NCCN at 20: Forward Momentum
Authors: Robert W. Carlson
Journal: Journal of the National Comprehensive Cancer Network (2015)

NCCN completes its 20th year with a remarkable legacy of success and substantial forward momentum. The successes have been well outlined in the past year’s “NCCN Anniversary Reflections,” in JNCCN and include growth from a small, little-known alliance of 13 academic cancer centers to a high-visibility, leading alliance of 26 major academic cancer centers. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) began as 10 and have grown to 61. The NCCN Guidelines are the most widely used clinical practice guidelines in oncology, and arguably within any area of medicine. The use of the guidelines has expanded beyond the United States, with more than 36% of the more than 6 million yearly NCCN Guidelines downloads coming from outside the United States. NCCN has tremendous influence among payers in terms of oncology coverage decisions by way of both the NCCN Guidelines and the NCCN Drugs & Biologics Compendium. The NCCN has a hugely successful Continuing Education Program, with 195 activities and more than 30,000 participants in 2014. The Oncology Research Program has funded 127 research grants sponsored by more than 15 different companies, offering opportunities for access to new agents for investigators from early career through late career. All of these successes have been possible because of the high quality of our NCCN Member Institutions, the commitment and participation of faculty and staff from our member institutions, and the remarkably committed, superb staff at NCCN headquarters. NCCN has no intention of resting on prior successes, however. Multiple major initiatives are underway to enhance existing programs and to start new programs to further the NCCN mission. In response to stakeholder requests, in October 2015 NCCN released the first NCCN Guidelines with NCCN Evidence Blocks, a system of scoring individual guideline recommendations based on efficacy, safety, data quality, data consistency, and affordability, and to display that information in a graphic format that is efficient to use. The NCCN Evidence Blocks, which provide information on why the experts on a guideline panel have made a specific recommendation, allow for efficient comparison across multiple options of care and provide further transparency for providers, patients, and other users. The use of NCCN Guidelines in lowand middle-resource settings around the world has led to the development of the NCCN Framework for Resource Stratification of the NCCN Guidelines. This framework provides detailed recommendations about the allocation of resources in limited-resource settings so as to maximize the impact of the available interventions and to provide a framework for incrementally improving cancer care, all while maintaining the context of the parent NCCN Guidelines. The first of these frameworks—for cervical cancer—was released in March 2015, and we have reports of how it is already changing the practice of oncology in limited resource settings. Other guidelines-related initiatives include a new Radiation Oncology Compendium and a new Diagnostic Imaging Appropriate Use Criteria, both of which will be released in early 2016. A major ongoing initiative is producing the NCCN Guidelines in a digital database that will allow NCCN content to be efficiently incorporated and used by computer-based systems in ways never before envisioned. The NCCN Continuing Education Program is developing new, innovative ways of providing continuing education across the spectrum of health care professionals, focusing on the specific educational needs of our learners and new ways of learning. In addition to the NCCN Frameworks, the International Program is enhancing existing 2015 th