Project Overview

This project titled Mapping the Evidence for the World Health Organization (WHO) Classification of Tumours: a Living Evidence Gap Map by Tumour Type (WCT EVI MAP), led by researchers of the WHO Classification of Tumours (WCT) programme at the International Agency for Research on Cancer (IARC), has received a grant of €3.5 million from the European Commission and has been developed under the umbrella of the International Collaboration for Cancer Classification and Research (IC³R).

This 4-year project, which is being undertaken in collaboration with six other international institutions, was launched on 1 July 2022.

The principal aim of the WCT EVI MAP project is to synthesize the existing evidence on cancer classification research to produce evidence gap maps (EGMs) for all known tumour types. These EGMs will make all the available evidence accessible, to inform the WHO Classification of Tumours, guide research efforts in all relevant fields of cancer research, and improve evidence-based practices within the broad community of scientists, clinicians, and decision-makers. This mapping exercise will emphasize existing evidence gaps and identify pockets of low-level evidence, as well as the overall quality level of the existing evidence. The final deliverable will be an open-access online tool that displays the results in an interactive way, enabling users to filter information tailored to their needs.

Improving cancer classification has a crucial impact on patient care, diagnosis, and treatment by informing decision-making processes with the best available evidence. By adapting the EGM methodology to the biomedical field, the WCT EVI MAP project is expected to promote the application of higher research standards in the field and to inspire researchers from other areas of public health to undertake similar projects.

Funded by the European Union
HORIZON Grant No. 101057127 

The WHO Classification of Tumours (WCT) underpins cancer diagnosis, and hence treatment and care of patients with cancer, as well as research on cancer epidemiology, prevention, diagnosis, and treatment. However, decisions for such a global reference tool are not always informed by the best available evidence, and risks exist of incorporating misinformation into the clinical decision pathway.

The aim of the Mapping the Evidence for the WCT: a Living Evidence Gap Map by Tumour Type (WCT EVI MAP) project is to develop a tool that maps the existing evidence, to synthesize it, show gaps within it, appraise its quality level, and identify pockets of low-level evidence. The resulting maps of reliable evidence will become the basis for the WCT, to facilitate evidence-based decision-making in pathology and to promote the application of higher research standards in the field. This project will adapt the recently developed evidence gap map (EGM) methodology, to use it for the first time ever in biomedicine (see an example of an EGM created by UNICEF in collaboration with EPPI-Reviewer on Child and adolescent mental health and psychosocial support interventions). The resulting EGMs will increase the discoverability and use of studies by the WCT decision-makers, commissioners of research, researchers, and others.

The WCT EVI MAP project is organized in three phases, in which a stepwise approach will be applied to (1) develop a framework and define levels of evidence based on expert consensus, (2) produce a series of EGMs in iterative cycles, describing the evidence for all tumour types, and (3) perform a descriptive analysis of the use of evidence in a continuously updated exercise.

The WCT EVI MAP project is expected to result in ground-breaking advances for the WCT and research in the field and to accelerate progress in cancer diagnosis and management. Integration of methods of evidence-based medicine has been shown to have a positive impact in other specialized medical fields, and this project is a first step towards evidence-based pathology.

Three main project phases

Background

Evidence-based medicine (EBM) has helped the medical community, researchers, decision-makers, and patients themselves to improve patient care, with special attention to treatment, diagnosis, and prognosis. The WHO Classification of Tumours series, also known as the WHO Blue Books, plays a key role in bringing together global knowledge and expertise on all aspects of tumour classification. In recent decades, the steadily increasing amount and complexity of the information and knowledge incorporated in the WHO Blue Books has made the series increasingly difficult to manage within the classic EBM framework, and the lack of specific pathology-based criteria makes it challenging to evaluate the quality of the evidence available. In addition, research efforts are not evenly distributed, resulting in gaps in the available evidence. The WCT EVI MAP project aims to uncover these pockets of low-level evidence, or no evidence at all, by applying the methodology of evidence gap mapping (using systematic reviews) and developing specific criteria to evaluate the quality of evidence in pathology (evidence-based pathology).

Strategic planning

The first year of the project will be dedicated to the training of team members on evidence gap mapping methods and the development of the levels of evidence via a Delphi study; an open-source solution will be developed for all the partners to work with, and a final evidence gap mapping framework and set of standard operating procedures (SOPs) will be delivered.

Applied modified e-Delphi study method

During years 2 and 3, the actual mapping for the WHO Classification of Tumours will be conducted simultaneously by all partners, depending on their expertise. In the final year, a living tool that gathers the results of all the evidence gap mapping into megamaps will lead to a database that will be available to any researcher, patient, physician, or decision-maker and will be used to inform decisions about patients’ needs, future research, and policies. The tool is expected to be maintained and regularly updated along with the sixth edition of the WHO Blue Books and will serve as a reference for cancer classification and research worldwide.

Seven key areas