This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Implications for the Clinical Applications of Clinical Trials

Raisa B. Deber, PhD; Gail G. Thompson

Arch Intern Med. 1987;147(9):1543-1547.

Abstract
• Conservative breast surgery and modified radical mastectomy may, according to recent reports, yield equivalent survival. Analysis of a 1985 Canada-wide study (N=228) compared surgeons and oncologists still recommending modified radical mastectomy (30%) with those recommending less aggressive surgery (69%) for a hypothetical stage I patient. The groups did not differ significantly in most physician characteristics, estimated survival and cure probabilities, importance of most treatment goals, uncertainty about treatment choice, or most attitudinal responses. Although equally involved with and cognizant of the value of clinical trials, the modified radical group expressed more skepticism about the ability of trial results to be transferred to practice and to take sufficient account of patient uniqueness, indicating greater focus on variation than mean results. Trial results might be more readily adopted if they are reported in accessible databases, incorporating patient characteristics potentially relevant to treatment choice. This would allow clinicians to individualize treatment by analyzing patient subsets of their own choosing.

(Arch Intern Med 1987;147:1543-1547)

Author Affiliations
From the Division of Community Health, Faculty of Medicine, University of Toronto.

Footnotes
Accepted for publication May 26, 1987.

Reprint requests to McMurrich Building, Second Floor, University of Toronto, 12 Queen's Park Crescent W, Toronto, Ontario, Canada M5S 1A8 (Dr Deber).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Factors Related to Underuse of Surveillance Mammography Among Breast Cancer Survivors
Keating et al.
JCO 2006;24:85-94.
ABSTRACT | FULL TEXT  

Variation in the Choice of Breast-Conserving Surgery or Mastectomy: Patient or Physician Decision Making?
Nattinger
JCO 2005;23:5429-5431.
FULL TEXT  

Consultation With a Medical Oncologist Before Surgery and Type of Surgery Among Elderly Women With Early-Stage Breast Cancer
Keating et al.
JCO 2003;21:4532-4539.
ABSTRACT | FULL TEXT  

Breast cancer survival by teaching status of the initial treating hospital
Chaudhry et al.
CMAJ 2001;164:183-188.
ABSTRACT | FULL TEXT  

The Effect of Age and Comorbidity in the Treatment of Elderly Women With Nonmetastatic Breast Cancer
Newschaffer et al.
Arch Intern Med 1996;156:85-90.
ABSTRACT  

The Importance of Mammographic Screening Relative to the Treatment of Women With Carcinoma of the Breast
Solin et al.
Arch Intern Med 1994;154:745-752.
ABSTRACT  

Underutilization of Breast-Conserving Surgery and Radiation Therapy Among Women With Stage I or II Breast Cancer
Lazovich et al.
JAMA 1991;266:3433-3438.
ABSTRACT  

Changing Treatment of Breast Cancer in New Mexico From 1969 Through 1985
Mann et al.
JAMA 1988;259:3413-3417.
ABSTRACT