Guideline Title
Glioblastoma.
Bibliographic Source(s)
Guideline Status
This is the current release of the guideline. This guideline updates a previous version: Alberta Provincial CNS Tumour Team. Glioblastoma. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2010 Feb. 14 p. (Clinical practice guideline; no. CNS-001). |
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Scope
Disease/Condition(s)
Glioblastoma
Guideline Category
Management
Treatment
Clinical Specialty
Geriatrics
Neurological Surgery Neurology Oncology Radiation Oncology
Intended Users
Advanced Practice Nurses
Physician Assistants Physicians
Guideline Objective(s)
To develop an updated, evidence-based guideline for the management of patients with glioblastoma
Target Population
Adults over the age of 18 years with glioblastoma Note: Different principles may apply to pediatric patients.
Interventions and Practices Considered
Major Outcomes Considered
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Methodology
Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources) Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence
Research Questions Specific research questions to be addressed by the guideline document were formulated by the guideline lead(s) and Knowledge Management (KM) Specialist using the PICO question format (Patient or Population, Intervention, Comparisons, Outcomes). Guideline Questions
Search Strategy Medical journals were searched using the Medline (1950 to December Week 4, 2012), EMBASE (1980 to December Week 4, 212) Cochrane Database of Systematic Reviews (4th Quarter, 2012), and PubMed databases. The search terms included: Glioblastoma [MeSH heading], Glioma [MeSH heading], Brain Neoplasms [MeSH heading], Astrocytoma [MeSH heading], high-grade gliomas, anaplastic gliomas, practice guidelines, systematic reviews, meta-analyses, randomized controlled trials, and clinical trials. The references and bibliographies of articles identified through these searches were scanned for additional sources. Articles were excluded from the review if they: had a non-English abstract, were not available through the library system, were case studies involving less than 10 patients, involved pediatric patients, involved anaplastic astrocytomas or anaplastic oligodendrogliomas as the only high-grade gliomas, or were published prior to the year 2000. All retrieved articles were graded using the criteria outlined by Lau et al. A search for new or updated clinical practice guidelines published from January 2000 to July 2012 was also conducted, and yielded 9 published guidelines by the following organizations: Cancer Care Ontario (CCO), the British Columbia Cancer Agency (BCCA), Cancer Care Nova Scotia (CCNS), the National Comprehensive Cancer Network (NCCN), the National Cancer Institute (NCI), the National Institute for Health and Clinical Excellence (NICE), the Australian Cancer Network, the European Society for Medical Oncology (ESMO), and the Canadian GBM Recommendations Committee.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review of Published Meta-Analyses
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence
Evidence was selected and reviewed by a working group comprised of members from the Alberta Provincial CNS Tumour Team and a Knowledge Management (KM) Specialist from the Guideline Utilization Resource Unit (GURU). A detailed description of the methodology followed during the guideline development process can be found in the Guideline Utilization Resource Unit Handbook (see the "Availability of Companion Documents" field). Evidence Tables Evidence tables containing the first author, year of publication, patient group/stage of disease, methodology, and main outcomes of interest are assembled using the studies identified in the literature search. Existing guidelines on the topic are assessed by the KM Specialist using portions of the Appraisal of Guidelines Research and Evaluation (AGREE) II instrument (http://www.agreetrust.org ) and those meeting the minimum requirements are included in the evidence document. Due to limited resources, GURU does not regularly employ the use of multiple reviewers to rank the level of evidence; rather, the methodology portion of the evidence table contains the pertinent information required for the reader to judge for himself the quality of the studies.
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Formulating Recommendations The working group members formulated the guideline recommendations based on the evidence synthesized by the Knowledge Management (KM) Specialist during the planning process, blended with expert clinical interpretation of the evidence. As detailed in the Guideline Utilization Resource Unit Handbook (see the "Availability of Companion Documents" field), the working group members may decide to adopt the recommendations of another institution without any revisions, adapt the recommendations of another institution or institutions to better reflect local practices, or develop their own set of recommendations by adapting some, but not all, recommendations from different guidelines. The degree to which a recommendation is based on expert opinion of the working group and/or the Provincial Tumour Team members is explicitly stated in the guideline recommendations. Similar to the American Society of Clinical Oncology (ASCO) methodology for formulating guideline recommendations, the Guideline Utilization Resource Unit (GURU) does not use formal rating schemes for describing the strength of the recommendations, but rather describes, in conventional and explicit language, the type and quality of the research and existing guidelines that were taken into consideration when formulating the recommendations.
