Quality assessment of scientific evidence about diagnosis and treatments for oral cancer
- Autores: Meisser Madera Anaya
- Directores de la Tesis: Gerard Urrútia-Cuchí (dir. tes.), X. Bonfill (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2020
- Idioma: inglés
- Tribunal Calificador de la Tesis: Ignasi Bolíbar (presid.), Juan Erviti López (secret.), Wael Sabbah (voc.)
- Programa de doctorado: Programa de Doctorado en Metodología de la Investigación Biomédica y Salud Pública por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TDX
- Resumen
Oral cancer is considered a public health problem worldwide. It has a 5-year survival rate of 50% due to diagnosis are commonly performed at advanced stage of the disease. Its treatment usually involves a multidisciplinary team to provide comprehensive healthcare to people that suffer from this disease. Nowadays, there is a vast number of scientific publications suggesting the use of different therapeutic interventions and recommendations for its diagnosis, but their quality is unknown. Thus, a critical appraisal of evidence about diagnosis and treatments for oral cancer is needed. Three independent studies were carried out using different methodology designs. In order to describe and assess the quality of scientific evidence on diagnosis and treatments for oral cavity cancer, we designed and conducted: i) an evidence mapping study to describe the available evidence about the main therapeutic interventions for oral cancer; ii) a systematically critical assessment study to determine the quality of clinical practice guidelines on treatments for oral cavity cancer; and iii) a systematically critical assessment study to assess the quality of clinical practice guidelines on oral cancer diagnosis, and to describe their recommendations. The evidence mapping study included 15 systematic reviews involving 118 primary studies, of which 55.1% were randomized controlled clinical trials. Ten systematic reviews scored “critically low” methodological quality. We extracted 30 PICOs focusing on interventions such as surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy; 18 PICOs were for resectable oral cancer, of which 8 were reported as beneficial. There were 12 PICOs for unresectable oral cancer, of which only 2 interventions were reported as beneficial. In the second study, 12 clinical practice guidelines were included. The mean scores for each AGREE II domain were the following: “scope and purpose” 88.4%±12.4%; “stakeholder involvement” 60.4%±25%; “rigor of development” 60.9%±25.3%; “clarity of presentation” 76.5%±19.8%; “applicability” 32.2%±30.7%; and “editorial independence” 61.6%±35.5%. Three guidelines were rated as “recommended”; six as “recommended with modifications”; and three as “not recommended”. In the last study, eight clinical practice guidelines were selected. The median scores of the six AGREE II domains were as follows: “scope and purpose” 97.9% (IQR: 96.2-100.0%); “stakeholder involvement” 86.1% (IQR: 69.8-93.1%); “rigor of development” 75.3% (IQR: 64.2-94.3%); “clarity of presentation” 91.7% (IQR: 82.6-94.4%); “applicability” 53.1% (IQR: 19.3-74.2%); and “editorial independence” 83.3% (IQR: 67.2-93.8%). Four guidelines were assessed as “recommended”, four “recommended with modifications”, and none “not recommended”. Twenty-three recommendations were provided, mostly with a low or very low level of evidence. Overall, the scientific evidence about treatments for oral cancer is limited and its quality is critically low. Likewise, the methodological quality of clinical practice guidelines on diagnosis and treatments for oral cancer was rated from suboptimal to moderate. Moreover, most recommendations were based on a low level of evidence. These findings highlight the need to address future research focused on new treatments and knowledge gaps identified in this field, and increased efforts are required to enable the development of high-quality evidence-based guidelines for oral cancer.
