Journal of Clinical Oncology, Vol 12, 1783-1788, Copyright © 1994 by American Society of Clinical Oncology
Effect of a National Cancer Institute Clinical Alert on breast cancer practice patterns
TP Johnson, L Ford, RB Warnecke, SG Nayfield, A Kaluzny, G Cutter, D Gillings, E Sondik and H Ozer
Survey Research Laboratory, University of Illinois at Chicago 60607.
PURPOSE: This study evaluates the effect of the 1988 National Cancer
Institute Clinical Alert regarding treatment of early-stage breast cancer
on the patterns of treatment provided to patients. PATIENTS AND METHODS:
Data analyzed were collected from the hospital and outpatient records of
12,534 female patients with a primary diagnosis of breast cancer (stages I
and II) initially diagnosed during the years 1983 through 1989. RESULTS:
Analyses revealed that the proportions of patients with a negative lymph
node status diagnosed after the May 1988 Clinical Alert who received
adjuvant treatment (tamoxifen and/or multidrug chemotherapy) were
significantly greater than predicted from treatment trends established
before the Alert's release. Proportions of patients with positive lymph
node status receiving adjuvant therapy subsequent to the Alert's release,
in contrast, did not fall outside the projected confidence intervals for
that group. Additional analyses showed a significant effect of the Clinical
Alert among several subgroups of node-negative patients. CONCLUSION:
Findings suggest that the Clinical Alert mechanism, followed by publication
in the peer- reviewed scientific literature, is an effective way to
communicate important research findings to practitioners in the community.
However, the Alert mechanism is controversial and should be used
judiciously to ensure its credibility.
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