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Correspondence (letter to the editor): Is the Care Provided Really Adequate?

The question of whether the healthcare provision for patients with breast cancer meets the standard is worth while. I am a gynecologist with a psycho-oncological subspecialism, and I find it baffling that this question seems to have been studied only in the context of surgery/chemotherapy/radiotherapy, whereas the problem of psychological advice and care were not taken into consideration at all. 
 
The guidelines state that psycho-oncological measures should be integrated into the basic concept, and that all patients should be informed at an early stage and as a rule about psycho-oncological measures during acute treatment and also during aftercare. High grade evidence supports these recommendations. 
 
It would be possible to convert these prescriptions, in analogy to other evidence based recommendations, into reference ranges and to question patients accordingly. Why was this not done, and why was this central research area not touched? 
 
I fear that the results might be depressing. After more than 20 years’ experience I would state with confidence that the physical treatment may meet a high standard but that the women are often left alone with the shock of their illness and dealing with it. Psychosomatic care from the beginning still does not seem to be important enough for hospitals to particularly pay attention what the S3 guideline has to say on the subject. Psycho-oncological care during aftercare benefits very few women; applications to obtain it are laborious, and it is not available as an adjuvant routine measure like chemotherapy or hormone therapy. 
 
While it is satisfying that the concept of guideline conform treatment has been mostly implemented, the question remains of how do authors base their findings on an idea of "adequate" care provision if they don’t question this area which is so crucial for the quality of life?