Several years ago, during Dr. Gardner's tenure as President of the Society
of Surgical Oncology (SSO), the SSO's Executive Council agreed to the development
of practice guidelines for early referral of potential cancer patients.
This move was stimulated by the spread of managed care and the fear that
an emphasis on cost containment might establish a barrier to early referral.
We had all witnessed the disastrous consequences of delayed treatment of
cancer patients and were concerned that these influences might discourage
the use of advanced diagnostic techniques, such as MRI, CT, biopsy, and
endoscopy, which are vital in the diagnosis of soft-tissue sarcomas, abdominal
or gastrointestinal cancer, and breast and lung cancer.
We recognized that medicine is not an exact science. Clear choices of
appropriate treatments are not always obvious, and considerable disagreements
may arise among physicians of different or even the same specialty with
regard to treatment algorithms. We do strongly believe, however, that the
diagnosis and management of complicated problems in malignant disease,
done correctly the first time, is both good medical practice and cost efficient.
We did not have treatment protocols as our specific aim, and therefore,
the extensive development cycles required to produce evidence-based practice
guidelines were unnecessary. We felt that we were free to use the broad
clinical experience residing in the membership of the Society to produce
guidelines for early referral that were not likely to result in significant
The task of overseeing the development of these practice guidelines
was given to Dr. Alfred Cohen, Chairman of the Clinical Affairs Committee
and, with mutual consultation, we put together the site committees listed
in Table 1.
After extensive work and rewriting, a series of practice guidelines
were produced that cover all of the main sites that surgical oncologists
diagnose and treat. Some of those guidelines are presented in this issue
of oncology and others will appear in future issues.
We realize that patients are not all the same. Differences in presentation
may lead to variations in treatment approach. The purpose of these guidelines
is to encourage the early involvement of cancer specialists in the evaluation
of patients who may have the disease. The guidelines are designed to facilitate
a sharing of the burden of responsibility of early diagnosis between the
family physician and specialist. We recognize that the intricate relationship
between doctor and patient may modify the approach in some cases.
Our Society does not suggest that these guidelines replace good medical
judgment. That always comes first. We do believe that family physicians,
as well as directors of health maintenance organizations, will appreciate
the provision of these guidelines as a reference for better patient care.