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Noha Rashad,1 Mohamed Abdulla,2 Mohamed Farouk,3 Yasser Elkerm,4 Salem Eid Salem,5 Maha Yahia,5 Amr S Saad,6 Ahmed Hassan Abdel Aziz,6 Ghada Refaat,6 Ibrahim Awad,7 Maha ElNaggar,8 Khaled Kamal,6 Basel Refky,9 Mohamed Abdelkhalek,9 Ahmed Touny,10 Loay Kassem,2 Emad Shash,5 Abdelhay A Abdelhay,11 Bahaa Eldin Mahmoud,11 Karima Oualla,12 Nesrine Chraiet,13 Hussein AwadElkarim H Maki,14 Yasser Abdel Kader2 1Medical Oncology Department, Faculty of Medicine, Suez University, Suez, Egypt; 2Clinical Oncology and Nuclear Medicine Department, Kasr Al-Aini Medical School, Cairo University, Cairo, Egypt; 3Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 4Department of Cancer Management and Research, Medical Research Institute Hospital, University of Alexandria, Alexandria, Egypt; 5Department of Medical Oncology, National Cancer Institute (NCI), Cairo University, Cairo, Egypt; 6Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 7Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 8Clinical Oncology Department, Assiut University Hospital, Assiut, Egypt; 9Department of Surgical Oncology, Oncology Center Mansoura University, Mansoura, Egypt; 10Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt; 11Department of Diagnostic Radiology, Cairo University, Giza, Egypt; 12Medical Oncology Department, Hassan II University Hospital Sidi Mohamed Ben Abdellah University, Fes, Morocco; 13Medical Oncology Department, Salah Azaiez National Cancer Institute, Tunis, Tunisia; 14Clinical Oncology Department, Ahfad University for Women, Khartoum, SudanCorrespondence: Noha Rashad, Medical Oncology Department, Faculty of Medicine, Suez University, Faisal, Suez Governorate, Egypt, Tel +20 1225157339, Email Noha16880@gmail.comPurpose: Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide and the second cause of cancer related mortality. Treatment options for patients with metastatic CRC (mCRC) expanded during the last two decades, with introduction of new chemotherapeutic and targeted agents. Egypt is a lower middle-income country; Egyptian health care system is fragmented with wide diversity in drug availability and reimbursement policies across different health care providing facilities. We report the results of consensus recommendations for treatment of patients with metastatic colorectal cancer developed by Egyptian Foundation of Medical Sciences (EFMS), aiming to harmonize clinical practice through structured expert consensus-based recommendations consistent with the national status. EFMS recommendations could be utilized in other countries with similar economic status.Methods: EFMS recommendations were developed using a modified Delphi process, with three rounds of voting till the final recommendations were approved. A non-systematic review of literature was conducted before generating the provisional statements. Content experts were asked to vote on some recommendations in two different resource groups (restricted resources and non-restricted resources). External review board of experts from a low income and lower-middle countries voted on the applicability of EFMS recommendations in their countries.Results: The current recommendations highlighted the discrepancy in health care between restricted and non-restricted resources with expected survival loss and quality of life deterioration. Access to targeted agents in first line is very limited in governmental institutions, and no access to agents approved for third line in patients who failed oxaliplatin and irinotecan containing regimens for patients treated in restricted resource settings.Conclusion: Management of mCRC in developing countries is a challenge. The currently available resource-stratified guidelines developed by international cancer societies represent a valuable decision-making tool, adaptation to national status in each country based on healthcare system status is required.Keywords: colorectal cancer CRC, consensus recommendations, metastatic CRC, management in a lower-middle income country |
