婦人科がん治療ガイドライン : 医師と患者と家族の絆(特別講演,第65回日本産科婦人科学会・学術講演会)

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  • Evidence-based Guidelines for Treatment of Gynecological Cancers : Bonds of Confidence among a Doctor, a Patient and Her Family

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In 2002, the Japanese Society of Gynecologic Oncology (JSGO) established the Committee for Clinical Practice Guidelines which made safe and high -quality treatments available for all gynecological cancer patients at all medical institutions in Japan. We adopted five aims when we set out development of our guidelines; Our guidelines should describe treatment options currently considered appropriate, should minimize existing treatment disparities between institutions, should make cancer treatments safer and their outcomes better, should save manpower resources and medical expenses by optimizing treatments, and should help patients and health professionals to share a common recognition. We also showed three points as basic concepts of the guidelines as follows; (1) The guidelines merely describe standard treatments and never narrow the range of available treatment options in practice. (2) In practice, each treatment given to a patient is chosen at the physician's discretion by reference to guidelines. (3) The guidelines make appropriate treatments available for all patients without disparities and also prevent malpractices. We made and published"Guideline for Treatment of Ovarian", "Endometrial" and "Cervical Cancer," one by one from 2004, and have published each revised edition every three or four years ever since. Our guidelines on the 3 gynecological cancers are also available in English. After the publication of ovarian and endometrial cancer treatment guidelines, we verified their evaluation by questionnaire surveys to our society members. Each content was highly evaluated. However, they were also pointed out a couple of issues as follows; The guidelines may; (1) provide a basis for lawsuits against physicians, (2) limit the physician's discretional power, (3) lead to uniform or defensive medicine, thereby preventing further progress of medicine. I'd like to show my concepts against these issues. Few unreasonable suits will be filed if appropriate treatments are chosen for all patients by reference to guidelines and are previously agreed to by the patients. One point to note is that in the presence of guidelines, physicians are required to assume the accountability for the basis of their practice. Even in the presence of guidelines, final treatment decisions are left to physicians. Guidelines describe not only standard treatments but also optional treatments and rather assist physicians in fully informing their patients about all treatment options during informed consent discussion. Guidelines do not provide complete answers or explanations to all clinical questions. By clarifying uncertainties about some questions with few supporting high-quality evidence, guidelines can also encourage new clinical studies to be planned and new treatments to be developed. Although our guidelines were for the use of physicians at the beginning, we accepted the results of the questionnaire surveys and patient's demands, and further developed and published "Guide to Three Gynecological Cancers' Treatment Guidelines for Patients and their Families". The purpose was to help patients/families share a commom recognition about the disease with health professionals and choose the optimal treatment for their disease. This guide focused and answered on clinical questions of the greatest significance and interest for patients/families, and also incorporated many figures, photos, and illustrations and used as plain language as possible to be understandable for non-professionals. Some members of Japanese Gynecological Cancer Self-Aid Patient Groups also contributed to the development of this guide. As most of the anxiety, misunderstanding and claim from patients/families derive from insufficient information or explanation from physicians, this guide is thought as a suitable tool for better communicating each other with confidence and choosing the optimal trea tment for the patient. Our guidelines are not perfect, merely describe current consensus, and should be updated or upgraded with new accumulated evidence. We are now planning to update our guidelines every three or four years. More Japanese cancer patients will become able to equally benefit from treatments, if guideline-based cancer treatments are provided at board-certified institutions by board-certified clinical oncologists. In Japan, 615 board-certified medical oncologists are now practicing treatment of gynecological cancers at 178 board-certified institutions. Hereafter, we are going to verify the benefit of the JSGO Gynecological Cancer Clinical Practice Guidelines in improving the outcome of cancer therapy as several years have already passed since they were published.

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