title: Updating clinical recommendations for breast, colorectal and lung cancer treatments: an opportunity to improve methodology and clinical relevance.
abstract: BACKGROUND
  clinical guidelines can improve quality of care summarising available knowledge and proposing recommendations for health care decisions. Being up to date is one of their quality requisites. Little experience is available on when and how guidelines should be updated. We report on the update process of evidence-based clinical recommendations on anticancer drugs.
  
  
  METHODS
  three multidisciplinary panels, supported by methodology experts, updated the recommendations. The methodologists were in charge of the qualitative and quantitative synthesis of the evidence. The panels were responsible for the final decision about risk/benefit profile of the drugs and strength of the recommendations. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used.
  
  
  RESULTS
  six recommendations out of 15 were completely updated in 8 months time. In four cases, the strength of the recommendation changed; in two of them, we moved from a weak to a strong positive one. Despite the increased certainty about the positive risk/benefit profile, this was translated in a change in the strength of the recommendation only in one case out of three. Three recommendations were refined making them more clinically specific.
  
  
  CONCLUSIONS
  accumulation of evidence is an opportunity for guideline panels to refine methodological rigour, clinical relevance and to foster consensus on recommendations. This requires time and resource investments.
authors.affiliation: Department of Oncology, Ematologia e Patologie dell'Apparato Respiratorio, Università degli Studi di Modena and Reggio Emilia, Modena; Centro Cochrane Italiano, Istituto di Ricerche Farmacologiche Mario Negri, Milano. Electronic address: elena.parmelli@unimore.it.
authors.forename: E
authors.initials: E
authors.lastname: Parmelli
authors.affiliation: Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna.
authors.forename: D
authors.initials: D
authors.lastname: Papini
authors.affiliation: Centro Cochrane Italiano, Istituto di Ricerche Farmacologiche Mario Negri, Milano.
authors.forename: L
authors.initials: L
authors.lastname: Moja
authors.affiliation: Centro Valutazione Efficacia Assistenza Sanitaria, Azienda Unità Sanitaria Locale, Modena.
authors.forename: E
authors.initials: E
authors.lastname: Bandieri
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Inbaro, Chieti.
authors.forename: M
authors.initials: M
authors.lastname: Belfiglio
authors.affiliation: Centro Prevenzione Oncologica, Azienda Ospedaliero-Universitaria San Giovanni Battista, Torino.
authors.forename: G
authors.initials: G
authors.lastname: Ciccone
authors.affiliation: Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna.
authors.forename: R
authors.initials: R
authors.lastname: De Palma
authors.affiliation: Department of Medical Oncology, Azienda Unità Sanitaria Locale, Ravenna.
authors.forename: M
authors.initials: M
authors.lastname: Leoni
authors.affiliation: Department of Oncology, Ematologia e Patologie dell'Apparato Respiratorio, Azienda Ospedaliera Universitaria Policlinico, Modena, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Longo
authors.affiliation: Centro Valutazione Efficacia Assistenza Sanitaria, Azienda Unità Sanitaria Locale, Modena.
authors.forename: N
authors.initials: N
authors.lastname: Magrini
authors.affiliation: Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna.
authors.forename: I
authors.initials: I
authors.lastname: Moschetti
authors.affiliation: Department of Oncology, Ematologia e Patologie dell'Apparato Respiratorio, Università degli Studi di Modena and Reggio Emilia, Modena; Centro Cochrane Italiano, Istituto di Ricerche Farmacologiche Mario Negri, Milano; Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna.
authors.forename: A
authors.initials: A
authors.lastname: Liberati
mesh_terms: D001943:Breast Neoplasms / Q000188:drug therapy*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D004358:Drug Therapy / Q000379:methods / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008495:Medical Oncology / Q000379:methods / Q000592:standards*