FACULTY OF MEDICINE

The use of Cochrane breast cancer reviews by guideline developers and Cochrane (public) users

Cochrane Breast Cancer Group, NHMRC Clinical Trials CentreML Willson, D O’Connell, A Goodwin, N Wilcken

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Setting the scene

› A scoping exercise

› Increasing volume of trial data available (Bastian et al, PLoS Medicine 2010)

› Utility of systematic reviews:

- can guide treatment decisions

- part of the research evidence component of clinical practice guidelines

› Aim:

- assess Cochrane review usage by clinical guidelines and our readers

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Cochrane Breast Cancer Group: producers of Cochrane (systematic) Reviews

› Established in 1996

› Search for evidence, evaluate its quality and publish results as Cochrane Reviews

› Published in an online database and available via The Cochrane Library

› Reviews known to be methodologically rigorous

› Over 88 Protocols, Reviews and Titles

› Sometimes integrated into clinical practice guidelines

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Cochrane Breast Cancer Group: Review portfolio

› Topics are decided upon by an international, multidisciplinary Editorial Board

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Cochrane Breast Cancer Group: metrics

› Publishers provided a short list of 8 ‘most cited’ + top 10 ‘most accessed’

› 13 of the 18 ‘most cited/accessed’ Review topics covered:

- Prevention, early detection, familial breast cancer, allied health (ie exercise), psychosocial care, complementary therapy, lymphoedema

› 5 of the 18 covered treatments

- Chemo- and targeted therapy, radiation and surgery

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Specific aims

1. Assess the uptake of Cochrane breast cancer Reviews in clinical practice guidelines

2. Compare ‘most cited/accessed’ Reviews to those used in guidelines

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Methods: guideline selection & basic metrics

› Selected 7 key clinical guideline developers or consensus panels:

1. Advanced Breast Cancer Consensus (ABC1)

2. American Society of Clinical Oncology (ASCO)

3. Cancer Australia (CA)

4. Central European Cooperative Oncology Group (CECOG)

5. European Society for Medical Oncology (ESMO)

6. National Institute for Health and Care Excellence (NICE)

7. Scottish Intercollegiate Guideline Network (SIGN)

› Published from 2001 to March 2014

› For each guideline, recorded:

1. Number and title of Cochrane Review citations

2. Scope of guideline

› Categorised Cochrane Review usage for each guideline developer

› Compared Reviews in guidelines to ‘most cited/accessed’ Reviews

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Results: no. and scope of guidelines

› 28 guidelines included, published July 2001 to July 2013

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Results: Cochrane Review usage

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Results: Cochrane Review usage over time

Cumulative no. of guidelines + Cochrane Reviews in guidelines

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Results: most cited/accessed in guidelines

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Results: summary

1. An increase in Cochrane review uptake in guidelines over time

- Variation in Cochrane review citations by guideline developers

2. An overlap with Reviews used in guidelines and ‘most cited/accessed’ Reviews

- 10 of 18 ‘most cited/accessed’ Reviews were used once or more than once

3. Slight disconnect

- 8 of 18 ‘most cited/accessed’ Reviews were not used

- i.e. peripheral topics

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Limits, discussion, future implications

› A preliminary assessment; small sample (n=28)

› Room to improve communications with guideline developers about upcoming guideline topics

› Identified some gaps in our Topics list that will need to be addressed

› ‘Most cited/read’ reviews tended to be on peripheral topics (e.g. exercise)

› Results provide a useful baseline for monitoring the use of our Cochrane reviews

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Acknowledgements

› A/Prof Nicholas Wilcken (Joint Co-ordinating Editor)

› Dr Annabel Goodwin (Joint Co-ordinating Editor)

› Prof Dianne O’Connell (Statistical Editor)

› Cochrane Breast Cancer Group funders:

- National Health and Medical Research Council (NHMRC)

- National Breast Cancer Foundation (Australia)

› Supported by:

- NHMRC Clinical Trials Centre, University of Sydney

Backup slides