Randomized Clinical Trials in Melanoma

Spanknebel, Kathryn; Temple, Larissa; Hiotis, Spiros P.; Yeh, Alice; Coit, Daniel G.

doi:10.1016/s1055-3207(03)00074-7

Cited by 2 publications

(1 citation statement)

References 32 publications

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“…Elective lymph node dissection with its associated high morbidity rates can now be avoided in patients with malignant melanoma without clinically detectable regional metastases, as it has been shown not to be associated with a survival benefit in a number of RCT 34 . The results of more than 70 RCT have also helped define the role of chemotherapy, immunotherapy and vaccine therapy in the management of the disease 35 …”

Section: Introductionmentioning

confidence: 99%

Will the Dilemma of Evidence‐based Surgery Ever Be Resolved?

Abraham

2006

ANZ Journal of Surgery

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Exponents of evidence-based medicine do not undermine the importance of clinical expertise and skills, but they emphasize that decision-making in medicine should be based on the best available evidence derived from the systematic analysis of observations made in an objective, unbiased and a reproducible fashion. The randomized controlled trial (RCT) is the most scientifically rigorous means of hypothesis testing in epidemiology. Discrepancies between established surgical and other interventions and best available evidence are common. These can be in the form of significant delay in adopting a new intervention despite strong supportive evidence, adopting an intervention before supportive evidence becomes available for reasons of novelty or pear pressure and the lack of supportive evidence for many established common practices. This is compounded further by the paucity of good quality evidence for most surgical procedures. This is arguably because of the inherent difficulties in conducting surgical RCT. The practical, ethical and financial ramifications are complex and the nature of surgical disease often compromise the chances of success or completion of RCT. Carrying out surgical RCT may have more implications on the clinician's authority, autonomy and income and their results are more likely to be influenced by his/her expertise and competence than medical RCT. Furthermore, the success of surgical RCT is often jeopardized by very low recruitment rates. The aim of this study is to discuss the dilemma of producing evidence in surgery.

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Section: Introductionmentioning

confidence: 99%