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Pitfalls and controversies of guidelines in oncology.

Over the last years research in oncology has generated a proliferation of information that has made it difficult to make clinical decisions on the basis of the available scientific findings 1 . Since the 1980s the extensive development of guidelines has aimed to supply recommendations useful for the clinical practice. This need became critical when the resources for oncology were found to be limited and evidence-based medicine was established 2 . On the other hand, the development of guidelines is essential on the basis of other considerations. The benefits resulting from the proper use of guidelines have improved the quality of health care and patients’ health status. A pre-established diagnostictherapeutic pattern removes useless or unnecessary procedures and reduces waiting times, mean hospital stay and, therefore, health care expenditure. Guidelines are a useful tool for the young resident oncologist who benefits from an ethical guide that complements his/her own experience and provides patients with the assurance of proper medical treatment. The patient feels more protected and safeguarded and not at the mercy of the physician’s personal decisions. Uniformity of procedures allows the patient better to approach his/her discomfortable situation. Moreover, guidelines may be useful for the evaluation of the physician’s responsibility: indeed, guidelines are drawn up by specialists selected by scientific societies or groups of oncologists and are based on an objective evaluation of the relevant literature. Guidelines are designed to evaluate objectively the conduct of the physician, even at the forensic medicine level 3 . The main characteristic of guidelines is their consistency: the recommendations should be consistent with the literature and aim at identifying interventions which ensure the best possible results. The development of guidelines involved an increasing number of multidisciplinary specialists who have supported their adoption in the various medical areas 4 . The need for applying a