For every guideline topic, the following key issues can be considered which are important for the final recommendations:

  • Does early diagnosis result in better outcomes?
  • Who needs surveillance?
  • At what age or time from exposure should surveillance be initiated?
  • At what frequency should surveillance be performed?
  • When should surveillance be stopped?
  • What surveillance modality should be used?

The guideline development process consists of five steps.

Step 1: Determine concordances and discordances among existing guidelines

The first step of the process it to extract the recommendations as formulated in the published long-term follow-up guidelines of the COG, DCOG, UKCCLG, and SIGN and to determine concordances and discordances. According to the Institute of Medicine, clinical practice guidelines are defined as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”. This effort encompassed published guidelines that were developed following systematic evaluation of the quality of the late effects literature, linking therapeutic interventions with adverse outcomes. At the initiation of the harmonization process in 2010, four societies (COG, DCOG, SIGN, UKCCLG) had published health screening recommendations for childhood cancer survivors and disseminated these recommendations beyond their institutional, national and cooperative groups.

Step 2: Formulate clinical questions

Focused clinical questions are formulated based on the discordant guideline areas to identify the underlying evidence. For the concordant guideline areas no new search for evidence is performed.

Step 3: Identify available evidence

For every clinical question the supporting evidence is identified. The electronic database PubMed/MEDLINE is searched. The evidence available in existing guidelines and provided by experts in the field is also considered.

Step 4: Summarize and appraise quality of the evidence

The evidence found in the literature should be summarized in evidence tables . The evidence tables provide information about study and patient characteristics, primary study outcomes, risk of bias, including selection bias, attrition bias, detection bias and confounding, and additional remarks, such as other factors that may bias results.

The quality of the body of evidence is appraised using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Step 5: Formulate recommendations

The IGHG guideline panel discusses the evidence and formulates recommendations considering the quality of the evidence, the benefits versus harms of the surveillance intervention, and the need to maintain flexibility of application across health care systems.
The quality of the evidence and the strength of the recommendations are categorized according to a 4-level color grading system.

The IGHG methodology is described in the Handbook.