal polyp in Japan, this guideline seeks to provide recommendations for endoscopic management and surveillance after treatment. Guideline developers created a number of clinical questions and statements for the current concept and diagnosis/treatment of various colorectal polyps including epidemiology, screening, pathophysiology, definition and classification, diagnosis, treatment/management, practical treatment, complications and surveillance after treatment, and other colorectal lesions (submucosal tumors, non-neoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumor/carcinoma).
This is a clinical practice guideline for the treatment of colorectal cancer. The overarching aim of the guideline is to provide standard treatment strategies for colorectal cancer, to eliminate treatment disparities among institutions, to eliminate unnecessary treatment and insufficient treatment, and to deepen mutual understanding among health-care professionals and patients. Issues addressed include: surgical treatment, treatment strategies after resection, as well as palliative care options.
This is a clinical practice guideline for adults with a newly diagnosed lesion with a suspected or histopathologically proven low grade glioma (LGG). The objectives of the guideline are to provide recommendations on the role of imaging for management of LGG including optimal imaging techniques for both diagnsosis and follow-up, as well as imaging sequence and parameters. Techniques discussed include anatomic MR imaging, perfusion weighted MR imaging, diffusion weighted MR imaging, MR spectroscopy, PET and SPECT imaging. Primary outcome of interest is diagnostic specificity, as well as sensitivity and predicitve data.
This clinical practice guideline addresses care of adult patients with differentiated thyroid cancer, specifically within Nova Scotia. The guideline provides recommendations on pre-surgical evaluation of thyroid nodules, surgical treatment and complications, pathology reporting, grading and tumour staging (TNM), risk prognostic systems, and post-surgical radioactive iodine (RAI) therapy. Protocols for lab and diagnostic follow-up, management of local and regional recurrences, early and long-term follow-up, and supportive and palliative care management are also addressed.
This is a clinical practice guideline for cervical cancer screening for asymptomatic women aged over 20. The guideline committee considered the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing. Other areas of interest addressed in this guideline include: the age to begin and the age to terminate and screening interval; as well as the false-positive and resulting the psychological harms in screening.
A clinical practice guideline for the radiologic management of hepatic malignancies. The guideline examines disease variants and potential treatment, including transplantation, ablative therapies, and systemic therapies. Outcomes of interest include long-term survival and reduced toxicity.
This is a clinical practice guideline for patients with invasive cancer of the cervix. The guideline addresses staging techniques using imaging. This includes a review of the use of radiographs, excretory urography, transabdominal ultrasound (TRUS), computed tomography (CT), magnetic resonance imaging (MRI), lymphangiography and lymphoscintigraphy, positron emission tomography (PET) and PET/computed tomography, and nuclear medicine bone scan. Trachelectomy assessment is also discussed.
This is a clinical practice guideline for patients with early-stage unfavourable Hodgkin lymphoma. The guideline reviews treatment principles and important clinical trials. Recommendations are provided on chemotherapy and chemoradiotherapy regimens, including a discussion on optimal radiation dose, volume, and techniques. Special topics of interest include the management of refractory Hodgkin Lymphoma.
This is a clinical practice guideline for adults with nasopharyngeal carcinoma. Clinical presentation and evaluation is reviewed, and treatment recommendations are provided for Stage I, II, and III or IV disease. Treatment of recurrent or metastatic disease is also discussed. Outcomes of interest include toxicity from treatment, overall survival, progression-free survival, and distant control.
A clinical practice guideline for head and neck cancers, with specific epidemiological information for nasopharyngeal cancer. The guideline examines diagnostic work-up, follow-up, and treatment, primarily through systemic and chemotherapy treatments. Outcomes of interest include reduced local and distant failures through appropriate risk identification and improved regimens for induction chemotherapy.
A clinical practice guideline for the use of colorectal endoscopic submucosal dissection and endoscopic mucosal resection in patients with colorectal cancer. The guideline examines diagnostic indications, perioperative diagnosis, treatment techniques, and postoperative care. Outcomes of interest include recurrence, curability, and delayed bleeding/perforation.
A clinical practice guideline for the screening, assessment and management of psychosocial distress, depression and anxiety in adults with cancer. The guideline examines appropriate clinical intervals for psychosocial screening, contributing factors, and interdisciplinary care. Outcomes of interest include improvement in cancer-related worry and reduced post traumatic stress.
This is a clinical practice guideline for the diagnosis and management of biliary tract cancers. The guidelines consist of algorithms that outline diagnosis and treatment followed by clinical questions regarding seven topics: prophylactic treatment, diagnosis, biliary drainage, surgical treatment, chemotherapy, radiation therapy, and pathology. Recommendations are therefore drawn from these clinical questions, and include recommendations as to what the first step in the diagnosis of the biliary tract cancers is, what the appropriate procedure for preoperative biliary drainage is and when it should be performed, and whether radiation therapy is useful for patients with unresectable biliary tract cancer.
This is a clinical practice guideline for the diagnosis and management of medullary thyroid carcinoma (MTC) in both pediatric and adult patients. Recommendations are organized by sections that include: ethical considerations for genetic screening, surgical treatment, treatment of patients with hormonally active metastases, and hormone replacement. Although the guideline group acknowledges that there has been significant advances in the diagnosis and treatment of patients with MTC, they close with a statement around the fact that there is critical need for more effective therapies for patients with advanced MTC.
This is a clinical practice guideline for primary care providers, medical oncologists, radiation oncologists and other clinicians caring for female adult breast cancer survivors. The guideline provides key recommendations for breast cancer survivorship care as it relates to surveillance and screening for breast cancer recurrence, risk evaluation and genetic counseling, and laboratory tests and imaging. Additionally, the guideline discusses the nature of support survivors should be provided with to address a number of psychosocial issues including depression, body image issues, financial challenges, and cognitive impairment.
A clinical practice guideline for the staging and treatment of squamous cell carcinoma. The guideline examines treatment options, primarily surgical excision, and provides guidelines for immunocompromised and high-risk patients. Outcomes of interest include improved tissue sparing through Mohs micrographic surgery, and improved understandings of surgical margins. This guideline is Chapter 5 of 5 of the Non-melanoma Skin Cancer in Canada guideline series.
A clinical practice guide for the staging and treatment of basal cell carcinoma. The guideline examines numerous treatment options, including cryosurgery, topical, and photodynamic approaches. Outcomes of interest include reduced recurrence rates with surgical excision and Mohs micrographic surgery. This guideline is Chapter 4 of 5 of the Non-melanoma Skin Cancer in Canada guideline series.
This clinical practice guideline provides recommendations on influenza vaccinations for children and adults with solid tumours or hematologic malignancies. Recommendations are provided for vaccine type (live versus inactivated) and administration in relation to the therapy cycle, and are stratified by patient age (adult versus pediatric). Topics of discussion include the effects of age, duration, and type of systemic therapy in regards to response of patients to the influenza vaccine, as well as contraindications and precautions for immunization.
This is a clinical practice guideline for adults over the age of 18 years with unresectable stage III and stage IV cutaneous melanoma, without involvement of the central nervous system (CNS). The guideline reviews the use of BRAF biomarker testing, and provides recommendations for first- and second-line systemic therapy options. BRAF Inhibitors, MEK inhibitors, immune checkpoint Inhibitors, other biological agents (e.g. imatinib and bevacizumab), and chemotherapy agents are reviewed.
This is a clinical practice guideline for adults over the age of 18 years with Merkel cell carcinoma of the skin. The guideline provides recommendations on staging and work-up, treatment options including surgery, radiation, and chemotherapy, and follow-up care. The guideline also provides recommendations on management of recurrences, and reviews sentinel lymph node biopsy protocol.
This is a clinical practice guideline for adults with pancreatic cysts. The guideline evaluates the evidence for diagnosing and managing pancreatic cysts. Important aspects discussed in the guideline include the taking of a detailed patient history, the use of imaging, and surgery. Outcomes of interest include the prevention of mortality from cystadenocarcinoma, the appropriateness of surgical intervention, and the progression of malignancy.
These clinical practice guidelines for survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment to aid health-care professionals who work with survivors of adult-onset cancer in the post-treatment period, including those in specialty cancer survivor clinics and primary care practices. The guidelines focus on the vast and persistent impact both the diagnosis and treatment of cancer can have on the adult survivor’s health, physical and mental states, health behaviours, professional and personal identity, sexuality, and financial standing.
The purpose of this clinical practice guideline is to provide guidance to the primary oncology team so as to help ensure each patient within their care experiences the best quality of life possible throughout the illness trajectory. The guideline was developed to facilitate the appropriate integration of palliative care into oncology practice. The guideline outlines procedure for screening, assessment, palliative care interventions, reassessment, and after-death care. The panel initially focused on the needs of patients in their last 12 months of life. More recent versions, however, have expanded the focus to all patients and family experiencing cancer throughout the disease trajectory.
This is a clinical practice guideline for patients at average or increased risk of developing sporadic colorectal cancer (patients with high risk colorectal cancer syndromes are not discussed). The guideline discusses risk assessment and provides recommendations for screening modality and schedule stratified by risk. Patients with increased risk include those with a personal history of adenomatous or sessile serrated polyps, colorectal cancer, inflammatory bowel disease, and/or positive family history of colorectal cancer. Screening tests include colonoscopy, flexible sigmoidoscopy computed tomographic colonography, and fecal-based screening.
This is a clinical practice guideline for individuals at risk of or having genetic mutations that increase their risk of breast or ovarian cancer. The guideline reviews hereditary breast or breast/ovarian cancer syndrome, Li-Fraumeni syndrome, Cowden syndrome/PTEN Hamartoma tumour syndrome, and other genetic mutations associated with breast/ovarian cancer. Recommendations are provided for initial risk assessment, formal risk assessment and genetic counselling, and management options for individuals with a clinical diagnosis following genetic testing.
This is a clinical practice guideline for patients with testicular cancer. The guideline provides recommendations on clinical presentation, diagnostic workup, risk assessment, and treatment. Management options are stratified by stage and cancer type (seminoma or nonseminoma). Second-line therapy for metastatic germ cell tumours is reviewed with recommendations provided for palliative therapy and treatment of brain metastases.
