This is a guest post from Dr. Jessie Gruman.
More Can Also Be Less: We Need A More Complete Public Discussion About Comparative Effectiveness Research
When the public turns its attention to medical effectiveness research, a discussion often follows about how this research might restrict access to new medical innovations. But this focus obscures the vital role that effectiveness research will play in evaluating current medical and surgical care.
I am now slogging through chemotherapy for stomach cancer, probably the result of high doses of radiation for Hodgkin lymphoma in the early 1970s, which was the standard treatment until long-term side effects (heart problems, additional cancers) emerged in the late 80s. So I am especially attuned to the need for research that tracks the short and long-term effectiveness — and dangers — of treatments.
Choosing a surgeon this September to remove my tumor shone a bright light for me on the need for research that evaluates current practices. Two of the three surgeons I consulted wanted to follow “standard treatment procedures” and leave a six-centimeter, cancer-free margin around my tumor. This would mean taking my whole stomach out, because of its anatomy and arterial supply.
The third surgeon began our consultation by stating that her aim would be to preserve as much of my stomach as possible because of the difference in quality of life between having even part of one’s stomach versus none. If at all possible, she wanted to spare me life without a stomach.
But what about the six-centimeter margin? “There isn’t really much evidence to support that standard,” she said. “This issue came up and was discussed at a national guidelines meeting earlier in the week. No one seemed to know where it came from. We have a gastric cancer registry at this hospital going back to the mid 1990s and we haven’t seen support for it there, either. A smaller margin is not associated with an increased risk of recurrence.” Read more »