Evidence-based medicine applied to cervical cancer.
All too frequently current healthcare is characterised by non evidence based practice, variation in practice, inadequate outcome data, inequality of access to optimal treatment and ultimately a lack of evidence base. By developing a culture of evidence based medicine some of these shortcomings could be addressed. In trying to develop a true assessment of evidence, we have to confront a huge literature, much of which does not inform clinical effectiveness which is a key underpinning of an evidence base. It is necessary to adopt methodologically sound protocols as well as a systematic approach to weighing the evidence. In general informative studies should specify the population studied, the intervention, with what it is being compared, and relevant clinical outcomes. It is clear that randomised controlled trials (RCTs) will carry most weight in terms of reducing outcome bias. The Cochrane Collaboration is an international collaboration dedicated to the science of systematic reviews and meta analysis. It functions through a process of peer review of Title of Review, Proposed Protocol, Completed Review with eventual publication in the electronic Cochrane Library. There is an active Cochrane Collaborative Review Group in Gynaecological Cancer. As far as evidence for the effective management of cervical cancer is concerned, the strongest evidence would relate to the effectiveness of concurrent chemoradiation for treating locally advanced disease compared with radiation alone.
Kitchener
Henry
H
Academic Unit of Obstetrics and Gynaecology, St. Mary's Hospital, Manchester M13 OJH, UK. hkitchener@central.cmht.nwest.nhs.uk
D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007391:International Cooperation; D010380:Peer Review; D016032:Randomized Controlled Trials as Topic; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy