Keefe Dorothy M, Peterson Douglas E, Schubert Mark M
Department of Medical Oncology, Royal Adelaide Hospital Cancer Centre, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
Support Care Cancer. 2006 Jun;14(6):492-8. doi: 10.1007/s00520-006-0059-0. Epub 2006 Apr 7.
It is important yet difficult to maintain currency in clinical oncology practice. The emergence of new diagnostic technologies and new paradigms for cancer treatment combine to produce a rapidly changing clinical approach to patients aided by the increasing use of multidisciplinary care teams and development of evidence-based protocols.
Teams of experts review the literature in a given area and produce management guidelines and protocols for use by practicing clinicians. Traditionally within Hematology/Oncology, these guidelines have been directed to management of a given tumor type. However, in recent years, attention has increasingly turned to supportive oncology; for example, there are now management guidelines for conditions such as neutropenic fever [Hughes et al. Clinical Infectious Diseases 34(6):730-751, 2002], antiemetic (The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer Annals of Oncology 17:20-28, 2006) and most recently, mucositis [Rubenstein et al. Cancer 100(9 Suppl):2026-2046, 2004]. It is critical that any guideline process should include education, evaluation, and timely update in its remit, because guidelines become highly compromised if their existence is not widely known, if they do not facilitate clinical practice, or if they are not reflective of contemporary medical literature.
The Mucositis Study Group (MSG) of the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology was created in 1998 to specifically address the multiprofessional approach to clinical care, research, and education associated with mucosal injury in cancer patients. A specific outcome has been the development of evidence-based guidelines for the management of mucositis [Rubenstein et al. Cancer 100(9 Suppl):2026-2046, 2004; The Mucositis Study Group of MASCC/ISSO 2005]. The original guidelines [Rubenstein et al. Cancer 100(9 Suppl):2026-2046, 2004] and a companion paper discussing the science behind mucositis [Sonis et al. Cancer 100(9):1995-2025, 2004], were published in 2004. The MSG has recently updated the guidelines [The Mucositis Study Group of MASCC/ISSO 2005].
This paper discusses the process involved and the lessons learned that might help other groups planning to undertake a similar project.
在临床肿瘤学实践中紧跟前沿既重要又困难。新诊断技术的出现以及癌症治疗新范式的涌现，加上多学科护理团队的日益广泛使用和循证方案的发展，共同促成了针对患者的快速变化的临床方法。
专家团队会对特定领域的文献进行综述，并制定管理指南和方案供临床医生使用。在血液学/肿瘤学领域，传统上这些指南是针对特定肿瘤类型的管理。然而，近年来，人们越来越关注支持性肿瘤学；例如，现在有针对诸如中性粒细胞减少性发热[休斯等人，《临床传染病》34(6):730 - 751，2002年]、止吐（癌症支持性护理多国协会止吐小组委员会，《肿瘤学年鉴》17:20 - 28，2006年）以及最近的口腔黏膜炎[鲁宾斯坦等人，《癌症》100(9增刊):2026 - 2046，2004年]等病症的管理指南。任何指南制定过程都必须在其职责范围内包括教育、评估和及时更新，这一点至关重要，因为如果指南不广为人知、不利于临床实践或不能反映当代医学文献，那么它们的作用就会大打折扣。
癌症支持性护理多国协会/国际口腔肿瘤学会的口腔黏膜炎研究组（MSG）于1998年成立，专门致力于解决癌症患者黏膜损伤相关的临床护理、研究和教育的多专业方法问题。一个具体成果是制定了基于证据的口腔黏膜炎管理指南[鲁宾斯坦等人，《癌症》100(9增刊):2026 - 2046，2004年；MASCC/ISSO口腔黏膜炎研究组，2005年]。最初的指南[鲁宾斯坦等人，《癌症》100(9增刊):2026 - 2046，2004年]以及一篇讨论口腔黏膜炎背后科学原理的配套论文[索尼斯等人，《癌症》100(9):1995 - 2025，2004年]于2004年发表。MSG最近更新了这些指南[MASCC/ISSO口腔黏膜炎研究组，2005年]。
本文讨论了所涉及的过程以及吸取的经验教训，这些可能有助于其他计划开展类似项目的团队。