This is a clinical practice guideline for mesothelioma. The guideline focuses on the diagnosis and management of malignant pleural mesothelioma (MPM). Topic areas discussed in the guideline include: surgery, chemotherapy, and radiation therapy.
This clinical practice guideline reviews workup and treatment of bone cancer, with specific recommendations provided for chondrosarcoma, chordoma, Ewing's sarcoma family of tumours, and osteosarcoma. Surveillance and relapse are also reviewed. An overview of systemic therapy agents is provided, and principles of radiation therapy are discussed.
A clinical practice guideline for the management of adult patients with cancer of the uterine cervix, including squamous, adenocarcinomas, and adenosquamous carcinomas. The guideline examines treatment, primarily through surgery and radiotherapy, staging, and follow-up. Outcomes of interest include improved survival benefits through chemoradiotherapy and improved outcomes thought the addition of ifosamide to recommended chemotherapies.
This guideline reviews the use of gynecological surgery for hysterectomy and myomectomy. Specific topics include morcellation techniques, diagnosis of uterine malignancy, and prognosis following surgery for uterine sarcomas. Complications with uterine morcellation are also discussed. Outcomes of interest include 5-year survival, abdominopelvic recurrence, and rate of complications.
This is a clinical practice guideline for patients of all age groups suspected of having cancers including lung and pleural, upper gastro-intestinal, lower gastrointestinal, breast, gynecological, urological, skin, head and neck, brain and central nervous system, haematological, sarcomas, and childhood cancers. Recommendations are provided on recognition and referral or investigations of cancer in primary care. Outcomes of interest include quality of life, sensitivity and specificity of diagnostic tests and signs/symptoms, positive and negative predictive values of diagnostic tests and signs/symptoms, and cost effectiveness.
This is a clinical practice guideline for patients with locally advanced stage III non-small-cell lung cancer (NSCLC). The guideline reviews heterogeneity in disease and provides recommendations on sub-staging, diagnostic work-up, assessment of relevant comorbidities, and treatment including chemotherapy, radiation, multi-modality therapies, surgical management, and targeted agents. Follow-up is also discussed. Outcomes of interest include mortality, survival (5 year, long-term), remission rates, and toxicity.
This clinical practice guideline discusses the use of rituximab as a treatment option for adult patients with lymphoma or chronic lymphocytic leukemia (CLL), including combination chemotherapy, rituximab monotherapy, and rituximab maintenance therapy for patients who respond to treatment with combination chemotherapy and/or rituximab. Screening for surface antigen for hepatitis B (HBsAg) and hepatitis B core antibody (HBcAb) prior to treatment with rituximab is also discussed. Outcomes of interest are overall survival, disease control (overall, progression free, failure-free, or disease free survival; response duration), response rate, quality of life, and toxicity.
A clinical practice guideline for cancer patients. The guideline examines the screening, diagnosis, and management of depression in patients with major depressive disorder or who have a suspected depressive disorder. Outcomes of interest include improved health outcomes and reduced adverse events.
This is a clinical practice guideline for the management of aggressive nonmelanomatous skin cancers of the head and neck, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Definitive radiotherapy (RT), postoperative RT, and chemotherapy are all discussed as treatment options, and the treatment of immunosuppressed patients is also examined. The guideline compares the appropriate treatment options for eight different clinical situations.
This is a clinical practice guideline for patients with recurrent rectal cancer. The guideline examines the appropriateness of treatment strategies including reirradiation, intraoperative radiotherapy, permanent seed implants, stereotactic body radiotherapy, and particle therapy. The effectiveness or radiation versus chemoradiation and the importance of preoperative or definitive radiation in these patients is also considered.
This is a clinical practice guideline for patients with low-risk prostate cancer. The guideline examines the role of active surveillance (AS) as a management strategy for low-risk prostate cancer patients, and aims to develop a standardized protocol to ensure that AS is offered to appropriate patients. Outcomes of interest include survival, and patient compliance.
This clinical practice guideline provides recommendations on use of systemic therapy for women with metastatic, recurrent, or persistent cervical cancer including women with squamous cell carcinoma, adenosquamous carcinoma, or adenocarcinoma of the cervix. The guideline discusses use of cisplatin-paclitaxel, cisplatin-vinorelbine, cisplatin gemcitabine, and cisplatin-topotecan, and reviews the substitution of carboplatin for cisplatin in any of these combinations. Additionally, the indications for use of bevacizumab in combination with cisplatin-paclitaxel or carboplatin-paclitaxel are discussed. Primary outcomes of interest are overall survival and quality of life, with other outcomes of consideration including response rate, progression-free survival rate, and adverse effects
A clinical practice guideline for the management of esophageal cancer. The guideline examines pre-treatment workup, staging, and treatment, primarily through surgical methods. Outcomes of interest include more complete esophageal dissection and clarified options for palliative care.
This is a clinical practice guideline for the treatment of female patients with locally advanced breast cancer. The guideline includes consideration of the role of breast-conserving surgery as compared with mastectomy. Other important aspects explored in the guideline include the role of radiotherapy following a mastectomy, as well as the treatment options for those female patients with locally advanced breast cancer who do not respond to initial neoadjuvant therapy.
This is a clinical practice guideline for patients suspected of having or diagnosed with pheochromocytoma and paraganglioma (PPGL). Recommendations are provided for diagnostic biochemical testing, imaging studies, genetic testing, perioperative medical management, and surgery. The guideline also discusses personalized management of PPGLs with recognition of the distinct genotype-phenotype presentations of hereditary PPGLs. Outcomes of interest include sensitivity of diagnostic tests, rates of metastasis or recurrence after treatment, and peri- and post-operative complications.
This guideline set provides recommendations on the supportive care for cancer patients, including oral and dental care, pain and symptom management, febrile neutropenia, and osteoporosis. Topics of discussion include prevention and treatment, and palliative care. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This is a clinical practice guideline for patients aged 18 or over with head and neck cancer. The guideline explores key dietetic issues in the management of this patient group, including screening and referral, and management during treatment including surgery and radiotherapy. Immunonutrition is discussed, and techniques are reviewed including tube feeding with recommendations provided for optimal method and timing. Special topics of interest include the impact of new treatment regimes on nutrition outcomes, including use of Intensity Modulated Radiotherapy (IMRT) and other systemic agents such as Epidermal Growth Factor Receptor (EGFR)-inhibitors.
This is a clinical practice guideline for patients diagnosed with or suspected of having intrahepatic cholangiocarcinoma (iCCA). The guideline discusses iCCA incidence, risk factors, and molecular pathogenesis, and provides recommendations on diagnostic assessment, staging, and management. Treatment options including surgery, liver transplantation, loco-regional therapy, and systemic therapy are discussed. Outcomes of interest include survival (recurrence-free, median, three-year, five-year), quality of life, and toxicity.
This is a clinical practice guideline for the treatment of localized prostate cancer. The guideline reviews patient information, radical treatment, high intensity focused ultrasound (HIFU) and hormones in mono-therapy. Outcomes of interest include survival (disease-free, overall, distant metastases-free, biochemical disease-free), treatment-related mortality, health related quality of life, and treatment-related adverse effects including impotency, toxicity, obstructive and irritative urinary symptoms and cardiovascular events.
A clinical practice guideline for patients with oral cavity cancers. The guideline examines diagnosis, treatment, and follow-up with a focus on radiotherapy and appropriate imaging techniques. Outcomes of interest include improved supportive care through nutritional therapy and improved follow-up timing.
A clinical practice guideline for patients with stage I and II breast cancer who have undergone whole-breast irradiation. The guideline examines minimization of recurrence risks through standardized adequate margin risks. Outcomes of interest include improving cosmetic outcomes and decreasing re-excision rates.
This is a clinical practice guideline for adult patients with invasive breast cancer who have had breast-conserving surgery or a mastectomy. The guideline examines what is the optimal radiotherapy treatment after surgery for patients with T1, T2, T3, T4 invasive breast cancer according to lymph node status. Other outcomes of interest include: the manner in which a positive margin should be handled for patients with breast conserving surgery, as well as what the optimal radiotherapy treatment after surgery should be for patients with invasive breast cancer who have had neoadjuvant chemotherapy.
This is a clinical practice guideline for adults with malignant melanoma. The guideline considers whether adjuvant interferon alpha should be offered to patients who have been rendered disease-free following the resection of cutaneous melanomas and who are at high risk for subsequent recurrence. Issues discussed include: steps of treatment, potential side effects, special considerations (such as toxicity, and patient education), and follow-up.
A clinical practice guideline for pelvic examination screening in asymptomatic, nonpregnant, adult women. The guideline examines the avoidance of unnecessary care in annual wellness visits, focusing on alternative screening methods sexually transmitted diseases and contraceptive prescription. Outcomes of interest include reduced emotional harms to patients and reduction in overdiagnosis.
This is a clinical practice guideline for adult patients with progressive glioblastoma after first line combined multimodality treatment with chemotherapy and radiation. The guideline reviews the benefits of re-irradiation, specifically with single fraction stereotactic radiosurgery (SRS) or fractionated stereotactic radiosurgery (FSRS), in the management of progressive glioblastoma. Outcomes of interest include safety, local tumour control, neurological and performance status, survival, and quality of life.
This clinical practice guideline provides recommendations for menstrual suppression in patients undergoing cancer therapy in whom menstruation may have a deleterious effect on their health, or in patients with physical and/or cognitive challenges. The guideline reviews circumstances within which it is appropriate to suppress menstruation and discusses reversible hormonal options for suppression. Outcomes of interest include efficacy and safety of hormonal options for suppression.
A clinical practice guideline for pediatric patients with hematopoietic cancer or receiving stem cell transplants. The guideline examines antifungal prophylaxis to prevent invasive fungal infections, primarily through fluconazole. Outcomes of interest include lower rates of fungal related mortality and improved optimal pediatric dosing.
A clinical practice guideline for adult and pediatric patients undergoing chemotherapy for cancer. The guideline examines the prevention and treatment of chemotherapy induced nausea and vomiting through both psychosocial and pharmacological interventions. Outcomes of interest include moderate improvement with minimal risk through non-pharmacological means, and reduction of negative stimuli.
