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Guideline-Adherent Care vs Quality Care in Cancer Patients: Twins or Distant Cousins?  Comment on “Deviations From Guideline-Based Therapy for Febrile Neutropenia in Cancer Patients and Their Effect on Outcomes”

Ronald C. Chen, MD, MPH
JAMA Intern Med. 2013;173(7):569-570. doi:10.1001/jamainternmed.2013.209.
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Everyone wants high-quality cancer care—patients want it, as do payers and policy makers, physicians, and other health care providers. For health services researchers, the challenge is: how do we measure quality? Perhaps the most intuitive metric is guideline adherence. For almost all types of cancer and cancer-related conditions, including febrile neutropenia (FN), there are published evidence-based guidelines. I do not think anyone would argue with the merits of providing evidence-based medical care—the use of proved and effective treatments to patients and limiting the use of unproved therapies. As many recent studies have demonstrated, the use of expensive, yet unproved, therapies is highly prevalent in cancer care.1 There is emerging evidence that financial incentives in our health care system may partly contribute to this practice.2,3 Guidelines and research can help mitigate this large-scale problem.

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