tailieunhanh - Management of oesophageal and gastric cancer

Although the project did not expect to identify many women with advanced cancer among women 30 to 39 years of age, it was clear that older women with cancer were being identified and that some women with early disease likely would not be able to access treatment services. Clients with cancer or who were unable to travel to Kisumu, Kakamega, or Nairobi for cancer care were referred to palliative care services at the provincial level, usually the Kisumu Hospice. In addition, there was an effort to enhance community-based palliative care services using the CHWs working with MYWO and clinic/hospital-based services. | SI GN Scottish Intercollegiate Guidelines Network NHS Quality Improvement Scotland Management of oesophageal 87 and gastric cancer A national clinical guideline 1 Introduction 1 2 Risk factors and risk factor modification 4 3 Presentation and referral 7 4 Diagnosis 11 5 Assessment and staging 13 6 Treatment principles 18 7 Surgery 20 8 Neoadjuvant and adjuvant therapies 27 9 Non-surgical treatments with curative intent 30 10 Palliative care 32 11 Information for discussion with patients and carers 42 12 Implementation audit and resource implications 46 13 Development of the guideline 50 Abbreviations 53 Annexes 55 References 60 June 2006 COPIES OF ALL SIGN GUIDELINES ARE AVAILABLE ONLINE AT KEY TO EVIDENCE STATEMENTS AND GRADES OF RECOMMENDATIONS LEVELS OF EVIDENCE 1 High quality meta-analyses systematic reviews of randomised controlled trials RCTs or RCTs with a very low risk of bias 1 Well conducted meta-analyses systematic reviews of RCTs or RCTs with a low risk of bias 1 - Meta-analyses systematic reviews of RCTs or RCTs with a high risk of bias 2 High quality systematic reviews of case control or cohort studies High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal 2 - Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3 Non-analytic studies eg case reports case series 4 Expert opinion GRADES OF RECOMMENDATION Note The grade of recommendation relates to the strength of the evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation. At least one meta-analysis systematic review of RCTs or RCT rated as 1 and directly applicable to the target population or A body of evidence consisting .