A B S T R A C T S
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
• Articulation of recommendations;
• External review; and
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,
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:
ARE PATIENT REPORTED OUTCOMES PROGRAMMES
ADAPTED TO THE GERIATRIC POPULATION?
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
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,
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:
INTRODUCTION: REPORT FROM THE ITALIAN NETWORK
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