journal article·2026-07-30

Quality Assessment of Clinical Practice Guideline Providing Recommendations for Oral Cancer: A Systematic Survey

Katalina Muñoz, Nicolás Portalier, Duniel Ortuño, Naira Figueiredo Deana, Wilfredo Alejandro González-Arriagada, Carlos Zaror

Applied Sciences· Volume 16· Issue 15
Publisher page

Abstract

The aim of this systematic survey was to evaluate the quality of clinical practice guidelines (CPGs) that provide recommendations for the detection, diagnosis, and treatment of oral cavity cancer (OCC). We conducted a systematic search in MEDLINE, EMBASE, Epistemonikos, CPG websites, and scientific societies to identify documents providing recommendations for the detection, diagnosis, and treatment of OCC. Two reviewers independently assessed the included CPGs using the AGREE II instrument. We calculated standardized scores for the six domains and provided a final recommendation for each CPG. We identified twenty-five CPGs published between 2019 and 2024. The mean scores (higher scores indicate better domain assessment) per domain were as follows: scope and purpose, 80.5 ± 11.6%; stakeholder involvement, 55.6 ± 16.7%; rigor of development, 48.3 ± 20.1%; clarity of presentation, 83.8 ± 8.2%; applicability, 33.6 ± 19.1%; and editorial independence, 57.3 ± 22.4%. The overall mean rate was 4.8 ± 0.8, with a maximum score of seven. Reviewers recommended five guidelines for use in practice, twelve were recommended with modifications, and eight were not recommended. The overall quality of CPGs on OCC was suboptimal. CPG developers should strengthen the use of systematic, transparent methodologies and frameworks for evidence synthesis and recommendation formulation, thereby improving the quality of recommendations and facilitating implementation across diverse clinical contexts.
Source: crossref · Quality: baseline

Affiliations

Center for Research in Epidemiology, Economics and Oral Public Health (CIEESPO), Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile

Master Program in Dentistry, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile

Faculty of Dentistry, Universidad de Los Andes, Santiago 7620001, Chile

Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco 4811230, Chile

Doctoral Program in Sciences in Applied Cellular and Molecular Biology, Universidad de La Frontera, Temuco 4811230, Chile

Clínica Universidad de Los Andes, Santiago 7620001, Chile

Funding

University of La Frontera · Universidad de Los Andes

References (63)

