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SGO Practice Guidelines: Introductory Remarks

SGO Practice Guidelines: Introductory Remarks

Thousands of practice guidelines/practice parameters have been published by various professional organizations. The American Medical Association,[1] American College of Physicians,[2,3] and others[4-6] have written extensively about methodologic, quality, and cost considerations in relation to such guidelines. In the early 1990s, the Society of Surgical Oncology participated in the development of extensive evidence-based standards of care for breast conservation treatment of primary breast cancer patients.[7]

More recently, the Society undertook a more ambitious initiative aimed at developing surgical practice guidelines directed toward the evaluation and initial management of patients with signs and symptoms cancer. These guidelines encompass the major cancer sites.

Scope and Format of the Guidelines

The Society of Surgical Oncology practice guidelines were based on detailed review by nationally recognized experts in their respective fields. Each guideline represents a consensus of multiple members of the Society of Surgical Oncology who are well known for their expertise. The authors have stressed the symptoms and signs of primary cancer without discussing screening programs. The guidelines also discuss the timely evaluation of the symptomatic patient, appropriate preoperative evaluation for extent of disease, and the role of the surgeon in the diagnosis and treatment of cancer.

Separate sections on adjuvant therapy, follow-up programs, or management of recurrent cancer have been intentionally omitted. For many sites, perioperative adjuvant combined-modality therapy has been shown to improve outcomes. Where appropriate, such therapy is discussed under surgical management.

The guidelines are presented in minimal outline form as a delineation of therapeutic options. It is not the intent of these guidelines to define in detail all of the alternatives, risks, and outcomes for surgical or combined-modality therapy of the cancer patient. For most sites, the generally acceptable therapeutic options are defined.

Following each guideline is a brief narrative highlighting and expanding on selected sections of the guideline document, with a few relevant references. The current staging system for the site and approximate 5-year survival data are also included.

References

1 Attributes to Guide the Development of Practice Parameters. Chicago, Office of Quality Assurance and Medical Review, American Medical Association, 1993.

2. Farmer RG ,White LJ: Medical quality assessment and the American College of Physicians. J Am Coll Cardiol 14:69A-71A, 1989.

3. Ball JR. Practice guidelines and their role in quality assurance and cost effectiveness. Qual Assur Health Care 2:31-36, 1990.

4. Phelps CE: The methodologic foundation of studies of the appropriateness of medical care. N Engl J Med 329:1241-1245, 1993.

5. McDonald CJ, Overhage JM: Guidelines you can follow and can trust: An ideal and an example (editorial). JAMA 271,:872-873, 1994.

6. Browman GP, Levine MN, Mohide EA, et al: The practice guidelines development cycle: A conceptual for practice guidelines development and implementation. J Clin Oncol 13:502-512, 1995.

7. Winchester DP, Cox JD, for the American College of Radiology, American College of Surgeons, College of American Pathologists, and Society of Surgical Oncology: Standards for breast-conservation treatment. CA Cancer J Clin 42:134-162, 1992.

 
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