This clinical practice guideline provides recommendations on the management of metastases in the central nervous system (CNS) in women with secondary breast cancer. Surgery, radiotherapy, systemic therapies, and multimodal treatment are reviewed. Diagnosis and management of spinal chord compression is also discussed. Outcomes of interest include survival, local control, progression free survival, recurrence of brain metastases, response rate, neurocognitive and psychological impairments, adverse events, and quality of life.
This is a clinical practice guideline for female patients aged 19 and older. The guideline provides recommendations on the screening, diagnosis, treatment, and follow-up care of endometrial cancer. Prevention and risk reduction strategies are also discussed.
A clinical practice guideline for patients with suspected colorectal neoplasia. The guideline examines diagnosis and differentiation through endoscopic imaging, including virtual and conventional methods. Outcomes of interest include improved lesion characterization and improved detection of hereditary syndromes.
A clinical practice guideline for female patients with hormone receptor–positive breast cancer. The guideline examines the use of adjuvant endocrine therapy, particularly with tamoxifen. Outcomes of interest include reduced recurrence improved mortality with extended tamoxifen therapy.
A clinical practice guideline for the management of muscle-invasive and metastatic bladder cancer. The guideline examines diagnosis and staging with specific focus on imaging recommendations, including MRI and CT. Treatment options, including radical chemotherapy and surgery are also discussed based on imaging results. Outcomes of interest include improved treatment selection, specifically in cases where previous treatments have failed.
This is a clinical practice guideline for the diagnosis and treatment of squamous cell carcinoma in situ (Bowen's disease). Various treatment options are compared with attention to invasiveness of therapy and cost, complexity, and general availability of required equipment. Other outcomes of interest include treatment efficacy, aesthetic result, wound healing, and morbidity.
This clinical practice guideline reviews the use of sentinel node biopsy (SLNB) as a diagnostic tool for adult patients with malignant melanoma. The guideline reviews indications and contraindications of SLNB, pathological examination of the sentinel nodes, and indications for therapeutic node dissection and recommended extent of dissection. The use of ultrasound-guided fine-needle aspiration is also discussed. Outcomes of interest include test sensitivity, specificity, and positive and negative predictive value, as well as rate of nodal recurrence and survival.
This clinical practice guideline reviews the risk factors, assessment, treatment and overall management of febrile neutropenia in adult cancer patients. Combination therapy, monotherapy, and empiric vancomycin are discussed as treatment options and recommendations are provided for dosage and schedule. Outcomes of interest include success rate of antibiotic treatment, failure rate, survival, and mortality.
A clinical practice guideline for adult and pediatric hepatocellular cancer patients. The guideline examines assessment and treatment for both curative and non-curative therapies. Outcomes of interest include clarified follow-up timing and early involvement of supportive care.
A clinical practice guideline for patients with biliary tract and gall bladder cancers. The guidelines examines assessment and treatment based on disease staging or re-staging, primarily thought chemotherapy or surgery. Outcomes of interest include improved nutritional supplementation and reduced need for follow-up imaging.
A clinical practice guideline for adult patients with locally advanced, unresectable, and recurrent thymoma. The guideline examines treatment options, primarily surgical resection, as well as preferred approaches to therapy. Outcomes of interest include ranged overall survival, and improved recommendations for patients medically unfit for surgery.
This is a clinical practice guideline for male patients who have undergone radical prostatectomy for clinically localized prostate cancer and who have been found to have either positive surgical resection margins (R1), tumour extension beyond the prostatic capsule (pT3a), seminal vesicle invasion (pT3b), or more than one of these features. The guideline provides recommendations on the use of adjuvant radiotherapy following radical prostatectomy. Outcomes of interest include survival (prostate cancer-specific, metastasis-free, biochemical progression-free, and locoregional recurrence-free), time to initiation of androgen deprivation therapy, toxicity (acute and late), and quality of life.
This is a clinical practice guideline for adult patients with advanced (non-resectable; either locally advanced or metastatic) adenocarcinoma of the gastroesophageal junction (but not with squamous cell carcinoma). The guideline provides recommendations on chemotherapy treatment with review of chemotherapy agents by class, as well as comparison of 5-fluorouracil (CIV)/epirubicin/cisplatin regimens vs. other chemotherapy. The guideline also discusses the contribution of targeted therapies. Outcomes of interest including overall survival, objective response rate (complete plus partial response), time to disease progression, adverse effects, and quality of life.
A clinical practice guideline for the use of plaque brachytherapy in patients with choroidal melanoma and retinoblastoma. The guideline examines appropriate staging criteria, treatment planning, and alternative surgical and radiation therapy techniques. Outcomes of interest include improved visual acuity and local control.
A clinical practice guideline for the management of patients with differentiated and medullary thyroid cancer. The guideline examines the management of thyroid cancer from diagnosis to follow-up, with specific focus on radioiodine remnant ablation and appropriate post-treatment follow-up. Outcomes of influence include improved outcomes in total thyroidectomy and improved personalised decision making.
A clinical practice guideline for patients with castration-resistant prostate cancer. The guideline primarily examines treatment through chemotherapy agents in common clinical scenarios. Outcomes of interest include reduced skeletal-related events and reduced adverse outcomes.
A clinical practice guideline for the treatment of small cell and non small cell lung cancer. The guideline examines treatment options for multiple stages of lung cancer, and provides palliative and supportive recommendations. Outcomes of interest include optimal systemic and concurrent therapies, and benefits based on operability. This guideline is wiki-based and is constantly updated as new evidence arises - this review pertains to the guideline as of June 27, 2014.
A clinical practice guideline for the early detection of cancer in adolescent and young adult patients aged 15 to 24. The guideline reviews common signs and symptoms of cancer and provides recommendations on appropriate investigations and timely and appropriate referral depending on symptom presentation. This guideline is wiki-based and is constantly updated as new evidence arises - this review pertains to the guideline as of June 27, 2014.
This is a clinical practice guideline for patients diagnosed and living with recurrent brain metastases. The guideline discusses different retreatment options such as whole-brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), surgery without radiation, and chemotherapy. The guideline also examines the role of best supportive care (BSC) and the follow-up of patients, including a discussion of imaging modalities and intervals for follow-up imaging.
This is a clinical practice guideline for peripheral blood progenitor cell mobilization for autologous and allogeneic hematopoietic cell transplantation. The guideline addresses questions relating to an optimal stem cell mobilization regime including which growth factor is optimal, what chemotherapy and dose is most effective, and when to initiate leukapheresis. The guideline provides recommendations for both adult and pediatric patients.
This clinical practice guideline addresses breast cancer screening in asymptomatic women. Risk factors are discussed and recommendations are stratified by age and risk. Outcomes include risk estimates, over- and under- diagnosis harms, and screening effectiveness.
This is a clinical practice guideline for patients with rectal cancer who are newly diagnosed. The guideline provides recommendations on investigations to assess for metastases and synchronous lesions, imaging for local staging, optimal MRI protocol and criteria for local staging, optimal MRI criteria to select patients for neoadjuvant therapy, the role of multidisciplinary cancer conferences and the role of restaging MRI after neoadjuvant therapy.
A clinical practice guideline for female patients with early stage invasive breast cancer. The guideline examines systemic therapy selection based on patient and disease characteristics, and recurrence risk. Outcomes of interest include breast cancer-free intervals, disease-free survival, and clinically complete response.
This is a clinical practice guideline for patients with anal canal cancer. The guideline provides recommendations for the pre-treatment evaluation, staging, and treatment options. Recommendations include a consideration of the appropriateness of x-ray, CT, and MRI; the American Joint Commission on Cancer pathological staging system; as well as resection, chemotherapy and radiotherapy.
A clinical practice guideline for adult patients with unresectable or metastatic/recurrent gastrointestinal stromal tumours that have become resistant or intolerant to imatinib mesylate. The guideline examines the efficacy of sunitinib malate as an alternative, and reviews what dosing regimens could be observed. Outcomes of interest include partial response, but no difference in quality of life.
This is a clinical practice guideline for adult patients with stage 1 testicular seminoma. The guideline outlines treatment options including radiotherapy and chemotherapy, and provides recommendations on follow-up surveillance. Outcomes of interest include cancer-specific survival, long-term toxicity (including second malignancy), and quality of life.
This is a clinical practice guideline for patients with suspected or confirmed multiple myeloma. Diagnostic procedures are recommended and treatment options outlined, including chemotherapy, induction therapy, high-dose therapy and autologous stem cell transplantation (ASCT), and allogeneic stem cell transplantation (AlloSCT). Recommendations are also provided for maintenance therapy and the treatment of medical conditions common in patients with myeloma. Outcomes of interest include treatment response rate, survival, toxicity, quality of life, and treatment-related mortality.
A clinical practice guideline for managing brain metastases in patients with human epidermal growth factor receptor 2 (HER2) –positive advanced breast cancer. The guideline examines local and systemic therapy treatment options based on prognosis and disease progression. Outcomes of interest include improved brain control and reduced risk of local recurrence.
This is a clinical practice guideline for the diagnosis and treatment of cancer and associated malignancies in adult patients with HIV. The guideline examines the most common HIV associated cancers, Kaposi sarcoma, high grade B-cell non-Hodgkin lymphoma and invasive cervical cancer, as well as a number of other cancers with higher risk profiles in HIV patients. Outcomes of interest include improved treatment options in consideration of HAART and increased prophylactic options in low-risk patients, specifically with regards to lifestyle changes and vaccinations.
A clinical practice guideline for patients with early stage breast cancer who may be candidates for sentinel node biopsy. The guideline examines the use of sentinel node biopsy in relation to axillary lymph node dissection, with a focus on patients who have metastatic findings. Outcomes of interest include longer disease free survival and improved therapeutic efficacy.
This is a clinical practice guideline for patients who are Rearranged during Transfection (RET) proto-oncogene mutation carriers. The guideline provides recommendations on the timing and extent of thyroid surgery. Recommendations are stratified by patient risk with considerations made to genetic characteristics, patient age at diagnosis, and calcitonin levels at the time of decision making. Postoperative management and follow-up is also discussed. Outcomes of interest include risk of metastasis and risks of extended surgery (including permanent hypoparathyroidism and permanent paralysis of the recurrent laryngeal nerve).