Show source-provided references
1. World Health Organizaton (WHO) (2026, February 14). Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030. Available online: https://iris.who.int/server/api/core/bitstreams/0e207c03-376e-447e-8bf4-f8550ca1664e/content.
2. Ferlay, J., Ervik, M., Lam, F., Laversanne, M., Colombet, M., Mery, L., Piñeros, M., Znaor, A., Soerjomataram, I., and Bray, F. (2026). Global Cancer Observatory: Cancer Today, International Agency for Research on Cancer. Available online: https://gco.iarc.who.int/today.
3. Ribeiro-Rotta, R.F., Rosa, E.A., Milani, V., Dias, N.R., Masterson, D., da Silva, E.N., and Zara, A. (2022). The cost of oral cancer: A systematic review. PLoS ONE, 17.10.1371/journal.pone.0266346 ↗
4. Oral health-related quality of life in oral cancer patients: Systematic review and meta-analysis10.2217/fon-2020-0881 ↗
5. Late stage diagnosis of oral cancer: Components and possible solutions10.1016/j.oraloncology.2014.09.005 ↗
6. Pan American Health Organization (2023). Handbook for Adapting and Implementing Evidence-Informed Guidelines, Pan American Health Organization.
7. Guidelines 2.0: Systematic development of a comprehensive checklist for a successful guideline enterprise10.1503/cmaj.131237 ↗
8. Quality assessment of clinical practice guidelines on treatments for oral cancer10.1016/j.ctrv.2018.03.001 ↗
9. Screening and diagnosis of oral cancer: A critical quality appraisal of clinical guidelines10.1007/s00784-018-2668-7 ↗
10. Page, M.J., Shamseer, L., Altman, D.G., Tetzlaff, J., Sampson, M., Tricco, A.C., Catala-Lopez, F., Li, L., Reid, E.K., and Sarkis-Onofre, R. (2016). Epidemiology and Reporting Characteristics of Systematic Reviews of Biomedical Research: A Cross-Sectional Study. PLoS Med., 13.10.1371/journal.pmed.1002028 ↗
11. Trustworthiness of treatment clinical practice guidelines has modestly improved since the introduction of Institute of Medicine standards: A systematic survey10.1016/j.jclinepi.2025.111962 ↗
12. Problems related to the application of guidelines in clinical practice: A critical analysis
13. Quality Appraisal of Clinical Practice Guidelines on Provision of Dental Services during the First Months of the Covid-19 Pandemic10.1016/j.jebdp.2021.101633 ↗
14. Zaror, C., Seiffert, A., Deana, N.F., Espinoza-Espinoza, G., Atala-Acevedo, C., Diaz, R., and Carrasco-Labra, A. (2023). Emergency and sequalae management of traumatic dental injuries: A systematic survey of clinical practice guidelines. BMC Oral Health, 23.10.1186/s12903-023-03409-w ↗
15. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews10.1136/bmj.n71 ↗
16. Modifications to the NEATS instrument for more appropriate and reproducible assessment of guidelines trustworthiness10.1002/gin2.12025 ↗
17. AGREE II: Advancing guideline development, reporting and evaluation in health care10.1503/cmaj.090449 ↗
18. Dental caries prevention in children and adolescents: A systematic quality assessment of clinical practice guidelines10.1007/s00784-018-2405-2 ↗
19. The measurement of observer agreement for categorical data10.2307/2529310 ↗
20. Correlation Coefficients: Appropriate Use and Interpretation10.1213/ANE.0000000000002864 ↗
21. Guidelines for the Surgical Management of Oral Cancer: Korean Society of Thyroid-Head and Neck Surgery10.21053/ceo.2018.01816 ↗
22. Management of Salivary Gland Malignancy: ASCO Guideline10.1200/JCO.21.00449 ↗
23. Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline10.1200/JCO.18.01921 ↗
24. Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head and Neck: ASCO Guideline10.1200/JCO.20.00275 ↗
25. Association of the Scientific Medical Societies (AWMF) (2026, April 30). The German Cancer Society (DKG) and the German Cancer Aid (DKH). Evidence-Based Guideline Oral Cavity Cancer. Available online: https://register.awmf.org/assets/guidelines/007_D_Ges_f_Mund-_Kiefer-_und_Gesichtschirurgie/007-100OLeng_S3_Long_version_oral_cavity_cancer_2021-11-abgelaufen.pdf.
26. Indian clinical practice consensus guidelines for the management of oral cavity cancer10.4103/0019-509X.278975 ↗
27. Surgery of sublingual and minor salivary gland cancer: REFCOR recommendations by the formal consensus method10.1016/j.anorl.2023.11.011 ↗
28. Radiotherapy for salivary gland cancer: REFCOR recommendations by the formal consensus method10.1016/j.anorl.2023.11.006 ↗
29. Radiotherapy for oral cavity cancers10.1016/j.canrad.2021.11.012 ↗
30. NCCN Guidelines(R) Insights: Head and Neck Cancers, Version 1.202210.6004/jnccn.2022.0016 ↗
31. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC)10.1186/s40425-019-0662-5 ↗
32. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition10.1017/S002221512400032X ↗
33. Latin American Consensus on the Treatment of Head and Neck Cancer10.1200/GO.23.00343 ↗
34. Systemic therapies for salivary gland carcinoma (excluding adenoid cystic carcinoma): REFCOR recommendations by the formal consensus method10.1016/j.anorl.2023.11.004 ↗
