Dear All,
Greetings from Al-Ain the oasis city. I just came back after attending the
conference in Barcelona and picked up the discussion on audit and research.
I think there is a very thin line between audit and research. Here is an
audit project which I think would easily fit in to the broad definition of
research. The authors have even used the term evidence in their title and
also have used techniques that will be normally used in original research.
The results of this audit project do add to our knowledge on the status of
cancer care in rural areas.
But still some might argue that this is only audit as the authors are
checking whether guidelines are being followed in rural areas and it can
become research only when the authors study why they (guidelines) are not
being followed and whether any changes (interventions) alters the status of
cancer care.
I wonder how many of you might vote with me that this paper by Tropman et al
can be considered as research as well as audit and not merely audit.
Tropman SE, Ricketts TC, Paskett E, Hatzell TA, Cooper MR, Aldrich T. Rural
breast cancer treatment: evidence from the Reaching Communities for Cancer
Care (REACH) project. Breast Cancer Res Treat 1999 Jul;56(1):59-66
BACKGROUND: Research shows that rural populations are more likely than their
urban counterparts to be diagnosed with late-stage cancer, but less is known
about appropriateness of cancer treatment in rural locations after
diagnosis. The objective of this analysis was to assess the degree to which
rural breast cancer treatment was received in concordance with national
recommendations.
METHODS: Data came from 251 stage I and II breast cancer patients residing
in rural North Carolina. State-of-the-art care was defined using the
National Cancer Institute's (NCI) physician data query (PDQ) database, and
cases were categorized into appropriate primary and/or adjuvant treatment.
Chi-square and Fishers' exact tests were used to assess changes in
appropriate treatment over time (1991-1996) and between stage. Multiple
logistic regression was used to determine whether any patient or disease
characteristics were associated with receipt of appropriate treatment.
RESULTS: Most (81-90%) of the breast cancer cases received the appropriate
primary therapy (mastectomy or lumpectomy followed by radiation therapy); of
these, the majority received a mastectomy (66-72%). Fewer women received
adjuvant therapy as recommended (27-61%), although significantly more stage
II than stage I cases did so (p < or = 0.05). Regression showed that stage
and estrogen-receptor (ER) status were associated with appropriate therapy.
CONCLUSIONS: The findings suggest that there exist deviations from NCI
established treatment recommendations among rural breast cancer patients.
More research is needed to develop better methods for dissemination of
state-of-the-art cancer information to rural physicians and patients, and to
understand how treatment decisions are made.
Cheers & regards,
Badri
Dr.P.Badrinath M.D,M.Phil,(Epid)PhD(Cantab)DFPHM(UK),MPH(Distinc)
Clinical Assistant Professor & Hon Consultant in Preventive Medicine,
Department of Community Medicine,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates.
Tel: 00 971 3 7039 652
Fax: 00 971 3 7672022.
http://myprofile.cos.com/badrishanthi
"For an excellent review of the current medical literature, go to Journals
Scan www.uaeu.ac.ae/jscan/" - BMJ 3rd June 2000, Netlines
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