This is a clinical practice guideline for individuals with or suspected of having Medullary thyroid carcinoma (MTC). The guideline provides recommendations on diagnosis, surgical treatment, and follow-up care. The use of chemotherapy and/or radiotherapy in the management of individuals with metastatic MTC is also discussed. The appropriate use of RET proto-oncogene molecular testing during diagnostic assessment is discussed, and the potential value in the use of tyrosine-kinase inhibitors as a treatment option is reviewed. Outcomes of interest include survival rate (median, overall, 10-year, progression-free), sensitivity and specificity of diagnostic tests, cure rate, rate of remission, and recurrence rate.
This is a clinical practice guideline for ductal adenocarcinoma of the pancreas. The guideline provides recommendations for extended pancreatectomy. Related topics examined in this guideline include: resectability, perioperative morbidity and mortality, and prognosis.
This is a clinical practice guideline for patients with cancer who suffer from weight loss and undernutrition (as called cachexia). These guidelines aim to give health professionals and patients practical and up-to-date advice to manage nutrition in the principal situations encountered during the cancer course according to the type of tumour and treatment. Outcomes of interest include: a nutritional evaluation, different types of nutritional care according to treatment type, the role of antioxidants and immunonutrition, as well as specific recommendations for palliative and elderly patients.
This guideline set provides recommendations on the management of head and neck cancers including oral and dental care. Topics of discussion include predisposing factors, prevention, screening, early detection, diagnosis and staging, management, and follow-up. Additionally, oral care through chemotherapy, radiation therapy, and bone marrow transplantation are discussed. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on the management of gynecologic cancers including gynecological sarcomas and cancers of the ovary (epithelial and non-epithelial carcinomas), endometrium, uterine cervix, vulva, fallopian tube, gestational trophoblastic neoplasia, and vagina. Topics of discussion include diagnosis and staging, management, and follow-up. Additionally, prevention and screening are discussed for ovarian, endometrial, and cervical cancers. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This is a clinical practice guideline for adults suspected of having or diagnosed with adult onset sarcoma. The guideline provides recommendations on diagnosis and staging, treatment, and follow-up care. Chemotherapy, radiotherapy, and surgery are discussed as treatment options. Outcomes of interest include local recurrence, survival (overall, long term), and quality of life.
This is a clinical practice guideline for adolescents and young adults - aged between 15 and 24 years of age - diagnosed with cancer of any type. The guideline reviews fertility discussions between practitioner and patient, options for fertility preservation, impact of treatments on fertility, and long term follow-up. Additional links for patient and practitioner resources are also provided.
This is a clinical practice guideline for adults diagnosed with or suspected of having soft tissue or visceral sarcoma. The guideline discusses diagnosis, staging and risk assessment, and treatment stratified by whether disease type is localized or advanced. Follow-up care is also reviewed. Treatment options for patients with special presentations and entities is also discussed, including patients with retroperitoneal sarcomas, uterine sarcomas, desmoid-type fibromatosis, and breast sarcomas.
This is a clinical practice guideline for women with endometrial carcinoma. The guideline reviews treatment options including: adjuvant therapy including radiation, vaginal brachytherapy, and chemotherapy; and therapy for advanced disease. Treatment for synchronous endometrial and ovarian cancer, fertility-sparing treatment, post-treatment patient surveillance, and the role of hormone replacement therapy in the development of endometrial carcinoma are also discussed. Outcomes of interest include survival (overall, 5-year, disease-specific), locoregional recurrence rate, survival rate after recurrence, and toxicity.
This is a clinical practice guideline endorsement for the selection of patients with lung cancer for epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors. The guideline addresses five principal questions including considerations about when molecular testing should be performed, the manner in which EGFR testing should be performed, and whether other genes should be routinely tested in lung adenocarcinoma. Other areas of interest include recommendations as to how EGFR and ALK testing should be validated, and how best to maintain quality control and quality assurance policies and procedures for EGFR and ALK testing in lung cancers.
This is a clinical practice guideline endorsement for people at risk for hereditary colorectal cancer (CRC) syndromes. The guideline provides recommendations on prevention, screening, genetics, treatment, and management. Topics of interest addressed in the guideline include: tumour testing for DNA mismatch repair (MMR) deficiency, genetic testing for Lynch syndrome, as well as follow-up recommendations in mutation carriers.
A clinical practice guideline for patients who have undergone treatment for soft tissue sarcomas. The guideline examines appropriate surveillance and follow up methods, including regular imaging and physical examination. Outcomes of interest include preference for x-rays over MRI or CT, and increased postoperative imaging.
A clinical practice guideline for patients with suspected or diagnosed oral cavity cancer. The guideline examines diagnosis, treatment, and potential reconstruction depending on cancer stage and site-specificity. Outcomes of interest include improved functional outcomes through reconstruction and improved adjuvant therapy for patients with increased risk factors.
This is a clinical practice guideline for patients over the age of 18 years with primary or metastatic brain tumours. The guideline provides recommendations on the management of seizures caused by brain tumours. Treatment options discussed include antiepileptic drugs, surgery, and radiation therapy. The guideline also reviews driving guidelines for those patients experiencing seizures, particularly in the context of the province of Alberta and the associated Alberta Transportation rules and regulations.
This is a clinical practice guideline for patients over the age of 18 years with primary germ cell tumours (GCTs) of the central nervous system. The guideline discusses staging and diagnosis, treatment, and follow-up care. Recommendations for treatment options are provided for germinoma and nongerminomatous GCT, and are stratified by whether disease is localized or metastatic. Additional recommendations are made for recurrent treatment, again stratified by histology.
This is a clinical practice guideline for adults over the age of 18 years with recurrent high-grade gliomas, including grade III anaplastic astrocytomas, anaplastic oligodendrogliomas, anaplastic oligoastrocytomas and grade IV glioblastomas. The guideline discusses diagnostic assessment for recurrence, and treatment options including systemic therapy, surgery, and re-irradiation. Factors of consideration when determining treatment course are also discussed.
This is a clinical practice guideline practice guideline for adult patients with ductal carcinoma in situ (DCIS) who have had breast-conserving surgery or a mastectomy. The guideline considers what the optimal radiotherapy treatment after surgery would be for patients with DCIS, as well as how a close radial margin of excision should be handled following breast conserving surgery. Additional areas of interest include: toxicity and side effects of radiotherapy.
A clinical practice guideline for adult patients with brain tumours, specifically focusing on nursing activities. The guideline examines management from diagnosis to survivorship or end-of-life care, with specific focus on symptom management and communication with patients and family. Outcomes of interest include improved patient education and supportive communication..
This is a clinical practice guideline for adult patients, with single or multiple brain metastases, arising from cancer of any histology, excluding germ cell tumours and hematologic malignancies. The guideline examines strategies for the management and treatment of adults with: a newly diagnosed solitary brain metastasis, newly diagnosed multiple brain metastases, as well as progressive or recurrent brain metastases. Management and treatment options explored vary by whether the metastatic disease is solitary, multiple, recurrent or progressive but include: neurosurgery, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), as well as supportive care.
A clinical practice guideline for the treatment of patients with endometrial cancer. The guideline examines the use of postoperative radiation therapy, and the use of external beam radiation or brachytherapy depending on risk factors and node status. Outcomes of interest include improved local control and improved high- and intermediate-risk treatment.
This is a clinical practice guideline for patients with stage I or II invasive breast cancer. The guideline reviews the relationship between margin width and ipsilateral breast tumour recurrence (IBTR), and provides recommendations on adequate margin width in those patients undergoing breast conserving surgery and whole breast radiation therapy. Outcomes of interest include IBTR rate, risk of IBTR recurrence, and margin width.
This clinical practice guideline is for children with cancer and/or undergoing hematopoietic stem cell transplantation. The guideline reviews evaluation and management of fever and neutropenia, including initial empiric antibiotic selection, continued management of inpatients, and management based on culture results. Management of fever in hematology/oncology patients who have completed therapy and/or are on therapy but are not neutropenic is also discussed.
This is a clinical practice guideline for adult patients with progressive glioblastoma. The guideline reviews diagnostic criteria and provides recommendations on techniques and ancillary studies that are most useful in separating malignant progression from treatment effect. Outcomes of interest include sensitivity, specificity, positive and negative predictive value, accuracy, and likelihood ratio of a positive and negative result.
A clinical practice guideline for adults with cancer at any stage of the cancer continuum. The guideline examines appropriate support for suffering, including self-management aids and spiritual issues. Outcomes of interest include improved self-efficacy and self-esteem.
This clinical practice guideline reviews the use of chemotherapy as a treatment for epithelial ovarian cancer. Chemotherapy and biological therapies are reviewed, and scheduling is discussed. Special considerations are made to age, histological subtypes, BRCA mutations, and obesity. Outcomes of interest include survival (overall and progression-free), treatment compliance, response to chemotherapy, adverse events, and quality of life.
A clinical practice guideline for patients undergoing therapy for head and neck and gastrointestinal cancers. The guideline examines the prevention and management of mucositis through multiple medical and alternative interventions. Outcomes of interest include lack of benefit with sucralfate and improved basic oral care.
A clinical practice guideline for patients with pancreatic cancer. The guideline examines assessment and treatment, primarily through radical resections including Whipple procedures. Outcomes of interest include reduced chemotherapy toxicity with gemcitabine and improved follow-up procedures.
A clinical practice guideline for gastric and gastro-esophageal junction cancer patients. The guidelines examines assessment by a multidisciplinary team, and treatment options including gastrectomy and endomucosal resection. Outcomes of interest include increased survival through combination therapy and potential benefit from biomarker targeted therapies.
This is a clinical practice guideline for female patients who are being considered for or are receiving systemic therapy for early-stage invasive breast cancer. The guideline examines the optimal adjuvant systemic therapy for female patients with early-stage operable breast cancer. Topics of interest include the use of chemotherapy, hormonal therapy, and targeted therapy, as well as patient and disease characteristics, and risk of recurrence.
