JCO global oncology · 2026
Evidence in National Comprehensive Cancer Network Harmonized Guidelines for Sub-Saharan Africa: A Meta-Research Analysis.
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Swartz Scott J, Spielman Gwynn, Agezew Samrawit, Falade Ayo S, DeBoer Rebecca J, Xu Mary Jue, Makupa Glory F, Eulade Rugengamanzi, Chau Courtney, Jung Da Kyung, Luhar Rohan D, Tewari Pariswi, Mrema Alita, Van Loon Katherine, Buckle Geoffrey C
Аннотация
PURPOSE: The National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for sub-Saharan Africa (SSA) have emerged as leading cancer treatment guidelines in SSA. The objective of this study is to examine the evidence cited in support of the NCCN-SSA guidelines, with a focus on population characteristics and generalizability to SSA.
METHODS: This meta-research analysis included all studies cited in support of treatment and/or management recommendations in the NCCN-SSA guidelines for the nine most common cancers in SSA. Studies were identified by two independent reviewers; duplicate studies, those lacking individual-level data, and those unrelated to treatment and/or management were excluded. Data on the study type, participant demographics (age, sex, race/ethnicity), and recruitment geography were abstracted from each full-text article. Descriptive analyses were performed using R to characterize the study type (eg, experimental, observational), demographics (mean age, percent female/male, percent by race/ethnicity), and geographic representation overall and by individual cancer type.
RESULTS: Overall, 4,589 citations were reviewed and 2,931 (63.9%) studies with individual-level data were included. Of the 2,061 studies reporting geographic information, 50 (2.4%) recruited in SSA; of these, 39 (83.0%) recruited from South Africa. Three studies (0.2%) recruited exclusively in SSA. Most studies (95.3%) recruited exclusively from high- or upper-middle-income countries. Only 29.2% of studies reporting participant race included >10% of Black study participants.
CONCLUSION: Most studies cited in the NCCN-SSA guidelines were conducted in high-income countries outside SSA. A small minority of all study participants were Black. These findings underscore potential limitations in the generalizability of the NCCN-SSA guidelines to SSA and highlight a pressing need to generate and incorporate context-specific data to guide care and inform policy.
METHODS: This meta-research analysis included all studies cited in support of treatment and/or management recommendations in the NCCN-SSA guidelines for the nine most common cancers in SSA. Studies were identified by two independent reviewers; duplicate studies, those lacking individual-level data, and those unrelated to treatment and/or management were excluded. Data on the study type, participant demographics (age, sex, race/ethnicity), and recruitment geography were abstracted from each full-text article. Descriptive analyses were performed using R to characterize the study type (eg, experimental, observational), demographics (mean age, percent female/male, percent by race/ethnicity), and geographic representation overall and by individual cancer type.
RESULTS: Overall, 4,589 citations were reviewed and 2,931 (63.9%) studies with individual-level data were included. Of the 2,061 studies reporting geographic information, 50 (2.4%) recruited in SSA; of these, 39 (83.0%) recruited from South Africa. Three studies (0.2%) recruited exclusively in SSA. Most studies (95.3%) recruited exclusively from high- or upper-middle-income countries. Only 29.2% of studies reporting participant race included >10% of Black study participants.
CONCLUSION: Most studies cited in the NCCN-SSA guidelines were conducted in high-income countries outside SSA. A small minority of all study participants were Black. These findings underscore potential limitations in the generalizability of the NCCN-SSA guidelines to SSA and highlight a pressing need to generate and incorporate context-specific data to guide care and inform policy.