START is intended as a state-of-the-art instrument to support clinical oncologists and physicians in their everyday oncology practice. START is provided for free on the Internet.
START is not a set of clinical practice guidelines. These are generally targeted to a specific geographical context. They are formulated by also incorporating cost/effectiveness evaluations. On the contrary, START mainly focuses on effectiveness, and available options on diagnosis and treatment are elaborated trying to combine objective knowledge and clinical expertise. Obviously, it is possible to use START as a reference instrument for the construction of clinical practice guidelines. START is evidence-based, being formulated according to a consistent methodology. However, an effort is made to provide critical and descriptive information as well, with the goal of encouraging an individualised clinical decision-making at the patient\’s bedside (possibly an explicit, even quantitative decision making).
START is an independent project. It grew up as from 1995 as an independent programme within the European School of Oncology. As from September 2002, it is one of the services provided by Alleanza Contro il Cancro (“Alliance Against Cancer”), the organization of the Italian institutes for cancer research under the auspices of the Italian Health Ministry. Alleanza Contro il Cancro has a Web portal, through which START is made available for free to oncologists and physicians.
START has a number of internal Editors who follow all the chapters and oversee the process of their preparation and updating. The founding Editors give rise to the Steering Committee, with organizational tasks. Each START chapter results from a definite, internal collaborative process. In fact, it first derives from a draft version assembled by one of the START Editors, possibly on the basis of selected contributions from Authors. A European Guest Editor may be appointed as needed. The draft chapter is formulated according to an evidence-based approach, in collaboration with the Statistical Editor. One or more European experts in the field then act as internal Reviewers for the chapter.
The chapter is eventually put online, and all the people taking part into its preparation are enlisted. Consensus assessment initiatives may be carried out on the final chapters by means of ad hoc initiatives on a European scale. They may result into changes to the chapter, and the entities involved in the consensus development process are enlisted as well. These entities may be European scientific societies, collaborative groups for clinical research, etc. Minor updatings and changes are made as needed, under the responsibility of the Editors. Regular updating of each chapter is carried out each year as agreed upon by the Editors with the Reviewers