A Global Standard

Oncology is the only medical specialty which has adopted treatment guidelines which are followed by virtually every cancer center and practice in the country and many other nations around the world. These guidelines, developed under the direction of the National Comprehensive Cancer Network (NCCN), are regimens which use multi-step decision trees to assist providers determine the most appropriate evidence-based treatment for a specific condition at a particular stage in a patient with an established diagnosis. Although not every cancer center is involved in the development of these standards, they are followed by virtually all centers and payer reimbursement is often based on compliance with these standards.

Many factors are used to determine the status of a patient’s cancer: the general diagnosis, any genetic mutations that make their cancer ‘different’ and susceptible to targeted therapy, how far the cancer has progressed (the ‘stage’), any conditions they may have that could affect treatment (comorbidities), a family history of cancer, a personal history of cancer, general health status, and others.

Diagnostic tests are used to make an initial diagnosis, identify genetic mutations, determine the presence of metastases, etc. These tests include biopsies, CT Scans, MRIs, PET scans, bone scans, ultrasounds, colonoscopies, endoscopies, blood tests, etc.

Sometimes several different regimens must be followed as a cancer ‘progresses’. This is done because not every person with a specific cancer will respond in the same way, or the cancer may mutate or become resistant (refractory) to a specific therapy, or has returned (recurred).