National Comprehensive Cancer Network

About NCCN

NCCN Publishes a Resource-Stratified Framework of Clinical Practice Guidelines for Multiple Indications

The National Comprehensive Cancer Network® (NCCN®) has published the NCCN Framework for Resource Stratification of NCCN Guidelines (NCCN Framework™) for Cervical Cancer and the preliminary versions of Breast Cancer and Hepatobiliary Carcinoma (including Gall Bladder Cancer).

The NCCN Framework™ guides evidence-based adaptation to available clinical treatment resources. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) are used widely around the world, including in a number of low and middle income countries (LMICs) where certain diagnostic tests and/or treatment approaches may be unavailable. The goal of the NCCN Framework™ is to define appropriate treatment pathways at four resource levels—Basic, Limited, Enhanced, and Maximal—and deliver a tool for health care providers to identify treatment options that will provide the best possible outcomes given specific resource constraints.

“NCCN is presenting a framework to help health care planners prioritize their use of cancer treatment resources in limited resource settings, and assist policy makers in outlining cancer control plans that are data-driven, evidence-based blueprints for action. As such, the NCCN Framework furthers NCCN’s mission to improve the lives of people with cancer around the globe,” said Benjamin O. Anderson, MD, University of Washington Professor of Surgery and Global Health Medicine at the Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, and Chair of the NCCN International Program Committee.

The NCCN Framework™ outlines a rational approach for building cancer management systems to provide the highest achievable level of care for stage-specific cancers by applying available or attainable tests and treatments. In addition, the NCCN Framework™ can be used to define strategic pathways for growth by illustrating how new resources or tools introduced in a stepwise fashion can optimally improve on current best practice models and cancer outcomes.

The four levels of NCCN Framework™ resources are defined as:

  • Basic: Essential services needed to provide basic minimal standard of care
  • Limited: Services that provide major improvements in disease outcomes, e.g. survival, that are not cost prohibitive
  • Enhanced: Services that provide lesser improvements in disease outcomes, or services that provide major improvements in disease outcomes but are cost prohibitive at lower resource levels
  • Maximal: Services that do not provide improvement in disease outcomes but are desirable services, or services that provide minor improvements in disease outcomes but are cost prohibitive in lower resource levels

NCCN believes that if higher-level resources are available, providers should use the higher level. If basic level cancer treatments or higher are unavailable, palliative and best supportive care should be provided.

NCCN develops and maintains 61 NCCN Guidelines for cancer prevention, detection, treatment, and supportive care, as well as more than 70 translations of NCCN Content in 12 languages and several international adaptations that allow for consideration of biologic differences in populations, local accessibility, and regulatory status of interventions used in specific global regions.

The NCCN Framework™ for Cervical Cancer and the preliminary versions of Breast and Hepatobiliary cancers are available at