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Docs generally following cancer patient guidelines

By Genevra Pittman

NEW YORK (Reuters Health) - Most older cancer patients are getting treatment that is in line with current expert guidelines, suggests a new study that looked at variations in surgical care for several cancers.

However, doctors didn't follow guidelines as closely for certain procedures -- especially when evidence for the "correct" treatment decision wasn't as convincing, according to the report published in Archives of Surgery.

The researchers, led by Dr. Caprice Greenberg of Brigham and Women's Hospital in Boston, compared the cancer care given to people on Medicare with treatment guidelines from the National Institutes of Health and cancer organizations.

"When there's really good evidence (for a specific treatment) it looks like people are pretty consistently getting that kind of care," Greenberg told Reuters Health.

But "if guidelines are based on consensus of what people think might be the right thing to do, guidelines aren't consistently followed," she added.

Greenberg said that finding points to a need for more studies to evaluate treatments for different cancers, in order to give doctors confidence in surgery guidelines.

For their report, Greenberg and her colleagues analyzed records from a database of people on Medicare -- all aged 65 and up -- with a new diagnosis of one of five types of cancer. The final pool included more than 100,000 people who had surgery for breast, colon, gastric, rectal or thyroid cancer between 2000 and 2005.

Guidelines for those diseases outline which patients, based on their cancer type and stage, should be referred for chemotherapy or radiation. For some cancers, the recommendations specify what type of surgery needs to be done for doctors to make an informed decision about further treatment.

Greenberg found that hospitals treated more than 90 percent of patients with breast, colon, and rectal cancer according to guidelines -- performing chemotherapy or radiation or referring them to another doctor for that purpose.

Hospitals were best about following guidelines for breast cancer surgery --possibly, the authors note, because those guidelines have been around for a long time, and there's lots of evidence backing them up.

Less than half of hospitals, however, followed guidelines related to surgery to remove groups of immune cell repositories called lymph nodes in patients with colon or gastric cancer. Removing more nodes can help doctors figure out if a cancer has started to spread and needs more intense treatment than one in its earlier stages. The guidelines call for a minimum number of nodes to be taken out and examined in each case.

But there's less evidence telling doctors exactly how to treat those patients, the researchers noted.

"Everyone knows that getting more lymph nodes is generally a good thing, but we don't necessarily know how many is a right number, or is that true for everybody," Greenberg said.

Still, Dr. George Chang said that the guideline for removing enough nodes in colon cancer patients "is pretty easy to achieve -- it's a pretty low bar."

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