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published analyses were not reviewed.
Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation
This guideline was reviewed and endorsed by the Alberta Provincial CNS Tumour Team. When the draft guideline document has been completed, revised, and reviewed by the Knowledge Management (KM) Specialist and the working group members, it is sent to all members of the Provincial Tumour Team for review and comment. This step ensures that those intended to use the guideline have the opportunity to review the document and identify potential difficulties for implementation before the guideline is finalized. Depending on the size of the document, and the number of people it is sent to for review, a deadline of one to two weeks will usually be given to submit any feedback. Ideally, this review will occur prior to the annual Provincial Tumour Team meeting, and a discussion of the proposed edits will take place at the meeting. The working group members will then make final revisions to the document based on the received feedback, as appropriate. Once the guideline is finalized, it will be officially endorsed by the Provincial Tumour Team Lead and the Executive Director of Provincial Tumour Programs. |
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Recommendations
Major Recommendations
The Alberta Provincial Central Nervous System (CNS) Tumour Team uses the classification system of the World Health Organization (WHO) to describe CNS tumours, which is based on histologic features of the tumour. Table 1 in the original guideline document outlines the grades and histologic characteristics.
Clinical Algorithm(s)
None provided |
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Evidence Supporting the Recommendations
Type of Evidence Supporting the Recommendations
The type of evidence supporting the recommendations is not specifically stated. |
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Benefits/Harms of Implementing the Guideline Recommendations
Potential Benefits
Appropriate management for patients with glioblastoma to improve outcomes and decrease the adverse effects of treatment
Potential Harms
Toxicity of treatment, including hematologic toxicity |
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Qualifying Statements
Qualifying Statements
The recommendations contained in this guideline are a consensus of the Alberta Provincial CNS Tumour Team and are a synthesis of currently accepted approaches to management, derived from a review of relevant scientific literature. Clinicians applying these guidelines should, in consultation with the patient, use independent medical judgment in the context of individual clinical circumstances to direct care. |
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Implementation of the Guideline
Description of Implementation Strategy
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Institute of Medicine (IOM) National Healthcare Quality Report Categories
IOM Care Need
End of Life Care
Getting Better Living with Illness
IOM Domain
Effectiveness
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Identifying Information and Availability
Bibliographic Source(s)
Adaptation
Not applicable: The guideline was not adapted from another source.
Date Released
2010 Feb (revised 2012 Sep)
Guideline Developer(s)
CancerControl Alberta - State/Local Government Agency [Non-U.S.]
Source(s) of Funding
CancerControl Alberta There was no direct industry involvement in the development or dissemination of this guideline.
Guideline Committee
Alberta Provincial CNS Tumour Team
Composition of Group That Authored the Guideline
Members of the Alberta Provincial CNS Tumour Team include medical oncologists, radiation oncologists, neurosurgeons, neurologists, nurses, neuropathologists, and pharmacists.
Financial Disclosures/Conflicts of Interest
Participation of members of the Alberta Provincial CNS Tumour Team in the development of this guideline has been voluntary and the authors have not been remunerated for their contributions. CancerControl Alberta recognizes that although industry support of research, education and other areas is necessary in order to advance patient care, such support may lead to potential conflicts of interest. Some members of the Alberta Provincial CNS Tumour Team are involved in research funded by industry or have other such potential conflicts of interest. However the developers of this guideline are satisfied it was developed in an unbiased manner.
Guideline Status
This is the current release of the guideline. This guideline updates a previous version: Alberta Provincial CNS Tumour Team. Glioblastoma. Edmonton (Alberta): Alberta Health Services, Cancer Care; 2010 Feb. 14 p. (Clinical practice guideline; no. CNS-001).
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the Alberta Health Services Web site .
Availability of Companion Documents
The following is available:
Patient Resources
None available
NGC Status
This NGC summary was completed by ECRI Institute on February 10, 2012. The information was verified by the guideline developer on March 30, 2012. This summary was updated by ECRI Institute on April 28, 2014. The updated information was verified by the guideline developer on May 22, 2014.
Copyright Statement
This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. |
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Disclaimer
NGC Disclaimer
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