2
Key Points
➤ Historically, some of the highest incidence rates for colorectal
cancers have been in "more developed" regions. However,
approximately 45% of these occur in "less developed" regions,
representing 9-10% of cancers in those populations.
➤ Since different regions of the world, both among and within countries,
differ with respect to resource access, ASCO has established a
process for stratifying guidelines according to resource availability
(basic, limited, enhanced and maximal – See Table 1). This framework
emphasizes that variations occur not only between but also within
countries—for example, between rural and urban areas.
Table 1. Framework of Resource Stratification
Setting
Basic Core resources or fundamental services that are absolutely necessary
for any public health/primary health care system to function; basic-
level services typically are applied in a single clinical interaction.
Limited Second-tier resources or services that are intended to produce major
improvements in outcome such as incidence and cost-effectiveness and
are attainable with limited financial means and modest infrastructure;
limited-level services may involve single or multiple interactions.
Universal public health interventions feasible for greater percentage of
population than primary target group.
Enhanced ird-tier resources or services that are optional but important;
enhanced-level resources should produce further improvements in
outcome and increase the number and quality of options and individual
choice. (Perhaps ability to track patients and links to registries)
Maximal May use high-resource settings' guidelines.
High-level/state-of-the art resources or services that may be used/
available in some high-resource countries and/or may be recommended
by high-resource setting guidelines that do not adapt to resource
constraints but that nonetheless should be considered a lower priority
than those resources or services listed in the other categories on the
basis of extreme cost and/or impracticality for broad use in a resource-
limited environment.
NOTE: Data adapted. To be useful, maximal-level resources typically depend on the
existence and functionality of all lower level resources.
Treatment
