Attitudes and practice in the management of metastatic colorectal cancer in Britain. Colorectal Cancer Working Party of the UK Medical Research Council.

Evidence-based medicine is widely held to be the essential basis of modern therapeutics. The principle of adopting into clinical practice those treatments proved to be of value in randomized trials, or in the systematic review of several trials, in encouraging a welcome proliferation of clinical research and meta-analysis. However, many things affect clinical practice; quantifiable therapeutic benefit is only one of them. Furthermore, in many situations, clear evidence of the best treatment is not available. When discussing ideas for a new trial in advanced colorectal cancer that was launched in 1996, the MRC Colorectal Cancer Working Party carried out a survey of the attitudes and practice of surgeons and oncologists who were treating this condition. This revealed substantial diversity of practice amongst experts in the treatment of this common disease, and prompted us to review the factors that affect clinical practice and to discuss the implications.