35. Salivary gland cancer: ESMO-European Reference Network on Rare Adult Solid Cancers (EURACAN) Clinical Practice Guideline for diagnosis, treatment and follow-up10.1016/j.esmoop.2022.100602 ↗
36. Clinical practice guideline of the Spanish society of oral surgery for dental care in patients with oral cancer
37. Oral cavity cancer management guidelines for low-resource regions10.1002/hed.25423 ↗
38. Summary of Japanese clinical practice guidelines for head and neck cancer - 2022 update edited by the Japan society for head and neck cancer10.1016/j.anl.2023.07.003 ↗
39. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up10.1016/j.annonc.2020.07.011 ↗
40. Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer10.1002/hed.25739 ↗
41. Alberta Health Services (2026, April 30). Oral Cavity Cancer. Available online: https://www.albertahealthservices.ca/assets/info/hp/cancer/if-hp-cancer-guide-hn002-oral-cavity.pdf.
42. Salivary gland carcinoma in children and adolescents: The EXPeRT/PARTNER diagnosis and treatment recommendations10.1002/pbc.29058 ↗
43. Recommendations for the use of biomarkers for head and neck cancer, including salivary gland tumours: A consensus of the Spanish Society of Medical Oncology and the Spanish Society of Pathology10.1007/s12094-022-02856-1 ↗
44. SEOM clinical guidelines for the treatment of head and neck cancer (2020)10.1007/s12094-020-02533-1 ↗
45. Brachytherapy in head and neck malignancies: Indian Brachytherapy Society (IBS) recommendations and guidelines10.5114/jcb.2020.100385 ↗
46. Adapting World Health Organization COVID-19 living guidelines balancing methodological rigor with efficiency and flexibility: A case study from Argentina10.1016/j.jclinepi.2025.111823 ↗
47. Quality appraisal of clinical practice guidelines for diabetes mellitus published in China between 2007 and 2017 using the AGREE II instrument10.1136/bmjopen-2018-022392 ↗
48. What information can we gain from the quality appraisal of guidelines with physical activity recommendations for cancer patients?A systematic review using the AGREE II and AGREE-REX tools
49. Zhang, Y., Liu, J., Liu, S., Zhang, Y., Su, X., Huang, S., and Duan, W. (2024). Clinical practice guidelines for the treatment of squamous cell carcinoma of the head and neck: An assessment based on the AGREE II, AGREE-REX tools and the RIGHT checklist. Front. Oncol., 14.10.3389/fonc.2024.1442657 ↗
50. Appraisal of clinical practice guidelines for salivary gland cancer management utilizing AGREE II instrument10.1016/j.amjoto.2024.104285 ↗
51. Review and Evaluation of European National Clinical Practice Guidelines for the Treatment and Management of Active Charcot Neuro-Osteoarthropathy in Diabetes Using the AGREE-II Tool Identifies an Absence of Evidence-Based Recommendations10.1155/2024/7533891 ↗
52. Zhang, M., He, X., Wu, J., and Xie, F. (2023). Differences between physician and patient preferences for cancer treatments: A systematic review. BMC Cancer, 23.10.1186/s12885-023-11598-4 ↗
53. The Effects of Patient Preference on Clinical Outcome, Satisfaction and Adherence Within the Treatment of Anxiety and Depression: A Meta-Analysis10.1002/cpp.2985 ↗
54. Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach10.1186/s12955-017-0621-0 ↗
55. Clinical practice guideline adaptation methods in resource-constrained settings: Four case studies from South Africa10.1136/bmjebm-2019-111192 ↗
56. Clinical Practice Guidelines in the Management of Breakthrough Cancer Pain: A Systematic Review using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Instrument10.1016/j.pmn.2022.02.010 ↗
57. Developing clinical practice guidelines: Target audiences, identifying topics for guidelines, guideline group composition and functioning and conflicts of interest10.1186/1748-5908-7-60 ↗
58. World Health Organization (WHO) (2026, April 05). Handbook for Guideline Development. Available online: https://apps.who.int/iris/handle/10665/145714.
59. Neumann, I., and Schünemann, H. (2026, April 05). The GRADE Book Version 1.0. Available online: https://book.gradepro.org/.
60. Hoffmann-Esser, W., Siering, U., Neugebauer, E.A., Brockhaus, A.C., Lampert, U., and Eikermann, M. (2017). Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments. PLoS ONE, 12.10.1371/journal.pone.0174831 ↗
61. The quality of clinical practice guidelines over the last two decades: A systematic review of guideline appraisal studies10.1136/qshc.2010.042077 ↗
62. Norris, S.L., Holmer, H.K., Ogden, L.A., and Burda, B.U. (2011). Conflict of interest in clinical practice guideline development: A systematic review. PLoS ONE, 6.10.1371/journal.pone.0025153 ↗
63. Living evidence-informed guideline on the early detection of oral squamous cell carcinoma and potentially malignant disorders: Cytology adjuncts to determine the need for biopsy, Version 2026 1.010.1016/j.adaj.2025.12.017 ↗