This is a clinical practice guideline for the treatment of acute promyelocytic leukemia with arsenic trioxide. The treatment is intended to be curative and to decrease regimen toxicity. Developers noted that acute promyelocytic leukemia is a rare subtype of acute leukemia (2.5 new cases in Manitoba per year in the last 10 years).
This clinical practice guideline addresses colorectal cancer screening for asymptomatic adults, in the primary care setting. Risk factors and screening test effectiveness are discussed and recommendations are provided based on age and risk. Outcomes of interest include colon cancer incidence, morbidity, and mortality, as well as outcomes of screening intervention including test effectiveness and adverse effects.
This practice guideline examines the use of EGFR tyrosine kinase inhibitors (EGFR TKI) for treatment of adult patients with advanced (stage IIIB or IV) non– small-cell lung cancer. The guideline provides recommendations on the sequence of chemotherapy and EGFR TKIs is reviewed, and discusses whether clinical characteristics (i.e. Asian ethnicity, female sex, adenocarcinoma histology and light/never smoking status) or molecular characteristics (presence of activating mutations of the EGFR gene, EGFR gene copy number, or EGFR protein overexpression) should influence use of EGFR TKIs. Outcomes of interest include overall survival, progression-free survival (PFS), response rate and quality of life.
This clinical practice guideline provides recommendations in relation to sentinel lymph node biopsy (SLNB) in vulvar cancer. The guideline seeks to determine whether SLNB can safely and effectively identify women with node-negative, early-stage vulvar cancer and can be used as an alternative to inguinofemoral lymph node dissection (IFLD). Additionally, the guideline provides guidance with respect to the appropriate techniques and procedures in SLNB for women with early-stage vulvar cancer. These include: the selection of appropriate patients; determining the appropriate technique, and management of patients with positive sentinel lymph nodes.
This clinical practice guideline provides recommendations on pancreatic cancer management including pre-treatment evaluation, surgical pathology report requirements, staging classifications, assessment of resectability, and treatment. Pancreatico-duodenectomy, radiotherapy, chemoradiotherapy, and chemotherapy are discussed as treatment options depending on resectability. Management of metastatic pancreatic cancer and locally recurrent disease are included in this review.
This is a clinical practice guideline for the pre-treatment evaluation, staging, and treatment of colorectal cancer. Topics addressed in the guideline include an overview of surgical pathology report requirements; as well as treatment options for clinically localized resectable colon cancer, clinically localized resectable rectal cancer, and locally advanced unresectable or metastatic colon or rectal cancer.
A clinical practice guideline for patients with esophagogastric junction tumour. The guideline examines staging, pre-treatment evaluation, treatment through surgery and adjuvant therapy, and basic follow-up. Important aspects include surgical pathology report requirements and post-operative management.
A clinical practice guideline for patients with esophageal cancer and gastro-esophageal junction cancer. The guideline examines diagnostic assessment and proposed treatment based on cancer staging, with a focus on chemoradiation and surgical therapies. Outcomes of interest include improved recommendations for patients with good and poor performance.
This is a clinical practice guideline for patients diagnosed with borderline resectable or locally advanced pancreatic cancer. The guideline reviews pre-treatment staging, therapeutic options including biliary decompression and neoadjuvant therapy, chemotherapy with and without gemcitabine, chemoradiation therapy (CRT), induction chemotherapy and CRT, and radiological re-evaluation. Outcomes of interest include survival (median, overall, progression-free), treatment toxicity, adverse events, and surgical resectability rates.
This is a clinical practice guideline for patients with a pathological confirmed diagnosis of locally advanced rectal cancer following appropriate radiological staging investigations. The guideline reviews treatment options including chemoradiation regimes and timing (adjuvant vs neo-adjuvant). Treatment related toxicities are also discussed. Outcomes of interest include overall survival, local recurrence, tumour response, and toxicity (acute and chronic).
A clinical practice guideline for adult patients with advanced stage or recurrent endometrial cancer. The guideline examines the use of chemotherapy, specifically combination chemotherapy, and hormonal therapy with a specific focus on the use of cisplatin, doxorubicin, and paclitaxel. Outcomes of interest include reduced adverse effects, and improvements in progression-free survival and overall survival.
A clinical practice guideline for the treatment of chemotherapy induced peripheral neuropathy in adult cancer survivors. The guideline examines appropriate and inappropriate pharmacologic agents for treatment and prevention. Outcomes of interest include reduced incidence and severity of chemotherapy induced peripheral neuropathy and increased pain management.
A clinical practice guideline for the treatment of adult male patients with metastatic castration-resistant prostate cancer. The guideline examines systemic therapy options in combination with androgen deprivation. Outcomes of interest include reduced toxicity risk and reduced disease progression.
A clinical practice guideline for the management of renal cell carcinoma. The guideline examines the diagnosis, staging, treatment, and follow-up of renal cell carcinoma, including updates on histology and localized disease treatment through venous thrombus. Outcomes of interest include improved management through nephron-sparing surgery and improved surveillance for small renal masses.
A clinical practice guideline for the management of penile cancers in adult male patients, focusing primarily on penile squamous cell carcinoma. The guideline examines the full continuum of cancer care for penile cancer patients, and provides a variety of treatment options based on staging and diagnosis. Outcomes of interest include improved functional and cosmetic treatment and reduced nodal recurrence.
A clinical practice guideline for non-muscle-invasive bladder cancer patients with Ta, T1, and CIS grade tumours. The guideline examines diagnosis and treatment with a particular focus on adjuvant treatment options. Outcomes of interest include reduced recurrence with smoking cessation, and improved early detection through imaging.
This is a clinical practice guideline for women with no signs or symptoms of BRCA-related cancer. The guideline provides recommendations on risk assessment, genetic counselling, and genetic testing for potentially harmful BRCA1 or BRCA2 mutations in asymptomatic women. The guideline also examines interventions aimed at decreasing the risk for development of BRCA-related cancer in women with potentially harmful BRCA mutations in their family. Outcomes of interest include accuracy and adverse effects of BRCA mutation testing, and effectiveness of testing and risk-reducing treatments.
A practice and professional guideline for the safe administration of systemic therapies, specifically chemotherapy, to patients by organizations that provide systemic cancer treatment. The guideline examines the appropriate selection of devices for vascular access, complications factors based on points of care, and recommended nursing practices. Key aspects include reducing fatal outcomes and improved organizational safety policies.
A clinical practice guideline for the management of patients with small cell and non-small cell lung cancer. The guideline examines the continuum of care for lung cancer, including the importance of smoking cessation, staging investigations, surgery as a curative option, radiotherapy recommendations, and palliative care considerations. Outcomes of interest include survival benefits with non-surgical management, reduced side effects in second line therapies, and increased staging specificity.
This is a clinical practice guideline for Barrett’s oesophagus and related early neoplasia. The guideline provides recommendations to guide patient management. The guideline addresses issues in Barrett’s oesophagus including: definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training.
This is a clinical practice guideline for head and neck cancer. The guideline considers the management of somatic pain induced by the treatment of head and neck cancer, particularly the management of early and late post-surgical pain. Areas of interest discussed in the guideline include: patient positioning during surgery, how to proceed during the immediate postoperative period, care-related pain, and physical therapy.
This is a clinical practice guideline for pancreatic cancer. The guideline examines treatment options for borderline resectable pancreatic ductal adenocarcinoma (BRPC). Topics explored in this guideline include: operative exploration, resection in the case of involvement of the mesentericoportal venous axis, and regimens of neoadjuvant therapy.
This guideline set provides recommendations on required reports for referrals for: breast, gastrointestinal (esophagus, stomach, colon-rectum, anus, pancreas, liver, biliary tract/gall bladder), genitourinary (testis, prostate, bladder), gynecology (endometrium, cervix, ovary, vulva & vagina), head and neck (parotid & submandibular gland, thyroid, mouth, palate, nasopharynx, oropharynx, hypopharynx, nose & antrum, ear), lung, lymphoma and leukemia, melanoma, musculoskeletal and sarcoma, neuro-oncology, primary unknown, and skin (basal cell & squamous cell carcinomas, mycosis fungoides – Sezary syndrome). The guideline provides recommendations on pathology reports, operative reports, laboratory reports, and imaging reports. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on the management of skin cancers including melanoma and non-melanoma. Topics of discussion include potential precursors, surveillance and early detection, diagnosis and staging, and management. Additionally, referral information and management policies are discussed. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on the management of musculoskeletal cancers including bone cancer and soft tissue sarcoma. Topics of discussion include prevention, diagnosis and staging, management, and follow-up. Additionally, diagnostic pathology, and treatment through chemotherapy, radiotherapy, and surgery are discussed. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on the management of lung cancers including mesothelioma and thymomas. Topics of discussion include prevention, early detection, diagnosis and staging, and management. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This is a clinical practice guideline for breast cancer. The guideline examines demographics and risk factors, prevention, screening and early detection, diagnosis, staging, management, and follow-up. Other important aspects explored in the guideline include: upper extremity rehab after axillary dissection, exercise for cardiovascular fitness, as well as benefits, risks, and costs. Please note that the sub-sections within this guideline were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline was accessed online.
This is a clinical practice guideline for males with locally advanced or metastatic prostate cancer. The guideline provides recommendations on management including psychosocial care, treatment for locally advanced disease, biochemical relapse, overt metastatic disease and/or loco-regional progressive disease, and castration-resistant prostate cancer. Palliative care, complementary and alternative therapies, socio-economic aspects of advanced prostate cancer, and emerging therapies are also discussed. Outcomes of interest include treatment efficacy, toxicity, morbidity, adverse effects from surgery, survival (overall, disease-free, prostate-cancer-specific) and disease progression.
This is a clinical practice guideline for the early detection of common cancers in adolescents and young adults aged between 15 and 24 years of age. The cancers covered include leukemia, lymphoma, brain tumours, soft tissue sarcoma, testicular cancer, thyroid cancer, and melanoma. The guideline discusses common signs and symptoms and provides recommendations on clinical assessment and referral. "Youth-friendly" communication between practitioner and patient is also discussed, and links for patient and practitioner resources are provided.
