How is Standard of Care for Cancer Treatment Determined? 

Written by: Rob Levy
Medically Reviewed By: Harold Burstein, MD, PhD, and Peter Enzinger, MD

In general, standard of care is treatment accepted by medical experts for a certain type of disease and that is widely used by healthcare professionals. It is also called best practice, standard medical care, and standard therapy. 

The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology lay out the recognized standards for cancer treatment. The guidelines are developed and updated by 61 individual panels comprising more than 1,700 clinicians and oncology researchers from the 32 NCCN member institutions, including Dana-Farber. The guidelines currently apply to 97% of cancers affecting patients in the United States. 

Harold Burstein, MD, PhD, an Institute Physician and breast oncologist at Dana-Farber is the Dana-Farber delegate to the breast cancer panel of the NCCN. (Each NCCN member clinic sends one delegate to an annual gathering to examine and update the guidelines for standard care.) 

“These are pretty high-level discussions of what the experts think is standard of care, defined by longstanding clinical practice and up-to-date data from large randomized clinical trials,” says Burstein. In addition to the guidelines, the NCCN compiles lists of drugs that are considered appropriate for use in a certain cancer; these drugs are also included in the Medicare and Medicaid–approved compendium of drugs. 

Another Dana-Farber contributor to the NCCN recommendations is Peter Enzinger, MD, director of the Center for Esophageal and Gastric Cancer at Dana-Farber Brigham Cancer Center. He helped write the guidelines for esophageal and gastric cancer.  

“These guidelines are used not only in the United States but have been translated into multiple languages and are considered the standard of care in many countries around the globe,” Enzinger notes.   

Other organizations beyond the NCCN generate their own guidelines: for example, the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO). Oncologists have additional tools at their disposal as well, including UpToDate — a subscription-based software system that provides recommendations to aid clinical decision-making. Most patients with cancer at Dana-Farber and almost every treatment center in the country get the standard of care therapy, says Burstein, but there are some situations where the standard of care isn’t so great that we aren’t open to new ideas,” he notes. “That may mean testing a new drug, or omitting radiation therapy, or trying a new dose of an existing treatment.” In such cases, the research approaches are tested against the standard approach in clinical trials. 

By drawing on the expertise of many prominent cancer specialists in the multiple types of cancer, says Burstein, the NCCN guidelines “provide evidence-based, consensus-driven treatment recommendations to ensure that all patients receive the preventive, diagnostic, therapeutic, and supportive services that are needed to increase the chance of a positive outcome.”