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Why isn't there a standard of care for lymphoma?
Feb 19, 2002

Dr Dezube; I was wondering why hasn't a National Standard of care been devised for treatment of non-Hodgkin's lymphoma. The Reason I'm asking is that because my orginal Oncologist firmly believed in only given diluted chemotherapy as treatment; I had 4 relapses in 20 months. I'm not angry but i don't want to see what happened to me, happen to others. We have standards of care for cardiac and respiratory disease; why not HIV? Nothing will change unless we are proactive and ask questions. Dr Dezube can you see the benefit of such a National guideline for treatment for people living with HIV/NHL. Thank you.

Response from Dr. Dezube

In order for me to answer the question of why there is no standard of care for AIDS-related lymphoma, you need to understand how standards of care are generated. These standards come out of clinical trials, typical large ones with tens of thousands of patients. Often these trials are randomized and involve placebos. Such trials appear regularly in the New England Journal of Medicine and in many other fine medical journals. Experts in the field then meet and discuss these articles and draw-up a "standard of care" which then often goes through many revisions. In the field of AIDS-related cancer, the number of patients is relatively small. Although there have indeed been randomized controlled trials, they were not of sufficient size to set a new standard. The trials, however, have nevertheless been important to influence prescribing practice, but they simply don't qualify as "standard of care". The best way for patients to facilitate the development of "standards of care" is to enroll in trials. Only though the clinical trial process can new drugs be tested and new standards of care be defined. I agree with you that we need to be proactive.


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