In the past few months I have had the privilege of traveling to Japan, the United Arab Emirates, and China with groups of physicians presenting NCCN Clinical Practice Guidelines in Oncology. One particularly rewarding aspect of these experiences has been recognizing how similar the management of cancer is in these diverse areas of the world. Physicians in all areas of the world are reviewing the same literature so that, with minor changes to account for regulatory availability of agents, access to specific technologies, and metabolic and genetic differences among populations, the treatments for common cancers are very much the same. Especially gratifying is seeing the dedication that physicians in all parts of the world show to their patients.
These travels have also illustrated a few significant differences, however, one of which is how physicians in different cultures talk about end of life issues with patients who have poor prognoses. In this area, when at its best, American medicine shines. In the United States, a continuum of care is becoming the “norm.” In this continuum, tumor-directed therapy continues throughout most of the course of the disease, even as its intent changes from potentially curative to palliative. Similarly, symptom management begins at diagnosis and becomes a greater focus when disease progresses. Patients, doctors, and nurses engage in ongoing conversations about both treatments and the changing goals of treatment.
Initially, the goal is often to cure the disease or to extend life as long as possible. During this period, fighting the cancer is...
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Joan S. McClure, MS, is Senior Vice President of Clinical Information and Publications for the NCCN. She is responsible for the NCCN Clinical Practice Guidelines in Oncology; associated Guidelines for Patients in both English and Spanish; the NCCN Drugs & Biologics Compendium; NCCN Information Technology; and JNCCN; and also serves as an Associate Editor for JNCCN. Ms. McClure previously managed national oncology information programs on contract with the U.S. National Cancer Institute (NCI). She directed investigator and patient recruitment efforts in oncology for a multinational contract research organization, where she also managed efforts to identify and develop standards for data for submission to regulatory authorities in the United States, Europe, and Japan.