Treatment options for advanced ovarian cancer, a disease that is often terminal, are primarily palliative in nature and inherently expensive, presenting a dilemma for the managed care organization, whose purpose is to provide high-quality health care at a reasonable cost. Kaiser Permanente Northwest, a staff-model health maintenance organization providing care to patients in Oregon, Washington, and Idaho, has a unique approach to treating advanced ovarian cancer that involves the use of flexible evidence-based practice guidelines. These guidelines, which consist of state-of-the-art chemotherapy protocols, provide the Kaiser physician with the flexibility to treat each patient according to the particular stage and potential curability of the tumor. The Kaiser Permanente system controls costs by reducing hospital bureaucracy and encouraging treatment options that can be administered on an outpatient basis. Kaiser Permanente also makes use of multidisciplinary teams in the coordination of care and emphasizes the development of and participation in clinical research so that existing guidelines can be updated to reflect the best standards of cancer care.