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 controversy.
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.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