This guideline provides recommendations on geriatric assessment (GA) in older oncology patients. Topics of discussion include the use of GA to predict oncology treatment-related complications, the association between GA findings and overall survival; (OA), and the impact of GA findings on oncology treatment decisions. The composition of and key domains within GA are reviewed, and recommendations are provided on implementing GA in clinical care.
This is a clinical practice guideline for patients diagnosed with or at risk of having anal cancer. The guideline outlines screening and prevention, diagnostic assessment and staging, treatment, and follow-up and surveillance. Special topics of interest include treatment of the elderly and personalized medicine. Management of advanced/metastatic disease is also discussed. Outcomes of interest include survival, recurrence rates and quality of life.
This is a clinical practice guideline for patients at risk for and affected with Lynch syndrome. The guideline examines appropriate provision of genetic testing and management of patients. Important aspects include: ways to assess individuals for the risk of colorectal cancer, tumour testing, algorithms for genetic evaluation of affected and at-risk family members of pedigrees with Lynch syndrome, and the provision of diagnosis and management strategies to health-care providers caring for these patients.
A clinical practice guideline for the diagnosis and management of focal liver lesions, including hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts. The guideline examines diagnosis, including imaging characteristics, and treatment modalities. Outcomes of interest include a focus on local availability of expertise and resources, and improved 5-year survival through early detection.
A clinical practice guideline for acute bowel obstruction caused by colorectal cancer and patients with early stage rectal cancer. The guideline examines the efficacy of stenting and bowel resection as an alternative to emergency procedures, and less invasive treatments, including transanal endoscopic microsurgery, as first-line treatment for early stage cancer. Outcomes of interest include reduced hospital stay and improved bowel function.
A clinical practice guideline for patients with suspected or diagnosed malignant pleural effusions. The guideline examines diagnosis and treatment for symptomatic and asymptomatic patients, including therapeutic thoracentesis. Outcomes of interest include improved relief of dyspnea and reduced hospital stay time.
This is a clinical practice guideline for patients over 18 years of age with metastatic colorectal cancer. The guideline reviews surveillance and treatment options including surgery, radiotherapy, palliative chemotherapy and biological therapy. Outcomes of interest include survival (overall, progression-free), and toxicity.
This is a clinical practice guideline for adult patients with hepatocellular carcinoma. The guideline provides recommendations on diagnostic assessment, staging, and management. Treatment options including resection, liver transplantation, radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), transarterial chemo-embolization (TACE), transarterial radioembolization (TARE), sorafenib, and stereotactic body radiotherapy (SBRT) are reviewed.
This is a clinical practice guideline for patients over 18 years of age with pancreatic cancer. The guideline reviews diagnostic work-up, staging, and treatment options for both potentially curable and unresectable pancreatic cancer. Comparisons are made between FOLFIRINOX and gemcitabine chemotherapy regimes. Outcomes of interest include survival, adverse events, and response rate.
This is a clinical practice guideline for patients 18 years or older with non-metastatic breast cancer. The guideline discusses neo-adjuvant therapy for breast cancer, including eligibility, advantages and dis-advantages, available therapies. Optimal treatment monitoring, surgical considerations, and the role of radiotherapy are also discussed. Outcomes of interest include prognostic factors, response rate, accuracy of diagnostic procedures, survival (disease-free, overall), and relapse rate.
This is a guideline for adjuvant systematic therapy for early stage (lymph node negative and lymph node positive) breast cancer. The guideline discusses risk categories for lymph node negative breast cancer, provides treatment recommendations for lymph node negative breast cancer, and explores chemotherapy options for lymph node negative breast cancer. Other areas of interest include: treatment recommendations for lymph node positive breast cancer, chemotherapy options for lymph node positive breast cancer, and adjuvant hormonal therapy for hormone receptor positive disease only.
This is a clinical practice guideline for the use of targeted medical therapies in the management of progressive glioblastoma in adult patients. The guideline reviews single- and multi-agent antiangiogenic therapies and targeted therapy based on specific molecules or signaling pathways. Outcomes of interest include survival (median, overall, progression free), quality of life, toxicity, and mortality.
This clinical practice guideline reviews the use of cytotoxic chemotherapy in the management of progressive glioblastoma in adult patients. Comparisons are made among a variety of single- and multi-agent therapies. Outcomes of interest include toxicity, survival (median, overall, and 6 month), response rate, tumour control, and quality of life.
This is a clinical practice guideline for adult patients with previously diagnosed glioblastoma who are suspected of experiencing progression of the neoplastic process. The guideline provides recommendations on surveillance imaging techniques for determining tumour progression. Outcomes of interest include accuracy, sensitivity, specificity, and positive and negative predictive values.
This is a clinical practice guideline for men with suspected or diagnosed localised, locally advanced, or metastatic prostate cancer. The guideline examines diagnosis and staging, primarily through PSA testing and biopsy, as well as timelines for active surveillance options. The guideline also examines multiple treatment options based on cancer staging, including hormone therapy, radiotherapy, and radical surgical options. Outcomes of interest include increased prediction of outcomes, overall survival, and reduced risk of bone density loss.
A clinical practice guideline for the use of vitamins as a preventative measure in the general population, specifically healthy adults without special nutritional needs. The guideline examines the use of single and paired nutritional supplements to improve overall health and prevent cancer and/or heart disease. Outcomes of interest include increased risk factors and the potential variation of oxidative properties based on numerous underlying nutritive factors.
This is a clinical practice guideline for patients with apparent early stage endometrial cancer at the time of diagnosis, that may have low or high risk features. The guideline examines pre-operative investigations, surgery techniques, and adjuvant treatment including radiotherapy and chemotherapy, with recommendations taking risk into consideration. The use of multidisciplinary team management is also discussed. Outcomes of interest include treatment risks, complications, and survival rates. This guideline is wiki-based and is constantly updated as new evidence arises - this review pertains to the guideline as of July 11, 2014
This clinical practice guideline examines the effects of G-CSF, pegfilgrastim, and biosimilar XM02 on the primary and secondary prevention of infection in adult patients with haematological malignancies or solid tumours who are undergoing chemotherapy. Considerations are made to patient age, patient risk for febrile neutropenia (FN), and timing of treatment. Comparisons are made between pegfilgrastim and filgrastim, and pegfilgrastim and placebo and primary outcome of interest is incidence of febrile neutropenia (FN).
This is a clinical practice guideline for patients with resectable pancreatic ductal adenocarcinoma. The guideline provides recommendations on pancreatoduodenectomy, with comparisons made to extended versus standard lymphadenectomy during surgery. Primary outcome of interest is survival benefit.
This is a clinical practice guideline for prostate cancer survivors. The guideline discusses health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, and psychosocial issues. Care coordination and implications for clinical practice are also discussed.
A clinical practice guideline for patients at risk of developing melanoma due to the use of indoor tanning devices. The guideline examines risk due to use, impact of age, and frequency of use as it relates to cutaneous malignant melanoma. Outcomes of interest include relative risk and increased risk.
This is a clinical practice guideline for patients with head and neck cancer. The guideline examines the use of intensity modulated radiation therapy (IMRT) as a treatment method, with a particular focus on dose objectives. Recommendations are provided on dose limits and dose coverage for different regions of interest, while considering tolerance and the risk of early and late side effects.
This is a clinical practice guideline for the management of patients with diffuse large B-cell lymphoma (DLBCL). The guideline provides recommendations for diagnosis, staging, and treatment, and the appropriateness of different techniques is examined for different clinical situations. Outcomes of interest include overall survival, event-free survival, progression-free survival, failure-free survival, adverse events, and toxicity.
This is a clinical practice guideline for adult patients (18 years or older) with unresectable metastatic colorectal cancer. The guideline provides recommendations on sequential chemotherapy strategies for treatment with palliative intent. The cytotoxic agents discussed include initial fluoropyrimidine (5-FU or capecitabine) either alone or in combination, irinotecan and oxaliplatin. Outcomes of interest are overall survival, toxicity, and quality of life.
This is a clinical practice guideline for health-care providers (HCPs) to help screen, identify and manage cancer-related distress experienced by individuals diagnosed with cancer and their families. This guideline seeks to assist HCPs to become aware/sensitive to cancer-related distress; educate HCPs about management strategies for cancer-related distress; identify referral options for management of cancer-related distress by front-line HCPs; provide direction for cancer-related distress management and treatment options; assist front-line HCPs to identify and access appropriate specialist psychosocial care referral; and support the provision of person-centred care with a focus on cancer-related distress.
This is a clinical practice guideline for obese patients with cancer who are candidates for hematopoietic stem cell transplantation (HCT). The guideline examines the pharmacologic agents used for preparative regimens in these patients. Dosing recommendations are provided for various HCT conditioning agents.
This is a clinical practice guideline for patients with a pathological confirmed diagnosis of breast cancer. The guideline reviews diagnostic assessment, staging, and neoadjuvant treatment regimes depending on whether breast cancer is operable or inoperable. The guideline also discusses challenges involved with neoadjuvant therapy.
A clinical practice guideline for patients with small cell and non-small cell lung cancer who have undergone curative treatment. The guideline examines screening and disease control through imaging and follow-up visits to prevent recurrence. Outcomes of interest include increased follow-up recommendations for the first two years after treatment, when recurrence is most likely to occur.
A clinical practice guideline for adult patients with chronic lymphocytic leukemia (CLL). This guideline examines the use of alemtuzumab, and its associated adverse treatment-related toxicities. Although no definitive data on quality of life or overall survival was identified, case-series studies suggest alemtuzumab could still be a reasonable option for patients with progressive and symptomatic CLL.
A clinical practice guideline for systemic therapy treatments in patients with human epidermal growth factor receptor 2 (HER2) –positive advanced breast cancer. The guideline examines optimal first, second, and third line treatments based on progression and the presence of other receptor-positive diseases. Outcomes of interest include improved follow up, survival and toxicity profiles.
A clinical practice guideline for the treatment of fatigue in adult cancer survivors. The guideline examines the assessment and treatment of fatigue in cancer survivors, particularly through psychosocial interventions and physical activity. Outcomes of interest include improved fatigue relief and patient mood.
