By Edward Susman
Special to DG News
FORT LAUDERDALE, FL -- March 21, 2000 -- The chairman of the committee looking into how well member institutions follow guidelines written for the National Comprehensive Cancer Network (NCCN) said she would rate doctors highly for being in general concordance with the treatment algorithms.
"For the first time out, I'd give them an 'A'-but not an A-plus," said Jane Weeks, MD, associate professor of medicine at Harvard Medical School and the Dana-Farber Cancer Institute, in Boston. Dr. Weeks spoke at the NCCN's annual meeting, which was held in Ft. Lauderdale, FL on March 16-19, 2000.
Dr. Weeks heads the NCCN's Outcomes Research Project, which is gathering data from member institutions on various disease states. The first project, to collect data regarding how patients are treated for breast cancer, began July 1, 1997 and now includes 10 of the 17 institutions in the network.
"We want to monitor ourselves whether we are following, ourselves, the guidelines that we have developed," said Joyce Niland, Ph.D., director of biostatistics for City of Hope National Medical Center, in Duarte, CA, and director of the NCCN's Data Coordinating Center at City of Hope.
She said the report covers 80,000 points of data entry on the first 3,137 new breast cancer patients seen by the NCCN facilities in the system. The hospitals send their encrypted data over the Internet to where it is archived.
Among the findings on data regarding breast conservation therapy, Dr. Weeks said that of the 679 women with Stage 1 disease and eligible for the lumpectomy, 68 percent received that treatment. By institution that ranged from 53 percent to 80 percent; in 427 women with Stage 2 breast cancer and also eligible for breast conservation, 47 percent under went the lumpectomy, a range of 37 percent to 58 percent, depending on the institution.
"These are higher than national rates, but frankly not as high as we would like to see," Weeks said. "The guidelines identify both mastectomy and breast conservation surgery as reasonable option so mastectomy is concordant with the guidelines, although breast conservation therapy for women who are eligible for it are deemed preferred in the guidelines."
But, she said, the remarkable thing about that part of the study was the wide differences between member institutions.
Dr. Weeks said other instances showed what appeared to be discordance, such as the prescription of tamoxifen to women following DCIS surgery. The guidelines suggest that post-surgical treatment for this group of women is not necessary, but only 35 percent of doctors went along with that guideline.
She said that guidelines rewritten for the current NCCN meeting now list tamoxifen as an option as chemopreventive.
Discordance in the guidelines gives researchers a chance to go back and review why doctors treat patients in a certain manner and constitute a feedback mechanism, part of the dynamics of writing the algorithm, she said.