title: Modification and implementation of NCCN guidelines on hepatobiliary cancers in the Middle East and North Africa region.
abstract: The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) on Hepatobiliary Cancers address hepatocellular cancer, cancer of the gallbladder, extrahepatic cholangiocarcinoma, and intrahepatic cholangiocarcinoma. Hepatocellular cancer incidence is higher in the Middle East and North Africa (MENA) region than in the West, and hepatitis B and C infections are particularly important; the incidence of gallbladder cancer is among the highest in the world. Regional problems include delay in diagnosis, shortage of trained staff, and insufficient liver transplant facilities. Furthermore, costs associated with molecular and targeted therapies are an increasing concern. A committee was formed, consisting of leading specialists and decision-makers from the region, with each member being tasked to suggest modifications to the existing guidelines based on review of the literature and consultations with local colleagues. This committee met as a group, and then continued to discuss and debate the suggested modifications electronically. Several recommendations were finalized after vigorous debate. The final approved recommendations were then presented in April 2009 to the chair of the NCCN Hepatobiliary Cancers Panel for onward transmission and approval. This project represents an effort to modify and implement the NCCN Guidelines on Hepatobiliary Cancers in the MENA region, while taking into consideration local differences in patient and disease characteristics. The hope is that this will form the basis of future local, regional, and international cooperation in guideline development and research.
authors.affiliation: Department of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. aasim@skm.org.pk
authors.forename: Muhammed Aasim
authors.initials: MA
authors.lastname: Yusuf
authors.forename: Vinay Kumar
authors.initials: VK
authors.lastname: Kapoor
authors.forename: Refaat Refaat
authors.initials: RR
authors.lastname: Kamel
authors.forename: Ather
authors.initials: A
authors.lastname: Kazmi
authors.forename: Najam
authors.initials: N
authors.lastname: Uddin
authors.forename: Nehal
authors.initials: N
authors.lastname: Masood
authors.forename: Abdulmajeed
authors.initials: A
authors.lastname: Al-Abdulkareem
mesh_terms: D000352:Africa, Northern / Q000453:epidemiology; D018912:Arabs / Q000706:statistics & numerical data*; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000628:therapy; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D002173:Cancer Care Facilities; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000628:therapy; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000628:therapy; D019317:Evidence-Based Medicine; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008877:Middle East / Q000453:epidemiology; D015996:Survival Rate; D014481:United States