Interviews Show Positive Response to NCCN's Cancer Guidelines

FORT LAUDERDALE--Attendees at the first annual conference of theNational Comprehensive Cancer Network (NCCN) were enthusiasticabout the presentation of the Network's preliminary guidelinesfor eight different cancers, calling the meeting "excellent,""informative," and "the first comprehensive effortat devising guidelines we can all live by."

David Ettinger, MD, of Johns Hopkins Oncology Center, who chairedthe NCCN non-small-cell lung cancer guidelines panel, was pleasedwith the feedback he received from physicians at the conferenceabout improvements they would like to see, such as more specificlevels of evidence for recommendations.

In an interview with Oncology News International, Dr. Ettingernoted the large amount of work yet to be done in completing theguidelines in a reasonable period of time and in beginning theprocess of measuring outcomes.

Several attendees interviewed by Oncology News International mentionedthat they were pleased to see cancer guidelines being writtenby oncolo-gists. "If practitioners aren't putting guidelinestogether, we're going to have insurance companies doing it forus," said Linda Frame, RN, MS, OCN, director of educationat the Susan G. Komen Breast Cancer Foundation, Dallas.

Ms. Frame believes that by setting standards, guidelines willhelp women make informed decisions about their breast cancer treatment.

William C. Brooks, MD, medical director for cancer services, St.Paul Medical Center, Dallas, said that he plans to incorporateaspects of the guidelines into the teaching program at his institution.

Lisa Doria, RN, CNS, of the Hacken-sack Medical Center, NJ, saidthat the development of cancer guidelines is "a very largeproject for one group to accomplish on its own." She suggestedthat the NCCN might want to include other national organizationsin the process.

Some Concerns

Vincent Vinciguerra, MD, chief of oncology/hematology, North ShoreUniversity Hospital, Manhasset, NY, expressed concerns about guidelinesbecause they may "attempt to control the way I practice medicine,"but as the meeting progressed, he found that the NCCN's recommendationsreflected, for the most part, his own practice methods.

Dr. Vinciguerra's major concern is that the NCCN guidelines maylimit the number of treatments available to patients who haveincurable disease but are in good enough condition that they mightbe able to benefit from newer treatments.

He cited the breast cancer guidelines, which suggested supportivecare for patients with advanced disease who have failed two treatments."I feel that it would be inappropriate for some patientswho have a good performance status not to offer them a newer treatmentthat might give them some more time."

Although the NCCN advocates that patients enroll in clinical trialswhenever feasible, Dr. Vinciguerra said that in his experience,patients with advanced disease who have failed other therapiesgenerally do not meet the eligibility criteria.

Tim Whitten, vice president of marketing, Bristol-Myers SquibbOncology/Immunology, sees the guidelines effort as a means foroncoloists to remain in control of treating cancer patients. "Ithink this is in the patient's best interest, industry's bestinterest, and the oncologist's best interest."

A critical point, he believes, is for the NCCN to come up withmechanisms for updating the guidlines to include new treatmentsand technologies, and for getting those updates out to the physicianswho use them.

Mr. Whitten mentioned the difficulty in developing guidlines forcomplex diseases such as cancer and in reaching a consensus ontreatments for specific diseases stages. " We need clinicaltrials to answer those questions where there is no consensus,and hopefully industry, the NCCN, and other institutions willcome together to do those trials," he said.