Researchers from the Johns Hopkins School of Medicine and the Johns Hopkins School of Hygiene and Public Health in Baltimore, Md., found that, in some cases, guidelines were not used because doctors were unfamiliar with them, did not agree with them, or were not sure they could apply them well to patients. In other cases, doctors were not sure a particular guideline would yield the desired results. The study also cited doctors' perceptions of inconvenience and a lack of staff, facilities, or time as reasons for failing to follow guidelines.

For cancer patients, guidelines are of great value

The study has prompted leaders in the cancer field to emphasize the high value of guidelines to patients. "Recognized, accepted guidelines are expert distillations of years of hospital tumor board records, experienced doctors' expertise, and the latest scientific clinical studies," said Harmon Eyre, MD, executive vice president for research and medical affairs for the American Cancer Society (ACS).

"They're the procedures that have been shown to most often produce the best outcome for patients in specific situations. We believe cancer therapy doctors have the obligation to be aware of cancer practice guidelines, to choose the most appropriate ones, and to try to adhere to them," he added.

The ACS and the National Comprehensive Cancer Network (NCCN), a group of 17 top cancer centers in the US, plan a continued push for increased use of guidelines. NCCN plans to seek more collaboration among specialist doctors to achieve consensus where disagreement on specific guidelines exists.

Barriers should be removed

In addition, other barriers to the use of guidelines should be removed, such as time and convenience issues in prevention and early detection, said Dr. Eyre. "We can prevent a lot of cancers if we can find incentives for nurses in doctors offices to identify smokers so that the doctors can offer smoking cessation counseling at every visit. And if nurses routinely prepare women for a clinical breast exam once a year -- providing counseling on necessity and a gown so that the doctor's time is used well and inconvenience is minimized -- use of that early detection guideline can result in huge savings of lives and dollars."

Dr. Eyre envisions a future in which patients and insurers are informed about which doctors and facilities are getting better results from wider use of cancer treatment guidelines. "As a nation, right now we're not effectively collecting data on which institutions and doctors are using the guidelines most consistently. We should be. It means better outcomes," he said.

The NCCN has begun a pilot program at several of its cancer centers in which it is collecting that kind of data and getting feedback to patients, doctors, and even insurers, which should result in greater demand for adherence to the guidelines, according to William T. McGivney, PhD, chief executive officer of NCCN. "As more patients learn that the guidelines mean better outcomes for them, demand for treatment following approved guidelines increases," he said. "And insurers realize that money is expended efficiently when the best treatment is offered first."

Easy-to-understand guidelines for patients

ACS recently began translating NCCN's professional practice guidelines for cancer into easily understandable language and making them available free of charge to patients. Guidelines for treatment of breast cancer and prostate cancer are available at both the ACS and NCCN web sites or by calling 1-800-ACS-2345 or 1-888-909-NCCN.