European clinical practice guidelines on the use of chemotherapy for advanced oesophageal and gastric cancers: a critical review using the AGREE II and the AGREE-REX instruments

Purpose To assess the methodological quality of all relevant and recent European clinical practice guidelines (CPGs) for advanced oesophageal and gastric cancers, and to synthesise their recommendations on the use of chemotherapy. Methods We searched PubMed, EMBASE, guidelines repositories, and other sources from 2010 onwards. We appraised quality using AGREE-II and AGREE-REX. Results 11 CPGs were included (five high, five low, and one moderate quality). Most guidelines showed deficiencies in the domain applicability, with only three scoring above 60%. Nine did not report having sought the views and preferences of the target population. The lowest scores for AGREE-REX were item Values and Preferences of Target Users (1.6; SD 1.3), and item Values and Preferences of Policy/Decision-Makers (1.8; SD 1.7). The domain Clinical Applicability got the highest score and the domain Implementability got the lowest. Conclusions An urgent area of research is how to develop credible and implementable recommendations on the clinical use of CT for advanced oesophageal and gastric cancer. Systematic review registration: PROSPERO (CRD42021236753).

Automated summary

This study aimed to assess the methodological quality of recent clinical practice guidelines for advanced oesophageal and gastric cancers in Europe and synthesize their recommendations on chemotherapy. The results showed deficiencies in the applicability domain of most guidelines, and a lack of consideration for patient views and preferences in some guidelines.