Guía de atención integral con evaluación económica para la prevención, el diagnóstico, el tratamiento y el seguimiento del cáncer de piel no melanoma: carcinoma escamocelular.

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Artículo de investigación
Rev Asoc Colomb Dermatol. 2015; 23: 3 (Julio-Septiembre), 189-215

Guía de atención integral con evaluación económica para la prevención, el diagnóstico, el tratamiento y el seguimiento del cáncer de piel no melanoma: carcinoma escamocelular.

Comprehensive Guide, with economic assessment, for the prevention, diagnosis, treatment and monitoring of non melanoma skin cancer: squamous cell carcinoma
Autor(es): 
Álvaro Acosta
aeacostam@unal.edu.co
Médico dermatólogo oncólogo; coordinador, Dermatología Oncológica, Instituto Nacional de Cancerología; profesor titular, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
Xavier Rueda
Médico dermatólogo oncólogo, Instituto Nacional de Cancerología Bogotá, D.C., Colombia
Guillermo Sánchez
Médico, especialista en Epidemiología General, magíster en Epidemiología Clínica, doctor en Salud Pública, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
Ingrid Arévalo
Médica, magíster en Epidemiología Clínica y PhD (c) en Medicina Preventiva y Salud Pública, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
Hugo Eduardo Herrera
Médico dermatólogo, Asociación Colombiana de Dermatología y Cirugía Dermatológica y Universidad El Bosque, Bogotá, D.C., Colombia
Ana Francisca Ramírez
Médica dermatóloga, especialista en Dermatología Oncológica, Asociación Colombiana de Dermatología y Cirugía Dermatológica, Bogotá, D.C., Colombia
Guillermo Jiménez
Médico dermatólogo, especialista en Dermatología Oncológica y Cirugía Dermatológica, Asociación Colombiana de Dermatología y Cirugía Dermatológica, Bogotá, D.C., Colombia
Omar Darío Segura
Médico, magíster en Epidemiología Clínica, Epidemiólogo de Campo, PhD (c) en Salud Pública, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
Magda Cepeda
Médica, magíster en Epidemiología Clínica, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
Andrea Esperanza Rodríguez
Médica, especialista en Estadística Aplicada, magíster en Epidemiología Clínica, Fundación Universitaria de Ciencias de la Salud, Bogotá, D.C., Colombia
John Alexander Nova
Médico dermatólogo, magíster en Epidemiología Clínica, Centro Dermatológico Federico Lleras Acosta Bogotá, D.C., Colombia
Martha Cecilia Valbuena
Médica, especialista en Dermatología y Fotodermatología, Centro Dermatológico Federico Lleras Acosta, Bogotá, D.C., Colombia
Resumen: 

Objetivo: Generar recomendaciones para la prevención, el diagnóstico, el tratamiento y el seguimiento del cáncer de piel no melanoma: carcinoma escamocelular, con el fin de apoyar al personal de salud en los diferentes servicios encargados de la atención de los pacientes con esta enfermedad, buscando garantizar una atención integral, homogénea, con calidad, equidad y eficiencia; además, generar indicadores de seguimiento a las recomendaciones de la guía, acordes con el contexto nacional. Materiales y métodos: Se conformó el Grupo Desarrollador de la Guía con un grupo interdisciplinario de profesionales y representantes de los pacientes. Se establecieron el alcance, los objetivos, las preguntas y los resultados de la guía. Se hizo una búsqueda de guías sobre manejo de carcinoma escamocelular, pero ninguna de las guías encontradas podía adaptarse, por lo que se decidió desarrollar una nueva guía. Se hizo una búsqueda bibliográfica de revisiones sistemáticas, metaanálisis, ensayos clínicos, estudios de cohorte, y estudios de casos y controles, en las bases de datos Medline (vía Pubmed y Ovid), Embase y Central (vía Ovid). Se evaluó la calidad metodológica de los artículos seleccionados. Posteriormente, se elaboraron las tablas de evidencia por medio del software GRADEpro® 3.6 y se generaron las recomendaciones bajo la metodología GRADE mediante consensos de expertos. Resultados: Se presentan las recomendaciones de prevención primaria, prevención secundaria, tratamiento (quirúrgico y no quirúrgico) y seguimiento del carcinoma escamocelular. Además, se presentan varias preguntas generales que sirven al lector para contextualizarse en el tema de la guía de práctica clínica, pero que no generan recomendaciones. Conclusiones: Se considera que las recomendaciones relacionadas con prevención son prioritarias en el proceso de implementación de la guía. Se presentan cuatro indicadores de auditoría para la guía de práctica clínica, relacionados con prevención, diagnóstico y tratamiento.

Palabras clave: 
Guía; Carcinoma de Células Escamosas; Neoplasias Cutáneas.

Summary: 

Objective: To generate recommendations for the prevention, diagnosis, treatment and follow-up for the non-melanoma squamous cell carcinoma with the aim of providing support for the health professionals in the different services in charge of its attention, looking to guarantee integral, homogeneous attention, with quality, equity and efficiency for the patients with this pathology; as well as generating follow-up indicators to the guide’s recommendation in accordance with the national context. Materials and methods: The Guide Development Group (GDG) was formed by an interdisciplinary group of professionals and patient representatives. Reach, objectives, questions, and outcomes for the guide were defined. A guide search about handling squamous cell carcinoma was performed, but none of the guides found was found to be adaptable, therefore writing a guide de novo was decided. A literature search was performed, including systematic reviews-meta-analyses, clinical trials, cohort studies, and case-control studies in the Medline (via Pubmed and Ovid), Embase and Central (via Ovid) databases. The methodological quality of the selected articles was evaluated. Subsequently, evidence tables were made through the GRADEpro® 3.6 software and recommendations were generated under the GRADE technology through experts’ consensus. Results:  Primary prevention, secondary prevention, treatment (surgical and non-surgical) as well as squamous cell carcinoma follow-up recommendations are presented. Additionally, several general questions are presented which serve the reader to be contextualized in the subject of CPG, but which do not generate recommendations. Conclusions: It is considered that the recommendations relating to prevention are a priority in the guide’s implementation process. Four auditing indicators for the CPG are presented relating to prevention, diagnosis, and treatment.

Key words: 
Guideline; Carcinoma, Squamous Cell; Skin Neoplasm
PDF del articulo

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  • ISDIN
  • GALDERMA