A clinical practice guideline for prostate cancer patients, particularly older men. The guideline examines diagnosis, staging, treatment and follow up, primarily for locally advanced and metastatic cancers. Outcomes of interest include improved functional outcomes and improvements in deferred treatment.
This clinical practice guideline reviews pre-treatment evaluation, management, follow-up, late effects, and survivorship of patients with classical Hodgkin lymphoma (HL). The guideline reviews management of early and advanced stage HL, as well as HL in pregnancy and in elderly patients. Chemotherapy and radiotherapy are discussed as treatment options, and PET/CT imaging is reviewed as a pre- and post-treatment assessment tool. Outcomes of interest include therapy related efficacy and toxicity, predictive value of assessment tools, survival, morbidity, and mortality.
This is a clinical practice guideline for patients diagnosed with or suspected of having basal cell carcinoma. The guideline reviews prognosis and risk factors, diagnosis, treatment, follow-up care, and prevention. Outcomes of interest include cure rate, recurrence, cost-effectiveness, and response rate.
This clinical practice guideline discusses the treatment of invasive fungal infections in cancer patients, including treatment of invasive Aspergillus infections, invasive Candida infections, mucormycosis, cryptococcosis, Trichosporon infections, fusariosis, and Scedosporium infections. Other topics of discussion include therapeutic drug monitoring of antifungal agents, empirical versus preemptive antifungal therapy, and immunotherapy and granulocyte transfusion. Interventional strategies including surgery, drug instillation, and embolization are also discussed. Outcomes of interest include efficacy and safety.
This guideline set provides recommendations on the management of hematologic cancers including amyloidosis, chronic leukemia, Hodgkin's lymphoma and other forms of lymphoma, monoclonal gammopathy of unknown significance, multiple myeloma, and solitary plasmacytoma. Topics of discussion include diagnosis and staging, management, and follow-up. Additionally, biopsy procedures, protein studies, and immunizations for this population are discussed. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on gastrointestinal cancer, with sub-sections discussing the following tumour sites: anus, bile duct, colon, esophageal and esophagogastric junction, gallbladder, liver, neuroendocrine tumours, lymphoma, gastro-intestinal stromal tumours (GIST), pancreas, rectum, small bowel, and stomach. Important aspects discussed in the guideline include: screening, diagnostic and staging, surgical therapy, staging, follow up and surveillance, and considers different treatment options. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This is a clinical practice guideline for patients diagnosed with or suspected of having endometrial cancer. The guideline reviews diagnostic evaluation, staging, and surgical management. The use and value of various surgical approaches including hysterectomy, lymphadenectomy, and cytoreductive surgery are discussed. Outcomes of interest include sensitivity, specificity, and positive predictive value of staging procedures, postoperative morbidity, and survival rates.
This is a clinical practice guideline for adult patients diagnosed with or suspected of having colon cancer. The guideline provides recommendations on diagnostic assessment and staging, pathology, treatment, and follow-up care. The use of KRAS mutational analysis and BRAF are reviewed, and N-RAS and MSI are discussed as predictors of treatment effectiveness. Comparisons are made between chemotherapy regimes, surgical techniques, and recovery programs. Outcomes of interest include sensitivity and specificity of diagnostic tests, survival (progression-free, overall), surgical outcomes (mortality, complications, readmissions, hospital stay, peri-procedural morality), and quality of life.
A clinical practice guideline for adult and paediatric patients undergoing colonoscopies for cancer surveillance. The guideline examines appropriate bowel cleansing procedures, including dietary recommendations and salvage options. Outcomes of interest include improved OTC purgative prescription and greater use of low-volume agents.
A clinical practice guideline for patients with advanced breast cancer. The guideline examines diagnosis and treatment, focusing on systemic therapies, and provides patient-centred recommendations. Outcomes of interest include reductions in skeletal-related events and optimized drug sequencing.
A clinical practice guideline for the treatment of oncological emergencies related to cancer or anticancer therapy for family physicians. The guideline examines complications associated with cancer and cancer therapy, including diagnosis and treatment. Outcomes of interest include improved patient safety and reduced unnecessary treatment.
A clinical practice guideline for pediatric brain tumour patients, specifically for nursing activities. The guideline examines management of brain tumour diagnosis and treatment, including symptom management and supportive care. Outcomes of interest include improved nursing surveillance of neurological and hereditary cognitive symptoms.
This guideline reviews the use and appropriateness of repeat surgical resection for adult patients with previously diagnosed malignant glioma who are suspected of experiencing progression of the neoplastic process and are amenable to surgical resection. Outcomes of interest include survival (median), operative morbidity, postoperative mortality, prognostic factors, and quality of life.
This is a clinical practice guideline for breast cancer patients currently undergoing cancer treatment. The guideline reviews the use of complementary and integrative therapies for the management of treatment related symptoms. Therapies such as acupuncture, hypnosis, meditation, relaxation and imagery, natural products (botanicals, minerals, vitamins), stress management and yoga are considered. Outcomes of interest include effectiveness of therapy for the management of clinical symptoms (such as fatigue, depression, pain, neuropathy, lymphedema, sleep, and anxiety, and chemotherapy-induced nausea and vomiting, among others), quality of life, organ toxicities, and adverse events.
This is a clinical practice guideline for female patients aged 19 and older. The guideline provides recommendations on screening, diagnosis, treatment, and follow-up care of ovarian, fallopian tube, and primary peritoneal cancers. Prevention and risk reduction strategies are also reviewed.
A clinical practice guideline for the use of computed tomographic colonography in patients with colorectal cancer. The guideline examines colorectal surveillance and polypectomy and their feasibility for patients with symptoms of colorectal cancers. Outcomes of interest include improvements over standard barium enemas and increased diagnostic sensitivity.
A clinical practice guideline for patients with gastroenteropancreatic neuroendocrine tumours (GEP NETs). The guideline examines multiple treatment options, including surgery and systemic therapies. Outcomes of interest include treatment response, median time to progression, and survival. This guideline is wiki-based and is constantly updated as new evidence arises - this review pertains to the guideline as of May 1, 2014.
This is a clinical practice guideline for the diagnosis and treatment of pancreatic cancer. Diagnosis, surgery, adjuvant therapy, radiation therapy, chemotherapy, and stent therapy are discussed. Outcomes of interest include survival and treatment efficacy.
This is a clinical practice guideline for patients who have bowel obstruction with advanced peritoneal carcinomatosis for which complete cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion are no longer relevant. The guideline provides recommendations on clinical assessment and treatment options for relieving intestinal obstruction or its symptoms. Treatment/management options include surgery, steroids, stents, nasogastric tubes (NGT's) and venting gastronomy, antisecretory drugs, and antiemetic management. Outcomes of interest include complication rate of surgical management (e.g. obstruction, perforation), morbi-mortality rates from surgery, and quality of life.
This clinical practice guideline provides recommendations on diagnostic assessment and follow-up for patients with cystic pancreatic neoplasms. Topics covered include indications for work-up, laboratory tests, serum markers, imaging and nuclear medicine, ultrasound/endoscopy, laboratory markers in cystic fluid, and pathology. Outcomes of interest include sensitivity and specificity, positive and negative predictive values, and accuracy of diagnostic/assessment procedures.
This is a clinical practice guideline on catheter-related infections (CRIs) in patients with malignancies. The guideline provides recommendations on diagnosis, management, and prevention of CRI in cancer patients. Topics discussed in the guideline include: risk factors for CRI, surveillance, the selection of catheters and sites, as well as a section on related unresolved issues requiring further study.
This is a clinical practice guideline for minimally invasive thyroid carcinoma (MIFTC). The guideline considers recommendations in the management of patients with MIFTC. Topics of consideration include: MIFTC definition, specimen processing, characteristics, diagnosis, prognoses, and therapy. Also of interest in the guideline is the distinction between MIFTC and widely invasive follicular thyroid carcinoma (WIFTC).
This is a clinical practice guideline for localized pancreatic head cancer. The guideline examines when to perform a pancreatoduodenectomy (PD) in the absence of positive histology. Other important aspects discussed in the guideline include: the issue of the preoperative biopsy, pancreatitis, and neuroendocrine neoplasms.
This guideline set provides recommendations on cancer screening. The guideline consists of sub-sections including: the definition, purpose, attributes, and impact of a cancer screening program; the “what, who, and when” of screening, follow-up, and outcomes. It also provides recommendations for the clinician in using screening tests. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on the management of metastatic cancer of unknown primary site including primarily adenocarcinomas and undifferentiated carcinomas. Topics of discussion include diagnosis and staging, management, and follow-up. Additionally, diagnostic pathology and special patient clusters are discussed. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on the management of neurological cancers including five primary subgroups: astrocytoma, oligodendroglioma, ependymoma, meningioma, and pituitary adenoma. Topics of discussion include prevention, diagnosis and staging, management, and follow-up. Additionally, the use of corticosteroids and anticonvulsants are discussed. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline set provides recommendations on genitourinary cancer, with sub-sections on: prostate, bladder, kidney, testis, penis, scrotum, renal pelvis and ureter, and female urethra. Important aspects discussed in the guideline include: predisposing factors and prevention, screening and early detection, diagnosis, staging, and management. Please note that the sub-sections within this set were published and revised at varying dates, and that the publication year referenced here refers only to the date that the guideline set was accessed online.
This guideline discusses psychosocial management of adolescents and young adults (AYA's) - aged between 15 and 24 - diagnosed with cancer of any type. Topics of discussion include effective communication, addressing the support and information needs of family members, addressing physical/medical issues that impact psychosocial wellbeing, addressing psychological wellbeing, helping to keep the patient connected with life outside their cancer treatment, providing age appropriate clinical management, and addressing palliative care needs. Other resources are also provided for patients, family and friends, and for health professionals.
This clinical practice guideline discusses cervical cancer control including: cervical cancer prevention and control programmes; community mobilization, education and counselling; HPV vaccination; screening and treatment of cervical pre-cancer; diagnosis and treatment of invasive cervical cancer; and palliative care. Treatment options for special populations including women who are pregnant and women living with HIV are also reviewed.
