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Abstract：
OBJECTIVE: It is unclear how NCCN guidelines recommend \"supportive care\" and \"best supportive care\" in oncology practice. We examined the usage of \"supportive care\" and \"best supportive care\" in NCCN guidelines and compared between solid tumor and hematologic malignancy guidelines.
METHODS: We reviewed all updated NCCN Guidelines for Treatment of Cancer in October 2019. We documented the frequency of occurrence, definition, and timing of introduction of each term. We compared between solid tumor and hematologic malignancy guidelines.
RESULTS: We identified a total of 37 solid tumor and 16 hematologic guidelines. Thirty-seven (70%) guidelines mentioned \"supportive care\" and 36 (68%) mentioned \"best supportive care.\" Hematologic guidelines were significantly more likely than solid tumor guidelines to use the term \"supportive care\" (median occurrence 19 vs. 2; P = 0.001) and to describe \"supportive care\" as management of cancer-related complications (N = 11/15, 73% vs. N = 2/22, 9%; P < 0.001). Domains of specialist palliative care were infrequently mentioned (N = 10/37, 27%). In contrast, solid tumor guidelines were significantly more likely than hematologic guidelines to mention \"best supportive care\" (median occurrence 6 vs. 0; P = 0.016). This term was rarely defined and mostly used in the advanced disease setting.
CONCLUSIONS: \"Supportive care\" and \"best supportive care\" were frequently used in NCCN guidelines, with significant variations in usage between solid tumor and hematologic oncologists. \"Supportive care\" was mostly limited to management of cancer-related complications and treatment adverse effects in NCCN guidelines, highlighting the need to go beyond the traditional biomedical model to more a patient-centered care model with greater integration of palliative care.
METHODS: We reviewed all updated NCCN Guidelines for Treatment of Cancer in October 2019. We documented the frequency of occurrence, definition, and timing of introduction of each term. We compared between solid tumor and hematologic malignancy guidelines.
RESULTS: We identified a total of 37 solid tumor and 16 hematologic guidelines. Thirty-seven (70%) guidelines mentioned \"supportive care\" and 36 (68%) mentioned \"best supportive care.\" Hematologic guidelines were significantly more likely than solid tumor guidelines to use the term \"supportive care\" (median occurrence 19 vs. 2; P = 0.001) and to describe \"supportive care\" as management of cancer-related complications (N = 11/15, 73% vs. N = 2/22, 9%; P < 0.001). Domains of specialist palliative care were infrequently mentioned (N = 10/37, 27%). In contrast, solid tumor guidelines were significantly more likely than hematologic guidelines to mention \"best supportive care\" (median occurrence 6 vs. 0; P = 0.016). This term was rarely defined and mostly used in the advanced disease setting.
CONCLUSIONS: \"Supportive care\" and \"best supportive care\" were frequently used in NCCN guidelines, with significant variations in usage between solid tumor and hematologic oncologists. \"Supportive care\" was mostly limited to management of cancer-related complications and treatment adverse effects in NCCN guidelines, highlighting the need to go beyond the traditional biomedical model to more a patient-centered care model with greater integration of palliative care.
摘要：
目的：目前尚不清楚NCCN指南如何在肿瘤学实践中推荐“支持治疗”和“最佳支持治疗”。我们检查了NCCN指南中“支持治疗”和“最佳支持治疗”的用法，并比较了实体瘤和血液恶性肿瘤指南。
方法：我们在2019年10月回顾了所有更新的NCCN癌症治疗指南。我们记录了发生的频率，定义,以及每个术语的引入时间。我们比较了实体瘤和血液恶性肿瘤指南。
结果：我们共确定了37个实体瘤和16个血液学指南。37（70％）指南提到“支持性护理”，36（68％）提到“最佳支持性护理”。“血液学指南比实体瘤指南更有可能使用术语“支持性护理”(中位发生率19vs.2；P=0.001），并将“支持性护理”描述为癌症相关并发症的管理（N=11/15，73%vs.N=2/22，9%；P<0.001）。很少提及专科姑息治疗领域（N=10/37，27％）。相比之下,实体瘤指南比血液学指南更有可能提到“最佳支持治疗”(中位发生率6vs.0；P=0.016）。这个术语很少定义，主要用于晚期疾病。
结论：“支持性护理”和“最佳支持性护理”在NCCN指南中经常使用，实体瘤和血液肿瘤学家之间的用法存在显着差异。在NCCN指南中，“支持性护理”主要限于癌症相关并发症和治疗不良反应的管理。强调需要超越传统的生物医学模式，更多的以患者为中心的护理模式，更多的整合姑息治疗。
方法：我们在2019年10月回顾了所有更新的NCCN癌症治疗指南。我们记录了发生的频率，定义,以及每个术语的引入时间。我们比较了实体瘤和血液恶性肿瘤指南。
结果：我们共确定了37个实体瘤和16个血液学指南。37（70％）指南提到“支持性护理”，36（68％）提到“最佳支持性护理”。“血液学指南比实体瘤指南更有可能使用术语“支持性护理”(中位发生率19vs.2；P=0.001），并将“支持性护理”描述为癌症相关并发症的管理（N=11/15，73%vs.N=2/22，9%；P<0.001）。很少提及专科姑息治疗领域（N=10/37，27％）。相比之下,实体瘤指南比血液学指南更有可能提到“最佳支持治疗”(中位发生率6vs.0；P=0.016）。这个术语很少定义，主要用于晚期疾病。
结论：“支持性护理”和“最佳支持性护理”在NCCN指南中经常使用，实体瘤和血液肿瘤学家之间的用法存在显着差异。在NCCN指南中，“支持性护理”主要限于癌症相关并发症和治疗不良反应的管理。强调需要超越传统的生物医学模式，更多的以患者为中心的护理模式，更多的整合姑息治疗。
