Howard David H, Soulos Pamela R, Chagpar Anees B, Mougalian Sarah, Killelea Brigid, Gross Cary P
David H. Howard (
Pamela R. Soulos is a program manager and data analyst at the Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at the Yale University School of Medicine and the Yale Cancer Center, in New Haven, Connecticut.
Health Aff (Millwood). 2016 Jul 1;35(7):1309-15. doi: 10.1377/hlthaff.2015.1490.
Conventional wisdom holds that physicians are slow to abandon ineffective medical practices. We evaluated this theory in the case of axillary lymph node dissection, a procedure to remove the lymph nodes near the breast to prevent the spread of breast cancer following breast-conserving surgery. A major trial conducted from 1999 to 2004, with results presented in 2010 and published in 2011, found that patients who met certain criteria could forgo axillary lymph node dissection. Using cancer registry data, we estimated that the proportion of patients undergoing axillary dissection declined by 32.6 percentage points after the trial was published. The decline began immediately after the trial was presented at a medical conference. The rapid decline in the use of axillary dissection belies the common belief that practice patterns are slow to change in response to new evidence, and it highlights the value of trials of established medical practices to patients and the health system.
传统观点认为，医生放弃无效医疗实践的速度很慢。我们以腋窝淋巴结清扫术为例对这一理论进行了评估，腋窝淋巴结清扫术是一种在保乳手术后切除乳房附近淋巴结以防止乳腺癌扩散的手术。1999年至2004年进行的一项大型试验，其结果于2010年公布并于2011年发表，该试验发现符合某些标准的患者可以放弃腋窝淋巴结清扫术。利用癌症登记数据，我们估计在该试验发表后，接受腋窝清扫术的患者比例下降了32.6个百分点。在该试验在一次医学会议上公布后，下降立即开始。腋窝清扫术使用的迅速下降与普遍认为的实践模式因新证据而变化缓慢的观点相悖，它凸显了对既定医疗实践进行试验对患者和卫生系统的价值。
