Evaluation of guidelines regarding surgical treatment of breast cancer using the AGREE Instrument: a systematic review

Abstract

Objectives: Many clinical practice guidelines and consensus statements (CPGs/consensus statements) have been developed for the surgical treatments for breast cancer. This study aims to evaluate the quality of these CPGs/consensus statements.

Methods: We systematically searched the PubMed and EMBASE databases, as well as four guideline repositories, to identify CPGs and consensus statements regarding surgical treatments for breast cancer between January 2009 and December 2016. We used the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument to assess the quality of the CPGs and consensus statements included. The overall assessment scores from the AGREE instrument and radar maps were used to evaluate the overall quality. We also evaluated some factors that may affect the quality of CPGs and consensus statements using the Mann-Whitney U test or Kruskal-Wallis H test. All analyses were performed using SPSS V.19.0. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: A total of 19 CPGs and four consensus statements were included. In general, the included CPGs/consensus statements (n=23) performed well in the 'Scope and Purpose' and 'Clarity and Presentation' domains, but performed poorly in the 'Applicability' domain. The American Society of Clinical Oncology (ASCO), National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), New Zealand Guidelines Group (NZGG) and Belgium Health Care Knowledge Centre (KCE) guidelines had the highest overall quality, whereas the Saskatchewan Cancer Agency, Spanish Society of Medical Oncology (SEOM), Japanese Breast Cancer Society (JBCS) guidelines and the D.A.C.H and European School of Oncology (ESO) consensus statements had the lowest overall quality. The updating frequency of CPGs/consensus statements varied, with the quality of consensus statements generally lower than that of CPGs. A total of six, eight and five CPGs were developed in the North American, European and Asian/Pacific regions, respectively. However, geographic region was not associated with overall quality.

Conclusions: The ASCO, NICE, SIGN, NZGG and KCE guidelines had the best overall quality, and the quality of consensus statements was generally lower than that of CPGs. More efforts are needed to identify barriers and facilitators for CPGs/consensus statement implementation and to improve their applicability.

Keywords: AGREE instrument; breast cancer; consensus; guideline; quality of guidance document; surgery; surgical management.

Figure 1

Flow chart of the systematic review.

Figure 2

Radar map to show the six dimensions (domain) of the quality of CPGs developed in Europe (A), North America (B), Asian/Pacific (C) regions and of consensus statements (D). ACR, American College of Radiology; AGO, German Group for Gynaecological Oncology; ASCO, American Society of Clinical Oncology; CA-NBOCC, Cancer Australia-National Breast and Ovarian Cancer Centre; CCO, Cancer Care Ontario; ESMO, European Society for Medical Oncology; EUSOMA, European Society of Breast Cancer Specialists; JBCS, Japanese Breast Cancer Society; KCE, Belgium Health Care Knowledge Centre; Malaysia, Malaysia Academy of Medicine of Malaysia; NCCN, National Comprehensive Cancer Network; NICE, National Institute for Health and Care Excellence; NZGG, New Zealand Guidelines Group; SASK, Saskatchewan Cancer Agency; SEOM, Spanish Society of Medical Oncology; SIGN, Scottish Intercollegiate Guidelines Network; SIOG, Society of Geriatric Oncology; SSO-ASTRO Society of Surgical Oncology-American Society for Radiation Oncology; ESO, European School of Oncology; St. Gallen, St. Gallen Consensus; D.A.C.H, German, Australia, Swiss Societies of Senelogy.Biedenkopf, the Biedenkopf expert panel members.