Guidelines for the Early Referral of Patients to Cancer Specialists

Several years ago, during Dr. Gardner's tenure as President of the Societyof Surgical Oncology (SSO), the SSO's Executive Council agreed to the developmentof practice guidelines for early referral of potential cancer patients.This move was stimulated by the spread of managed care and the fear thatan emphasis on cost containment might establish a barrier to early referral.We had all witnessed the disastrous consequences of delayed treatment ofcancer patients and were concerned that these influences might discouragethe use of advanced diagnostic techniques, such as MRI, CT, biopsy, andendoscopy, which are vital in the diagnosis of soft-tissue sarcomas, abdominalor gastrointestinal cancer, and breast and lung cancer.

We recognized that medicine is not an exact science. Clear choices ofappropriate treatments are not always obvious, and considerable disagreementsmay arise among physicians of different or even the same specialty withregard to treatment algorithms. We do strongly believe, however, that thediagnosis 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 practiceguidelines were unnecessary. We felt that we were free to use the broadclinical experience residing in the membership of the Society to produceguidelines for early referral that were not likely to result in significantcontroversy.

The task of overseeing the development of these practice guidelineswas given to Dr. Alfred Cohen, Chairman of the Clinical Affairs Committeeand, with mutual consultation, we put together the site committees listedin Table 1.

After extensive work and rewriting, a series of practice guidelineswere produced that cover all of the main sites that surgical oncologistsdiagnose and treat. Some of those guidelines are presented in this issueof oncology and others will appear in future issues.

We realize that patients are not all the same. Differences in presentationmay lead to variations in treatment approach. The purpose of these guidelinesis to encourage the early involvement of cancer specialists in the evaluationof patients who may have the disease. The guidelines are designed to facilitatea sharing of the burden of responsibility of early diagnosis between thefamily physician and specialist. We recognize that the intricate relationshipbetween doctor and patient may modify the approach in some cases.

Our Society does not suggest that these guidelines replace good medicaljudgment. That always comes first. We do believe that family physicians,as well as directors of health maintenance organizations, will appreciatethe provision of these guidelines as a reference for better patient care.