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and provide ratings of both the quality of evidence and the

strength of recommendations;

• Must be tiered for resources and stratified;

• Be reconsidered and revised as appropriatewhen important

new evidence warrantsmodifications of recommendations.

It also calls that guideline development groups must

adhere to Conflict of Interest as well as have a summary of

relevant available evidences that describe quality, quantity

and consistency of aggregate evidence. The eight standards

that are required for a good guidance are:

• Establishing transparency;

• Management of conflict of interest;

• Guideline development group composition;

• Clinical practice guideline–systematic review intersection;

• Establishing evidence foundations for and rating strength

of recommendations;

• Articulation of recommendations;

• External review; and

• Updating.

Adoption of guidelines is of importance. Policies for

implementations are required, that must be effective, with

multi-faceted strategies targeting both the individual and

healthcare system to promote adherence, adaptation as

well as incorporation in e-health record and computer

aided clinical decisions. To advance this goal, the guideline

structure should be formatted with vocabulary and content,

easily incorporable.

Evaluation of guidelines is important and it must be

scientifically done on principles and guidelines laid down for

it like using the tools – agree or magic.

Patients rely on healthcare providers for quality care,

expect providers have knowledge and expertise to make

health related decisions. Clinical practice guidelines can aid

clinicians and patients in deciding best options of treatment.

Guidelines hold the promise for quality care in medicine.

Disclosure of interest:

None declared




Paolo Bossi

Head and Neck Medical Oncology, Medical Oncology, Milan, Italy

Treatment or disease-related symptoms are common among

cancer patients, but report manner is often inaccurate. The

physician’s assessment of patients’ adverse events has been

demonstrated to underestimate the perceived burden of toxicity.

To this aim, systematic collection of symptom information

through patient-reported outcome (PRO) standardized

measures has been claimed as a more accurate approach.

PROs are any report coming directly from the patients, by

means of questionnaires, measures of single symptoms or

functional status assessment. The broader employment of

PRO improves patients’ quality of life and the control of their


Moreover, the systematic assessment of PROs showed

to reduce emergency room visits and ultimately led to an

improvement in survival, according to recent data.

To which extent this instrument in catching patient’s

symptoms may be widened to an elderly patient population

is a matter of debate.

There are several arguments in favor of the broader use of

PROs in a geriatric population.

First, the benefit of regular PRO assessment is higher when

the burden of symptoms is huge and when a prompt and

appropriate management could be started. In this regard,

older patients are frailer due to comorbidities and higher

treatment toxicity, so the earlier recognition of any adverse

event and the consequential treatment could be of benefit in

this population.

Second, in a recently published trial, patients randomized

to report their symptoms through an electronic system

had a better quality of life, less use of emergency health

services and higher survival than patients with usual care

of symptom monitoring. The magnitude of benefit of routine

PRO measurement through this electronic instrument was

shown to give a greater benefit to computer-inexperienced,

older patients.

The vulnerability of elderly patients could be the more

appropriate setting in which the PRO measures could exploit

their greater power of improving adverse events detection

and management precision.

However, there are several drawbacks in the process of

implementing PROs in the geriatric population.

PRO instruments can be lengthy and may annoy the

patients, so it is necessary to accurately select the requested

questionnaires and items to be self-completed.

Moreover, elderly patients with cognitive impairments

may not be the right group to be selected for a continuous

assessment of toxicities by means of PROs measurement. In

this regard, it is necessary to minimize the missing data in

such an assessment, in order to ensure a greater quality of

the collected data.

The employment of PRO programs is a possible outstanding

step in the evaluation of toxicity also in a geriatric population,

but it needs a careful and appropriate process of instrument

and patient selection.

Disclosure of interest:

None declared



Bruno Castagneto

GIOGer (Gruppo Italiano di Oncologia Geriatrica), Medical

Department, Novi Ligure, Italia

As pointed out by several epidemiological studies, cancer

incidence increases with age and the older population is

expected to grow steadily in the incoming decades. In Italy,

with regard to the population over the age of sixty years,

the incidence of cancer exceeds one thousand cases per one