Aim: To describe the process of co-designing resource-appropriate local cancer guidelines in the Solomon Islands, focusing on breast cancer management.
Methods: The process began with an initial draft, termed Prototype 1, developed by local and Australian experts, followed by a rapid literature review concentrating on existing and resource-adapted guidelines. The American Society of Clinical Oncology (ASCO) guidelines were chosen as the preferred template due to their broad applicability. A stakeholder consultation was conducted involving a local breast surgeon and oncologist, alongside content experts from Australia, to ensure the guidelines were contextually appropriate. Feedback from these consultations informed the development of Prototype 2. These revised guidelines will be pilot-tested in real-world settings within the Solomon Islands before requiring endorsement from relevant authorities, marking the completion of the development cycle.
Results: Existing guidelines offer broad guidance but necessitate local adaptation. Developing resource-appropriate guidelines involves more than adjusting for drug availability. The risks and benefits of treatment are heavily influenced by contextual factors, such as the availability of radiotherapy and supportive care for managing treatment toxicities. Standard practices, such as neoadjuvant chemotherapy, may not yield the same benefits in different contexts. Current guidelines often overlook person-cantered variables like access to care, and both direct and indirect costs, including opportunity costs. A significant advantage of the co-development process is the mutual and bidirectional learning it facilitates.
Conclusion: Developing resource-adapted cancer guidelines is crucial for promoting quality cancer care in low-resource settings. Each country's context is unique, necessitating a collaborative development process. Participation in guideline development allows COSA members to contribute to the global effort to improve cancer control.