Evidence Based Medicine is the integration of the best medical research evidence with clinical expertise and patient values into daily practice.

The current clinical dogma is that clinical decisions should, as far as possible, be evidence based. However, despite the 30 million pages published annually in over 30,000 biomedical journals, less than a quarter of all medical interventions are supported by solid scientific evidence. While clinicians always based their clinical practice on some evidence, the methodology for formulating and implementing evidence based management guidelines is now better defined. The process involves a careful scrutiny of the peer- reviewed literature for the available evidence, drawing the right inference from it and finally applying it in the routine practice. While the practice of evidence based medicine is desirable in all branches of medicine, it is even more important in oncology as oncological management is usually multidisciplinary, the benefits of adjuvant treatments are small and the therapeutic ratio of most treatments is generally narrow.

While there will always be some diversity in the practice of medicine and the logistical problems of treatment delivery, in this era of evidence based medicine, it will be difficult not to offer a treatment to a patient when there is irrefutable evidence or Grade 'A' recommendation for it. Similarly one cannot justify a toxic or expensive treatment when there is little or no systematic evidence for its use or Grade 'D' recommendation.

In this handbook, evidence based management guidelines have been presented for our common cancers: Head & Neck, Breast, Gynaecological and Gastro Intestinal. In formulating these management guidelines, site specific multidisciplinary clinical units comprising of Surgical, Radiation and Medical Oncologists, Pathologists and Radiologists have reviewed the published literature in terms of the quality of evidence and their applicability to the common clinical presentations of such cancers in India. The objective of this document is to provide general guidelines and promote the practice of evidence based medicine while taking into account the scientific quality of the evidence; resources or expertise available at the TMH; patient's performance status and their expected compliance.

The rapid pace of clinical research in oncology mandates a continuous process of review and refinements of the EBM guidelines, clinical skills and treatment facilities. These guidelines will be reviewed and updated annually. Feedback from the readers about the applicability of these guidelines in their practice will be invaluable in our efforts towards integrating the best available clinical evidence in our routine practice.

Dr (Ms) K A Dinshaw, DMRT, FRCR. 28th February 2003
Director, Mumbai
Tata Memorial Centre. India