[Regional implementation of guidelines as a lesson for cancer centers]

43 German Comprehensive Cancer Centers (CCC) are gathered together in a cooperative group (Arbeitsgemeinschaft Deutscher Tumorzentren e.V. = ADT). The main task of these centers is the development of interdisciplinary structures which ensure provision of the optimum facilities of diagnostic procedures, treatment modalities and follow-up management for every patient in all regions of Germany. To realize these efforts, the CCC have to establish expert groups dealing with definite tumor entities and establishing guidelines, which have to be propagated in the respective regions. The experts are responsible for the spreading of relevant information which has to be actualized periodically. The basis of this information system can be the guidelines which are developed together with the German Cancer Society (Deutsche Krebsgesellschaft e.V. = DKG). However, in some cases, the CCC have a longstanding tradition with the elaboration and use of their own guidelines. Yet, these regional guidelines should be in very close congruency with the overlaying national guidelines. Deviations from these general rules have to be explained by the citation of reliable literature from peer reviewed journals. All guidelines must be worked out sticking to the rules of "Evidence Based Medicine" (EBM). An inquiry launched by the ADT revealed different needs in several CCC for further establishment of interdisciplinary expert panels and guidelines.