And you're on mute, sir. Okay. So I'd like to. Can you see my slide okay. Okay, so the title of my talk today is the importance of evidence based decision making in a daily practice and the importance of making their dances. So I'd like to do, looking back my, my background history. Okay, so 40 years ago. Dr. KF, it's myself, joined the department of OB, OBGYN at the university hospital as a first year resident, and that the professors s ground round, Dr. KF got the treatment suggestions from Professor, always. And two weeks later, that professor gave me a different suggestion. So, um, I just wondered why, because the patient's condition was not so different from two weeks ago. So I whispered to my supervisor, Dr. Yu. I don't understand why the professor changed his suggestions, and the supervisor whispered back to him, shut up KF, all you have to do is follow the professor's order. I'm believing that the clinical decision can be made only by the professor. The questions here is, why did Professor S changed his suggestions. Okay. Probably, he has a good reasons from his experience. The problem was Dr. Yu did not explain why the professor changed his suggestions. Another problem, big problem is that Dr. KF stopped thinking the reasons, and believed just to follow the professor's order. And 80 years later, it's 1988. Dr. KF was in the US as a research fellow of, actually this is Wake Forest University in North Carolina. Okay. And he had a chance to join the clinical conference of gynecology oncology department. And he was really shocked because the residents were challenged to their professors. It was in the culture, the shocking phenomenon to him. So the discussion, and the discussion was based on the clinical data from the scientific literatures. And this is the first encounterment for him to the world of evidence based medicine at the time. At the same time, he witnessed the real world of clinical trials at the Wake Forest University, which was the one of the top recruiter of GOG. Professor Howard Homsley told him that the clinical trial is the best way to create high quality of evidences. Now I'm just looking back the situation in Japan. In 1980s and 1990s, there was no concept of evidence based medicine, and no treatment guidelines. In 2004, first treatment guideline was published for the ovarian cancer, and I actually joined to the writing team. So as a writing team member of the first ovarian cancer treatment guideline in Japan, I realized there was too many clinical questions to be answered, and too few high level evidences exist. Also, I realized that there are some adverse effects in the treatment guidelines itself. So, as you know, the benefit of the treatment guideline is standardize the treatment. But the adverse event, I mean the effect of the treatment guidelines was that young doctors only follow the guidelines. They're not thinking why this option is important, or stop thinking about alternative treatment options. So this is exactly the similar situation to the young Dr. KF, you know, not think anything. So, Dr. KF, I really got frustrated. What the hell is evidence based medicine? So I just, I thought that the evidence based medicine sounds like the medical practice, only based on the established or published evidences in the literature. But if I look at the definition, official definition of the evidence based medicine, it says that the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. And so the aim of the evidence based medicine is defined to integrate experience of the physician, value of the patient, the best available scientific information to guide decision making about the clinical management. This is a beautiful definition, I think. So I will make this kind of summarize the definition of the decision making in the medical practice. Yes, experience of the physician is very important. And having higher level of evidence makes your life much easier. So creating the evidence is also important. And the development of evidence means doing the clinical research. And clinical research will integrate the experiences of the multiple physicians, as you know. And the clinical trial, which is the interventional clinical research, provides higher level of evidence. So the conducting the clinical trial improves the level of the daily practice. So I will show the reasons. So what I meant is conducting the clinical trial will also improve the level of the daily practice. This is because clinical trial is an ultimate team medicine, and the clinical trial must be conducted under the protocol, need to monitor the safety of the patients very carefully, must be conducted under the full informed consent. So I'd like to explain a little bit more about the reasons. So the clinical trial is a multiple ultimate team medicine, because the physicians cannot conduct the clinical trials without having support by nurses, clinical research associates, and others. And also clinical trial is a team medicine with participating patients for the future patients. This is the beautiful illustration of what is the daily practice here and the clinical trial teams. This schema was provided by my good friend, Noriko Fujiwara, and she created this beautiful picture showing the difference of the daily practice and the clinical trials. And the second reason the clinical trial must be conducted under the protocol. So in order to conduct a clinical trial, it is not allowed to deviate from the treatment defined by the protocol, regardless of whether you like or dislike the protocol treatment, you have to follow. And the treatment specified in the protocol must be the standard of care or considered to be better. And that must be ethically and medically well designed. Therefore, by repeating clinical trials, it becomes common to discuss with your medical team what the standard treatments are. The reason number three is clinical trial needs to monitor the safety of the patients very carefully. So patient safety information should be should be well monitored and serious adverse events should be reported timely manner. Therefore, by repeating clinical trials, compliance with the medical safety rules becomes common rule in the daily practice. Reason number four, clinical trial must be conducted after full informed consent. This is very important. Most importantly, a clinical trial can create a culture in which it is standard practice to fully explain to patients and obtain their consent before performing a medical intervention every day. So this is the kind of the outcome of doing a clinical trial. Dr. DuBois at Germany published in the International Journal of Gynecologic Cancer in 2005 that this Kaplan-Meier curve shows that the survival outcome of ovarian cancer patients is better in the hospital where the clinical trial has been conducted, comparing to the hospital where the clinical trial is not conducted. So this is the beautiful outcome. So next question is, how can you do the clinical trials? I think jumping into the clinical trial may be a little bit overwhelming. So the first step for the young investigators will be conducting the retrospective clinical research with their colleagues, single or multiple institutions. And also, I'd like to propose the mental level investigators to consider to participate in existing clinical trials. This should be national or international. And at the same time, please consider forming a trial team in your department or institution. So we have the beautiful network of the clinical trials, which is the Gynecologic Cancer Intergroup, the worldwide network of the gynecologic cancer trial groups. We have 33 groups, but we have very few in Asia and Latin America and zero in Africa. And also we have, this is the group photos of the GCIG in 2018 in Munich meeting. And also we have the CCRN, which is the Cervical Cancer Research Network, which is the research network under the umbrella of GCIG. And the CCRN is focusing to promote high quality clinical research on cervical cancer in low middle income countries. And actually we have been conducting the education symposium in those cities here. And last year in February, we actually planned to have the education meeting in Da Nang, but it was unfortunately postponed because of the COVID-19. So we really want to come back probably in conjunction with IGCS too. And this is the list of the CCRN trials. If you are interested in, just please let me know. And the beautiful thing is that CCRN trials can be joined not only as a group, but also as an institution itself. So just think about to join. And also we have established the Asian Pacific Gynecological Oncology Trials. Joe has mentioned briefly, but we are now making the infrastructure of doing the clinical trials in Asia. So take our message from myself to the young doctors for today's talk. Please take your first step to make a new evidence. Have more clinical questions by seeing more patients. You have to work really hard. And having more experience. Experience is very important. And reading treatment guidelines more carefully. So just do not follow because it says so. And find new evidence to be created. And have your interest in conducting the clinical trials, please. And the Gynecological Cancer Clinical Trial Committee is always with you. So just think about to join us. Well, thank you for listening. Thank you for listening.

evidence-based decision-making

medical practice

treatment suggestions

clinical trials

patient involvement