Beyond Guidelines: Conventional Wisdom About Strict Adherence Can Be Misleading

Markman

"....Consider, for a moment, a recent editorial in The New York Times¹ that discussed an abstract presented at the 2013 annual meeting of the Society of Gynecologic Oncology dealing with a population-based study on the management of epithelial ovarian cancer.² The editorial noted that the study found “only 37% (of patients) received the care recommended in guidelines set by the National Comprehensive Cancer Network [NCCN].” It further commented that “this kind of failure is not uncommon in American medicine,” and “in the case of ovarian cancer, the consequences of inadequate care are tragic.”¹

While it is impossible to disagree with this general sentiment regarding the importance of adequate care for all cancer patients, including women with ovarian cancer, and to emphasize the critical relevance of efforts undertaken at the national, regional, and local hospital levels to optimize the quality of cancer care, the question to be addressed in this commentary is what specifically in this particular research project provides solid evidence to support the conclusion that the percentage of patients who did not receive care recommended in NCCN guidelines actually represents “inadequate care.”.........

"...One additional point can be made to seriously challenge the conventional wisdom regarding primary surgery in advanced epithelial ovarian cancer. In contrast to the complete absence of solid evidence-based data to support aggressive initial surgery, a landmark phase III study has revealed the therapeutic equivalence of primary chemotherapy (neoadjuvant chemotherapy) followed by surgery and additional cytotoxic therapy, compared with aggressive surgery followed by chemotherapy, with the neoadjuvant approach being found to result in less treatment-related morbidity and mortality.^4.....