Thousands of practice guidelines/practice parameters have been published
by various professional organizations. The American Medical Association,
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.
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 of 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.
Previous issues of ONCOLOGY featured the Society of Surgical Oncology's
practice guidelines on breast, lung, ovarian, and prostate cancers (June);
colorectal, esophageal, gastric, and pancreatic cancers (July); and laryngeal,
oropharyngeal and oral cavity, parotid, and thyroid cancers (August). This
issue includes guidelines on melanoma and sarcoma.
1. Attributes to Guide the Development of Practice Parameters. Chicago,
Office of Quality Assurance and Medical Review, American Medical Association,
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