{"id":8490,"date":"2025-09-25T23:37:00","date_gmt":"2025-09-25T23:37:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=8490"},"modified":"2025-09-25T23:37:00","modified_gmt":"2025-09-25T23:37:00","slug":"how-good-is-the-evidence-underlying-nccn-treatment-guidelines","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=8490","title":{"rendered":"How good is the evidence underlying NCCN treatment guidelines?"},"content":{"rendered":"

Centers for Medicare & Medicaid Services (CMS) and most
\nprivate payers in the U.S. have accepted the NCCN guidelines as a mandated
\nreference to determine payment for \u201coff\u2010label\u201d use of
\nanticancer drugs that are not approved for the specific indication by the U.S.
\nFood and Drug Administration.\u00a0 Thus, a key
\nquestion is what types of evidence are driving these guidelines.\u00a0 <\/p>\n

A paper by Liu et al. (2018)<\/a> examines the quality of evidence that underlies these guidelines.\u00a0\u00a0 They find that: <\/p>\n

In total, 1,782 recommendations were identified in 29 guidelines, of which 1,282 (71.9%) were based on low\u2010quality or low\u2010consistency evidence (low\u2010level evidence), including \u201ccase reports or clinical experience only\u201d (18.9%). A substantial proportion (31\/143, 21.7%) of category 1 (the highest level) recommendations were based on low\u2010level evidence. The majority of authors (87.1%) received payments from industry. However, no association was found between the prevalence of payments among authors and the percentage of recommendations developed from low\u2010level evidence per guideline. <\/p>\n

The evidence certainly highlights the need for more high quality evidence to support these decisions. Also interesting that industry payments did not influence the quality of evidence considered. <\/p>\n

A more recent paper by Noy et al. (2022)<\/a> looks at the quality of evidence available for different for radiation-related NCCN guidelines. They find that: <\/p>\n

Among all radiation therapy recommendations, the proportions of category I, IIA, IIB, and III CE were 9.7%, 80.6%, 8.4%, and 1.3%, respectively. When analyzed by disease site, cervix and breast cancer had the highest portion of category I CE (33% and 31%, respectively).\u00a0 <\/p>\n

One interesting study to do would be to have AI\u2013particularly an AI that cites its sources (like Perplexity)\u2013make treatment recommendations for the same disease categorization that NCCN uses . One could see to what extent (i) the AI-generated recommendations mimic NCCN guidelines, (ii) whether the AI-generated recommendations relied on more or less high-quality evidence when making these recommendations, and (iii) how frequently the AI \u2018hallucinated\u2019 and cited a source that was not at all relevant (or was made up!). An interesting research project for someone to take up!<\/p>","protected":false},"excerpt":{"rendered":"

Centers for Medicare & Medicaid Services (CMS) and most private payers in the U.S. have accepted the NCCN guidelines as a mandated reference to determine payment for \u201coff\u2010label\u201d use of anticancer drugs that are not approved for the specific indication by the U.S. Food and Drug Administration.\u00a0 Thus, a key question is what types of…<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-8490","post","type-post","status-publish","format-standard","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8490"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8490"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8490\/revisions"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8490"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8490"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8490"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}