Oral Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Implementation of an international guideline to effect clinical practice change (126156)

Liesel Byrne 1 , Julia Shingleton 1 , Aisling Kelly 1 , Cynthia Lean 1 , Shelley Rushton 1
  1. eviQ, Cancer Institute NSW, Sydney, NEW SOUTH WALES, Australia

Background 

The International Guideline for Anticancer Drug Dosing in Kidney Dysfunction (ADDIKD), developed by the Cancer Institute NSW, was published on eviQ in October 2022. eviQ, a program of the Cancer Institute NSW providing evidence-based, peer reviewed cancer treatment protocols and information, sought to drive the uptake of the key ADDIKD recommendations and effect clinical practice change, by incorporating the recommendations into over 700 drug treatment protocols and related content. 

 

Methods 

Implementation leveraged the eviQ reference committee model through 14 tumour specific ADDIKD meetings in 2023–2024. Over 100 expert cancer clinicians across Australia were engaged to review, discuss and approve adaptations of the ADDIKD recommendations into the eviQ drug treatment protocols. Under eviQ’s governance, each protocol was reviewed with the following considerations: 

  • indication/tumour type 
  • treatment intent (curative vs non-curative) 
  • patient population and ECOG status 
  • drug combinations and cumulative nephrotoxicity 

Following committee approval, protocols were systematically updated across the eviQ website. 

 

Impact on practice 

The ADDIKD guideline recommends assessing kidney function and the dosing of 59 anticancer drugs based on estimated Glomerular Filtration Rate (eGFR) via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation instead of using creatinine clearance via the Cockcroft-Gault equation. These are significant practice changes, requiring the employment of change management principles. Extensive communication and education were provided to support eviQ users, including a dedicated ADDIKD webpage, online education modules and quizzes, videos, timelines, and new eGFR and carboplatin dose calculators. The eviQ team presented at conferences and cancer centres, posted on social media, conducted webinars, and sent regular newsletters and emails.  

 

Discussion 

Implementing an international guideline into clinical practice is a complex multi-faceted process. Success depends on change management principles and a comprehensive education and communication strategy to ensure clinicians are informed, supported, and confident in adopting new dosing practices.