Nineteen hospitals make up the National Comprehensive Cancer Network (NCCN). The program began in 1995 “to develop a comprehensive set of diagnostic, treatment, and supportive care guidelines.” The guidelines are designed to guide medical decision making in cancer care. Forty-five panels cover 95% of “tumors encountered in oncology practices.” More than 600 clinicians and researchers have compiled “the best evidence” in drawing up the recommendations. Users must read a disclaimer and agree (by clicking a button) to the intended use of the guidelines before being allowed to view them. Health care professionals can request the guidelines on CD. A CD is currently available from a symposium on multiple myeloma.
Each guideline, in portable document format (PDF), is accompanied by a list of the panel members who composed it, a detailed index of its content, recommendations for clinical trials, and the Categories of Consensus, which explain the levels of evidence and types of studies included in the references that also accompany the guideline. The guidelines are divided into treatment of cancer by site; detection, prevention, and risk reduction; and supportive care. Extensive bibliographies accompany the guidelines, attesting to the meta-analysis that the panels have performed. Navigation through the longer documents is facilitated by live links in the table of contents. The guidelines are continually updated and augmented, and the dates of each version are noted. The emphasis is on evidence derived from analyses of published studies, preferably randomized, double-blind, controlled clinical trials.
There are also guidelines for patients, in English and Spanish. Printed copies may be ordered in addition to the PDF guidelines provided on the Website. Links to clinical trial information and a physician directory, searchable by geographical area as well as by type of cancer, are available. The physician directory includes links for patients for referral and assistance (at NCCN) in locating a suitable physician. The patient material is drawn up in conjunction with the American Cancer Society and is much more in-depth and useful than the cursory treatment of health subjects found on many consumer-level Websites. The site has detailed descriptions of diagnosis, treatment, side effects of therapies, and recommendations for finding appropriate care. A Spanish-speaking colleague of the reviewer confirmed the readability and usefulness of the information.
Besides the guidelines that are the main purpose of the network, NCCN holds an annual meeting for oncologists and, since 1977, has maintained an Outcomes Database that collects and synthesizes data for improvement in cancer care.
The NCCN Website provides a comprehensive guide to cancer for clinicians and patients. The alphabetical list of linked organizations goes from the Alliance for Lung Cancer Advocacy, Support, and Education (ALCASE) to the World Health Organization and includes every kind of cancer organization, from formal clinical discussions to advocacy groups, often with telephone numbers embedded in the entry. Except for a few international groups, all are from the Untied States.
The nineteen NCCN Network Hospitals are identified on a map showing locations and linking to further information. Each facility is described in detail, especially the adult and/or pediatric oncology services and availability of genetic screening or testing. As in other places on the NCCN Website, patients are encouraged to explore clinical trials. Complete referral information is provided for each hospital.
Current news stories and media links are provided, and an archive is provided with news back to the year 2000 and newsletters back to 1998. A further page lists industry and biotech advisory roundtables, with links to company Websites.
With the emphasis on evidence-based care that is increasingly being recognized as essential to medical decision making, the NCCN's compilations are a vital tool for oncologists. This reviewer's institution was a founding member of NCCN, but this review is from the librarian's point of view. If a library provides full text from the Cochrane Library or other bibliographic and full-text databases on evidence-based medicine, a link to the NCCN belongs on the list. Librarians who teach or demonstrate evidence-based medicine resources to clinicians can use the Categories of Consensus and descriptions of NCCN's research process as further examples of how meta-analysis of controlled clinical trials is performed and how the value of original sources is analyzed.