Guideline approach to cancer management

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OVER THE PAST DECADE, four cancer control demonstration projects focused on the establishment of guidelines for the management of breast cancer and three hematologic malignancies. Analysis of these projects identified factors which led to success or failure. Detrimental factors included any requirement that physicians collect data in a project-oriented fashion and the image of medical center authority over community hospitals. Using the fourth project as a model (the New Hampshire Breast Cancer Network Demonstration Project), success is best achieved by 1) a distinct planning phase, 2) equal participation of the target population in both planning and implementation, 3) educational programs which are not limited to physicians but include other health providers, and 4) development of an increased range of services such as: a) monitored mammography and registry feedback to primary physicians, b) a system of tumor conferences, c) hormone receptor assays, d) improved social services, and e) expanded physical therapy for mastectomy patients.

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