gms | German Medical Science

Guidelines based on well conducted clinical trials define which treatments will most reliably prevent symptoms and give confidence that the best approach is used. The practice of evidence based medicine means integration individual clinical expertise with best available external clinical evidence from systematic research. Without clinical expertise, practice risks becoming tyrannized by external evidence. It is suggested that there is a high clinical benefit in guideline based therapy. Supportive treatment is mostly an “Add-on-therapy”. Supportive Care and treatment according to guidelines is especially important in order to prevent , minimize and treat side effects of cancer and its treatments, to realize dose escalations of the tumour therapy with the result of a better survival rate and to ensure the quality of life of the patient. There are data that patients treated according to guidelines have a better survival but patients included in clinical trials what are the base for the guidelines are not the individual patients treated everyday in hospital. But an adherence to guidelines includes a quality assurance for the treatment process. Evidence based medicine has some limitations caused by the design of the trial. This leads to variation in interpretations of the evidence based literature. Guidelines are a subjective compromise by experts discussed in a consensus conference. It is an effort to unify the variations and to give general recommendations. Up to know there are useful guidelines on high level concerning supportive care for antiemetic therapy mucositis, growth factors and erythropoiesis stimulating factors. We have data that by following guidelines for supportive care there is a cost saving effect, especially in antiemetic therapy. It is necessary to update the guidelines in regularly intervals. One of the major topics in supportive care is the quality of life and satisfaction of the patient during the treatment. Some of these aspects were investigated by the PASCOQ-trial in 2004 including more than 4.600 patients. It was demonstrated that information and adequate treatment concerning side effects of cancer therapy is very important in order to improve the efficacy and the tolerance of the tumour therapy. A better adherence to guidelines can only be achieved through a complex and long-term process, consisting of efficient education, training and monitoring of all individuals involved. Guidelines in supportive care are useful only if they are accepted and well known for everybody. Guidelines in supportive care are a necessary part of tumour treatment concepts.