Clinical practice guidelines in cancer: the European perspective

The Organization of European Cancer Institutes (OECI) is a nongovernmental, non-profit organization founded in Vienna in 1979. Initially, its main objectives were to improve communication between European cancer institutions and to increase collaboration between them. Evolving healthcare programs over the past 10 years have given the OECI the opportunity to take up new challenges. The expertise of members within the organization has enabled the OECI to address the problem of quality in cancer care on a European scale and to develop initiatives to improve the overall management and outcome of cancer patients. The assembly of the OECI has subsequently been able to set up specific working groups on the following topics: clinical practice guidelines, data monitoring and evaluation, economic evaluation, pre-clinical and clinical research, medical education, communication with cancer patients and the use of information technology and telemedecine. Within the context of cancer care, many of these approaches have already been shown to be important in routine daily practice, not only within specialized cancer centres, but also across all centres and institutions involved in cancer care. The OECI provides an excellent forum to pursue research in these areas and bids for research funds from the European Community (Organization of European Cancer Institutes, 2000). In 1996, Andre Kuwalowski, the former president of the OECI asked the members for topics they particularly wanted to address. The development and dissemination of clinical practice guidelines was identified as a topic of high priority and one that is essential for improving the quality of care of cancer patients. It is recognized that guidelines must be implemented within a larger project that includes quality control, to show that where they are empolyed, patient outcome is better (Langmark, 1997). In order to avoid duplication of effort, the programme committee decided to adopt, disseminate and implement guidelines that had already been produced. It was initially planned to use the National Cancer Institute’s comprehensive cancer database PDQ® as a starting point. However, it soon became clear that various European institutions had already developed their own guidelines at a local, regional or national level. The Standards, Options & Recommendations (SOR) project was developed by the French National Federation of Cancer Centers (FNCLCC) and the 20 French Comprehensive Cancer Centres (CRCC) in collaboration with specialists from French public universities, general hospitals, private clinics and scientific societies. The program deals specifically with guidelines in cancer care (Fédération Nationale des Centres de Lutte Contre le Cancer, 1998) that are developed according to explicit quality criteria. Critical appraisal of the available evidence by multidisciplinary expert groups is an approach highly relevant to clinical practice in oncology.