Dr. Jack He, MD, MSc, RAc
To date, cancer treatment regimen is most likely to be a combination of standardization and individualization. It is about integrating individual clinical expertise and the best external evidence. Thereby oncologists can improve the treatment of cancer by integration of evidence-based medicine and customized cancer therapies into clinical practice when deciding upon a treatment regimen for a particular cancer patient. Evidence-based medicine is different from conventional medicine. Conventional medicine, also known as empirical medicine, is based on the assumption that symptoms need to be treated and is focusing on extensive clinical practice, clinical data and claims its scientific foundation of diseases. Evidence- based medicine is not going to replace empirical understanding, clinical expertise, clinical data and medical knowledge other than taking consideration of best evidence developed under strict scientific research in health care community. What is Evidence Based Medicine (EBM)? Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research, especially the accurate diagnosis, the effective and safe therapeutic regimens, and the precision of prognosis for individual patients.
As a matter of fact, philosophical origins of Evidence- based Medicine could be traced back to ancient Greece. Evaluation of the ergogenic properties of Ginseng was conducted by using controlled studies in early Song dynasty in China. In recent years, the core idea of EBM is proposed that individual clinicians should apply the newest and the best scientific evidence acquired through clinical experience and clinical practice and make solid clinical decisions about patients’ care. Clinicians should involve tracking down the best external evidence with which to answer our clinical questions and collect relevant data as well as proper follow up studies of external evidence on the basis of history of disorder and intensive physical and clinical examinations. Authenticity, reliability, and practicability of the data will be assessed. The appropriate diagnostic tests and more efficacious and safer treatment will be considered.
Subsequently, how the EBM can be adopted in clinical practice of cancer therapy. A case study can be an example. A 65 years old male patient, sleeve right lower lobectomy with extended lymph node dissection for right lung cancer was done 2 weeks ago, cytology and pathology studies on postoperative biopsies confirmed a diagnosis of squamous cell carcinoma with lymph node metastasis. Patient, patient families and doctor are wondering about whether surgery followed by chemotherapy can increase overall survival rate of lung cancer patients. So, the EBM trained doctor properly follows up the procedures: 1) Firstly, asking questions about the therapy, that means the chemotherapy is followed when necessary and whether postoperative adjuvant chemotherapy can increase overall survival rate for the individual patient. 2) Secondly, retrieving available clinical data from CD-ROMs and medical databases all over the world. 120 articles were found to be update, and 5 papers are relatively valuable on accumulative meta-analysis of NSCLC pneumonectomy followed chemotherapy regimen. 3) Then, systematic review and study the evidence of relevant trials were identified on the basis of the publication sequence. The death-risk was assessed by accumulative meta-analysis and the combined results were validated. 4) Eventually, comparing this case with meta-analysis results if the patient comes to be the similar outcomes, the positive interventions will inform patient and families for consent and judging whether an advanced treatment is acceptable and does better. As we all know, there are plenty of medical study resources available worldwide. Millions of medical papers are published and many new evidence are accessible everyday. Clinicians often work overload with scheduled appointments, neither is it possible to review all of related professional journals and book chapters, nor enough time to be allowed reading through recent publications. It should be better to learn and understand EBM approaches, to identify relevant studies and carry out systematic review and/or apply other available meta -analysis results to clinical practice.
Though more attention has been paid to EBM by medical professionals and experts, especially EBM plays a powerful role in cancer therapy. However, not only shall we emphasis on EBM procedures, but also should follow up studies from the basic sciences in oncology practice. Randomized trials are to be preferred, but no limitation with regard to nonrandomized clinical reports. It comes to be evidence based, but individual clinical expertise remains relatively significant in best clinical practice. Generally, Evidence-based Medicine in best oncology practice is still beyond to reach somehow. Definitely, it has become an integration of EBM guided treatment protocol’s standardization and individualization of patient’s need, nevertheless, individual clinical expertise of clinical specialists is very critical as well.