Eric-Charles Antoine

Taxol in the Management of Cancers of the Breast and the Ovary

Despite adequate primary treatment at the time of diagnosis, breast cancer remains a major cause of morbidity and early death for women. To date, 25-30% of axillary node-negative and 60-80% of axillary-node positive patients will develop recurrence within 10 years and subsequently die of the disease (1). Although improving since the wide spread of screening and use of systemic adjuvant treatments, breast cancer mortality rate cannot be considered as satisfactory, and further improvements are urgently needed. For many years doxorubicin-containing combinations have been the mainstay of treatment for metastatic disease and represent today the cornerstone of the chemotherapy programs used in the combined modality management of primary breast cancer. For decades, considerable research effort has been directed toward breast cancer chemotherapy in an attempt to improve anthracycline-based results, but no significant advances have been made. However, the introduction of taxanes in the early 1990s broke the plateau of drug discovery for breast cancer. Paclitaxel (Taxolj , the most extensively studied taxane agent, is one of the most active new drugs in advanced breast cancer with reported responses rates of 40-

Enhancing Clinical Practice Guideline Compliance by Involving Physicians in the Decision Process

Despite the proliferation of implemented clinical practice guidelines (CPGs) as decision support systems, there is still little evidence of changes in physicians behavior. The reasons usually evoked to explain the low physicians compliance consider the incompleteness of guidelines knowledge, the impreciseness of the terms used and the physicians psychological reluctance. Another reason comes from the original verbal design of CPGs as well as the impossibility to enumerate all the contexts in which a guideline applies, which avoid the automatised control of all CPGs interpretations and therefore the design of robust formal models. The ONCODOC approach proposes a decision support framework for implementing guidelines where the context-based interpretation is controlled by clinicians. The first application deals with breast cancer therapy. Experimented in real size at the point of care, the system demonstrated significantly high scores of theoretical agreement with CPGs recommendations and compliance.