PubMed · 9100532
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W J Frable. 1997-02-25. To the reader.. https://doi.org/10.1002/(sici)1097-0142(19970225)81%3A1%3C1%3A%3Aaid-cncr1%3E3.0.co%3B2-x
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OBJECTIVE: The primary objective of this study was to assess cancer screening guideline preference by Tennessee internists and family physicians. DESIGN: A one-page, 14-item survey was mailed to 580 internists and family physicians followed by a reminder postcard and a second survey within six weeks of the original mailing. The survey addressed physician practice characteristics, specific preferred cancer screening guidelines used, and self-evaluation of cancer screening and detection practices compared with the practice of coronary artery disease risk and prevention, depression, and obesity/adult-onset diabetes mellitus. SETTING: Internal medicine and family physicians in Tennessee. RESULTS: The overall survey response rate was 57% (N = 300). Of respondents, 83.4% were male and 16.6% were female. Eighty-three percent were board-certified, 30% had subspecialty training, and 62% practiced in a solo practice or a single-specialty group. There were few differences in guideline preference between generalists and subspecialists. Approximately 52% of respondents cited American Cancer Society (ACS) guidelines, 1.7% used US Preventive Services Task Force (USPSTF) guidelines, 34% cited a compilation of various guidelines, and 10% used no guidelines. More physicians rated their treatment of depression (22.9%) or obesity/diabetes mellitus (22.0%) as poor or needing improvement than rated their screening of cancer (16.3%) and coronary artery disease (12.5%) as poor or needing improvement. Survey respondents suggested that the ACS could be most effective in lobbying against tobacco and in providing patient education pamphlets. CONCLUSIONS: Most physicians report using ACS screening guidelines, rate their cancer screening practices as good or very good, and recommend that the ACS lobby against tobacco and provide patient pamphlets. This study reflects physician preference of various cancer screening guidelines. Further research is needed to determine factors influencing physician preferred guideline use as well as actual practices.
BACKGROUND: American Joint Committee on Cancer (AJCC) staging procedures were first published in 1977. Since 1991 the Commission on Cancer (COC) has required AJCC staging of all nonpediatric cancers. The National Cancer Data Base (NCDB) encouraged recording of AJCC staging through analyses of selected aspects of staging completeness. We reviewed the trend toward the adoption of routine AJCC staging by hospitals for the 5-year period 1990-1994. METHODS: NCDB reports for nearly 2 million stageable cancers diagnosed from 1990 through 1994 were examined with emphasis on the hospital cancer program environment. Staging was complete if the hospital submitted stage codes for > or =90% of stageable cases or absent if stage codes were submitted for <5%. Hospitals were classified by ownership and type of cancer program. Regional staging practices also were reviewed. RESULTS: Overall staging increased from 78% to 88%, with increases for every site except carcinomas of the skin, cancers of the extrahepatic bile ducts and urethra, melanoma of the eyelid, and retinoblastoma The percent of hospitals staging completely increased from 49% to 61%, and the percent not routinely staging decreased from 6% to 3%. Complete staging increased in all hospital categories except For-Profit. The trend toward complete staging was uneven among states and regions. CONCLUSIONS: Hospital staging policies were affected by activities of the AJCC, COC, NCDB, clinical protocol procedures, and state policies. The varied completeness of staging at the hospital level by state, region, and type of hospital indicates that the adoption of routine staging is ongoing.
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