This is a clinical practice guideline for elderly patients at risk of or diagnosed with non-small-cell lung cancer (NSCLC). The guideline discusses screening strategies and reviews treatment options stratified by stage. Surgery, radiotherapy, chemotherapy, targeted agents and second-line therapies are discussed. Other topics of consideration include the consideration of patient preferences and the importance of geriatric assessment when determining optimal strategy for management of cancer.
This is a clinical practice guideline for the treatment of patients with advanced breast cancer (ABC). Treatment options are discussed for inoperable locally advanced breast cancer (LABC), both inflammatory and non-inflammatory; and metastatic breast cancer (MBC), with recommendations specific to site of metastasis. Treatment recommendations are further stratified by cancer subtype (tumour status) and by specific populations including patients with BRCA-associated triple-negative or endocrine-resistant MBC and male patients with ABC.
This guideline reviews perioperative care for enhanced recovery after gastrectomy for cancer. Recommendations are provided on preoperative counselling and nutrition, surgical preparation, technique, and methods, analgesia and anaesthetic management, and postoperative care including management of fluid balance, urinary drainage, glycaemic control, and stimulation of bowel movement, among others.
This is a clinical practice guideline for patients over 18 years of age with primary invasive SCC cutaneous squamous cell carcinoma. The guideline reviews risk factors, staging, therapeutic interventions, and follow-up care. Outcomes of interest include prognostic factors, survival (five-year overall and recurrence free), local control, recurrence rate (regional and distant), nodal metastases, effectiveness of treatment, and adverse events.
This is a clinical practice guideline for patients with colorectal cancer or for patients who are otherwise at risk of Lynch syndrome or familial adenomatous polyposis (FAP). The guideline provides recommendations on the identification and referral of patients to genetic centres for counselling, and discusses appropriate follow-up screening for Lynch syndrome and FAP. The use of Microsatellite instability (MSI) as both a predictor of treatment effectiveness and a predictor of Lynch syndrome is reviewed, with MSI compared to immunohistochemistry when screening for Lynch syndrome.
This is a clinical practice guideline endorsement on adjuvant and salvage radiotherapy after prostatectomy. The guideline examines management of localized prostate cancer with adjuvant radiotherapy after prostatectomy compared to radical prostatectomy only. Aspects of interest include: adverse pathologic findings at prostatectomy, the risk of biochemical prostate-specific antigen (PSA) recurrence, and clinical progression of cancer.
A clinical practice guideline for ambulatory and inpatients undergoing treatment for solid tumours, at risk for venous thromboembolism. The guideline examines appropriate surveillance and follow up, and treatment through anticoagulants. Outcomes of interest include improved recommendations for the elderly and clarified preoperative medication timelines.
This is a clinical practice guideline for patients over the age of 18 years with stage II or III colorectal cancer. The guideline discusses follow-up care and provides recommendations regarding the timing and appropriateness of surveillance tests/procedures including CEA testing, colonoscopy, PET scans and CT scans. The guideline also discusses how physicians can educate patients about adopting healthy lifestyle behaviours to improve survival outcomes.
This is a clinical practice guideline for patients with malignant uveal melanoma. The guideline reviews diagnosis and work-up, primary management, adjuvant therapy, management of patients with metastatic disease, and management of high risk patients. Follow-up care is also discussed. Outcomes of interest include efficacy of treatments and imaging modalities.
A clinical practice guideline for the treatment of newly diagnosed and recurrent or relapsed medulloblastoma in adult patients. The guideline examines MRI workup, surgery with maximal safe resection, and management of localized and non-localized recurrence. Outcomes of interest include improved long-term survival rates with maximal excision and improved local control with postoperative radiotherapy.
A clinical practice guideline for patients with, or being screened for, Waldenström macroglobulinaemia. The guideline examines management, including consistent monitoring of immunoglobulin and biological therapy with rituximab-containing regimens. Outcomes of interest increased treatment uniformity and solidified indications for introduction of treatment.
This is a clinical practice guideline for the management of patients with early esophageal cancer, dysplastic and non-dysplastic Barrett's esophagus. This guideline examines treatment options and considers in what clinical situations endoscopic therapy is the most appropriate treatment. Treatment options explored and discussed include: endoscopic mucosal resection, radiofrequency ablation, photodynamic therapy, argon plasma coagulation, and multipolar electrocoagulation.
A clinical practice guideline for patients who have undergone radiation or chemotherapy for head and neck cancers. The guideline examines appropriate follow-up screening, prevention, and treatment of post-therapy pain and complications, including dental complications and neuropathy. Outcomes of interest include improved patient education and longer term screening.
This is a clinical practice guideline for adult cancer survivors who have completed their primary cancer treatment, including patients who are using ongoing therapies to manage their cancer or control symptoms. The guideline provides recommendations on the identification and management of fear of cancer recurrence (FCR). Outcomes of interest include health behaviours, psychological consequences of FCR, quality of life, and FCR interventions.
This is a clinical practice guideline for female patients aged 9 and above. The guideline provides recommendations on screening, diagnosis, treatment, and follow-up care of human papillomavirus (HPV) related cancers including cervical, vaginal, and vulvar. Special topics of interest include an overview of HPV vaccines and a discussion on controversies in care, including screening intervals and age to stop screening.
A clinical practice guideline for patients with malignant colonic obstruction and colorectal cancer. The guideline examines colonic self-expandable metal stent placement in prophylactic, elective, emergency, and palliative surgeries. Outcomes of interest include reduced colonic perforation and reduced mortality.
This is a clinical practice guideline for adult patients (18 years or older) with inoperable, advanced (Stage IV) colorectal cancer. The guideline provides recommendations on the use of intermittent systemic treatment strategies. Outcomes of interest include overall response rate, survival (overall, progression-free, failure free), toxicity, and quality of life.
This is a clinical practice guideline for adult patients over 18 years of age with possible chronic lymphocytic leukemia. The guideline reviews the management of chronic lymphocytic leukemia, including diagnosis and prognosis, first-line and second-line treatment options, and follow-up and supportive care. Outcomes of interest include survival (overall and progression-free), toxicity, overall response, and quality of life.
A clinical practice guideline for women with human epidermal growth factor receptor 2–negative (HER2-negative) or unknown advanced breast cancer. The guideline examines first-line treatment options including the benefits of single agent versus combination therapy, specifically the role of bevacizumab. Outcomes of interest include slowed disease progression, modestly improved survival, and increased communication concerning end of life planning.
A clinical practice guideline for the management of upper tract urothelial carcinomas. The guideline examines diagnosis, treatment, and follow-up, with recommendations for treatment based on risk stratification. Outcomes of interest include improved diagnosis to removal time recommendations and post-operative treatments.
This is a clinical practice guideline outlining surgical treatment options for patients with ulcerative colitis. The guideline examines indications for surgery, with a specific focus on the intractability of ulcerative colitis, as well as surgical and postoperative management. The guideline also provides recommendations for cancer screening by endoscopy for patients with long-standing ulcerative colitis. Outcomes of interest include improvements in quality of life and potential curative measures.
A clinical practice guideline for patients with newly diagnosed symptomatic multiple myeloma. The guideline examines the use of bortezomib, melphalan, and prednisone (VMP regimen) as first-line treatment. Outcomes of interest include overall survival and time to progression.
This is a clinical practice guideline concerning the diagnosis, therapy and follow-up of melanoma. The guideline examines such treatment options as excision, adjuvant therapy with interferon-alpha, and lymphadenectomy. In addition, new immunotherapies such as the CTLA-4 antibody ipilimumab are considered, and follow-up procedures are discussed.
A clinical practice guideline for the treatment of cutaneous melanoma patients with tumour immunotherapy. The guideline examines the clinical application of immunotherapy with interferon‐α2b, pegylated‐interferon‐α2b, interleukin‐2 (IL‐2) and ipilimumab for high-risk, advanced-stage cancer. Outcomes of interest include decreasing the adverse effects of depression and improved therapeutic strategies with immunotherapy and standard radiation.
A clinical practice guideline for neutropenic patients with hematological malignancies and stem cell transplant recipients. The guideline examines antifungal therapy, including pre-emptive and targeted management. Outcomes of interest include improved treatment definition based on fungal markers and appropriate treatment start points.
A clinical practice guideline for patients with cystic tumours of the pancreas. The guideline examines the diagnosis and management of pancreatic tumours, including assessment of biopsy and surgical assessment. Outcomes of interest include improved diagnostic imaging and improved follow-up.
This clinical practice guideline discusses supportive care for patients undergoing breast cancer treatment in low- or middle-income countries. Resource allocation recommendations are provided for health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment.
This is a clinical practice guideline for patients with cytomegalovirus (CMV) infection in haemopoietic stem cell transplantation. The guideline reviews risk factors and diagnostic assessment of CMV infection and disease, impact of host and donor CMV serostatus, prevention of CMV disease occurrence, primary prophylaxis for CMV, pre-emptive therapy, and management of CMV disease. Outcomes of interest include risk factors of CMV infection, sensitivity of diagnostic tests, efficacy of treatment, and toxicity.
This is a clinical practice guideline for adult patients with suspected biliary neoplasia. The guideline reviews evaluation and treatment options of biliary neoplasia including cholangiocarcinoma, gallbladder polyps, and adenocarcinoma of the gallbladder. Recommendations are provided for radiologic imaging and endoscopic approaches. Outcomes of interest include sensitivity, specificity of diagnostic procedures, and safety and effectiveness of endoscopic procedures.
This is a clinical practice guideline for adult patients undergoing flexible bronchoscopy (FB). The guideline provides recommendations on best practice in FB, with an overview of staff safety, procedure, complications, provision of patient information, and obtaining informed consent. The guideline also discusses the use of FB for diagnosis of lung cancer, interstitial lung disease, and infection, including review of biopsy and sampling technique. Outcomes of interest include test sensitivity, specificity, and diagnostic yield, complications and adverse effects of FB and of drugs used during procedure, and patient satisfaction.
This is a clinical practice guideline for patients with mature T-cell and natural killer (NK)-cell neoplasms (excluding c
