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Journal of Clinical Oncology, Vol 23, No 27 (September 20), 2005: pp. 6807 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.01.5545
The American Society of Clinical Oncology Recommended Breast Cancer Surveillance Guidelines Can Be Done in a Routine Office VisitVirginia Commonwealth University, Division of Hematology/Oncology, MCV Box 980230, Richmond, VA To the Editor: The ASCO Recommended Breast Cancer Surveillance Guidelines1 are being redone in 2005. Some oncologists have found these very useful in educating patients about what tests are helpful, and what tests are not helpful and not recommended.2 One persistent objection to more widespread use of these guidelines has been the complaint that they may take too much time to review. To see how much time the actual review took with patients, I did a consecutive timed review with 15 patients who were ending adjuvant treatment and ready to begin surveillance. I presented the printed patient follow-up guide (ASCO Patient Guide: Follow-Up Care for Breast Cancer) obtained from http://www.plwc.org to a sequential series of breast cancer patients, reviewed the guideline table with them, made spoken and written comments specifically for individual patients (Table 1), and timed the process. Approval for the study was granted by the Committee on the Conduct of Human Research; the study was exempt from consent requirements since it was a continuation of an already established office practice. The list of patient situations and actual times/discussion is available from the author.
In all patients studied, the process took less than 10 minutes, with an average of 6 minutes. I encountered no specific difficulties, in part because I had readily formulated answers for the questions that inevitably arose. As we found in our prior study with similar types of discussions about do-not-resuscitate orders,3 the problem may not be the time but the commitment to discussing difficult subjects, or lack of usable examples. Further research is needed to determine if this approach can be generalized to other practices and other practitioners, how best to present the information, and the comprehension of the knowledge, but at least the time issue should not be a burden. Author's Disclosures of Potential Conflicts of Interest The author indicated no potential conflicts of interest.
REFERENCES
1. Smith TJ, Davidson NE, Schapira DV, et al: American Society of Clinical Oncology 1998 update of recommended breast cancer surveillance guidelines. J Clin Oncol 17:1080-1082, 1999
2. Loprinzi CL, Hayes D, Smith TJ: Doc, Shouldn't We Be Getting Some Tests? J Clin Oncol 18:2345-2348, 2000 3. Smith TJ, Desch CE, Hackney MH, et al: How long does it take to get a "do not resuscitate" order? J Palliat Care 13:5-8, 1997[Medline]
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Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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