Abstract 2635: Contemporary clinical practice guidelines for the management of glioblastoma: an international survey
Authors: McLean Aaron Lawson , Walter Jan 
Published: July 2021

Abstract
Introduction: Clinical practice guidelines are systematically developed statements to assist clinician and patient decisions about appropriate healthcare for specific clinical circumstances. In some cases, guidelines are utilized by health policymakers and insurers in determining coverage and reimbursement policies. Little is known about the global status of guideline development and implementation for the management of glioblastoma multiforme (GBM) or about the incorporation of novel therapies such as tumor treating fields (TTFields) into these guidelines.
Methods: A comprehensive systematic review of published guidelines and consensus statements from national and international bodies such as health ministries and specialty societies, covering North, Central and South America, Europe, the Middle East, Africa and the Asia-Pacific region was performed. In addition, key stakeholders were surveyed to identify country-specific guidance and practice patterns, with a specific focus on guideline contemporariness and reference to TTFields.
Results: The vast majority of countries worldwide do not have national guidelines for GBM management. Three multinational guidelines were identified, from SNO/EANO, ESMO and Germany-Austria-Switzerland. In addition, 18 national guidelines from 16 countries were identified, with some countries having multiple national guidelines in place (USA, Germany, Brazil). In over half of cases, the national guidelines had not been updated within the past three years. 10/18 national guidelines and 2/3 multinational guidelines mentioned TTFields. A minority of guidelines had an explicit expiry or revision date.
Conclusions: An array of consensus guidelines and recommendations have been published to facilitate clinical decision-making in GBM. However, substantive differences exist between these guidelines regarding their contemporariness and revision process. Three years after the publication of a seminal randomized controlled trial (Stupp et al., 2017) attesting to the efficacy of TTFields in newly diagnosed GBM, little over half of published national guidelines mention the therapy, let alone recommend it. While guidelines naturally reflect local clinical, administrative and health-economic concerns, unwarranted variation in the production, quality, content and implementation of guidelines has potential implications for the quality of care. Ideally, guidelines should be updated dynamically when new evidence indicates a need for a substantive change in the guideline based on a priori criteria. An ongoing revision process for guidelines, perhaps with shorter validity periods or a more flexible approach, may facilitate more expedient adoption of novel therapies in clinical practice guidelines and in practice.
Citation Format: Aaron Lawson McLean, Jan Walter. Contemporary clinical practice guidelines for the management of glioblastoma: an international survey [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2635.