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A Consultant-Extender System for Breast Cancer Adjuvant Chemotherapy

[+] Article, Author, and Disclosure Information

This work was supported by Grant #IR 18-CA 16409 and NO 1-CN45129 from the National Cancer Institute. Dr. Carpenter was an American Cancer Society Junior Faculty Clinical Fellow from 1974-1977.

This paper was presented in part at a joint meeting of the Society for Advanced Medical Systems and the Society for Computer Medicine, Boston, Massachusetts, 10-13 November 1976.

▸Requests for reprints should be addressed to David Wirtschafter, M.D.; Clinical Information Systems, University of Alabama in Birmingham, 809 South 19th Street; Birmingham, AL 35294.

Birmingham, Alabama

© 1979 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1979;90(3):396-401. doi:10.7326/0003-4819-90-3-396
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We have implemented a consultant-extender system that enables community physicians, in cooperation with regional specialists, to deliver adjuvant chemotherapy to patients with node-positive breast cancer. The system employs computer-generated care protocol forms that indicate the data to be collected and the drug dose(s), with the appropriate rules for their administration. This continuous process of monitoring and modifying therapy assures protocol compliance and facilitates quality of care assessment. Seventy-three physicians throughout Alabama delivered appropriate chemotherapy at nearly 97% of 2612 visits by 195 patients. Disease-free intervals of 149 of those patients treated in a prospective clinical trial are indistinguishable from those of comparable patients treated largely within academic centers. This system provides a mechanism for decentralizing speciality care, incorporating community physicians into clinical trials, and improving continuing medical education techniques.





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