Evidence-based Medicine and Cancer Treatment-- An interview with Professor Fok Tai Fai

Prof. Fok Tai Fai
Associate Dean of the Faculty of Medicine,
Chairman of Department of Paediatrics, CUHK

Why is Evidence-based Medicine (EBM) so important?
The four major steps involved in EBM are: 1) formulating a specific clinical question; 2) searching for available evidence; 3) critical appraisal of evidence; and 4) integrating evidence, clinical judgment and patient value to formulate a treatment plan.

The study of EBM is becoming more important and popular because medical professionals have realized that making health care decisions based simply on personal knowledge gained from past experience is not scientific enough. They need up to date objective evidence-based information to help them make the best decisions about treatment.

For example, physicians in the 40s' gave premature babies extra oxygen to increase their chance of survival. Unfortunately, many babies became blind after this treatment. Research done in the 50s' showed that too much oxygen given to premature babies would lead to blindness thus clearly demonstrating the importance of EBM in clinical practice.

How EBM helps in treating cancer?
EBM is crucial in treating serious illnesses like cancers. Cancers can never be cured by making decisions based on only one or two similar past cases. Treatment methods must be decided only after referring to all available evidence. Physicians are required to take into account the findings of scientific research studying the efficacy and safety of all possible therapeutic options and balance the risks and benefits of each of these options.

For example, doctors at the Lady Pao Children's Cancer Centre will first carefully evaluate the patient's condition and response to previous treatment before proceeding with further therapy and they will never use any method that has not been tested. One of the references often used is the Cockrane Database. It contains reviews on all the available medical evidences and is easy for doctors to apply the information in their diagnoses and treatments.

Of course, doctors never completely accept everything they read because not all of it may be accurate. They have to make informed decisions making use of their own first hand experience and all the other information available.

Is EBM being valued by the medical profession?
The CUHK Department of Paediatrics takes great notice of EBM. We critically analyze the evidence recorded in medical literature by applying the EBM techniques during our weekly Journal Club meetings. Staff are continually conducting medical research and publishing articles in medical journals. During our weekly Research Meeting, we reevaluate both the progress of each research project and methods we should take to obtain objective and reliable results.

EBM is gaining greater attention by the medical profession worldwide. In the Chinese University, including the Department of Paediatrics, there are many research projects that employ the EBM approach to evaluate the use of traditional and alternative medicine in the treatment of a variety of medical conditions, including cancer. Traditional and alternative medicine is already gaining popularity in the community especially among patients with chronic and potentially fatal diseases such as cancer. While it is likely that some of the traditional / alternative medical practices might be beneficial to some of the patients, others might not have any therapeutic effect or might indeed be harmful. It is important for medical researchers to determine the benefits and risks of each of these practices.