The Media's Princess Bride Tomorrow will mark the tenth anniversary of the night the Princess of Wales died in a Paris car wreck while being pursued, as always, by photographers. But it turned out to be more a Faustian bargain than a fairy tale.
Economic modeling, including cost-effectiveness, cost-benefit, and cost-consequence analysis 3.
Because this paper attempts to identify not only the major opportunities and challenges confronting cancer outcomes research but also specific pathways forward in a number of domains, it takes the form of an extended, multipart essay rather than a summary document that only highlights the tasks ahead.
While the sections and subsections below proceed in a sequence that we believe is natural and cumulative, they can be pursued in any order or even selectively, depending on reader interest.
That said, the remaining sections focus in turn on: Macro-level analyses, examining current and potential approaches for population monitoring of trends in HRQOL, patient satisfaction with care, and economic burden.
Meso-level analyses, which encompass a diverse range of outcomes-oriented studies including as subsection topics taken up in turn: Micro-level analyses, highlighting both the challenges in using cancer outcome measures in clinician-patient decision making and a number of specific opportunities to make progress.
Improving the data and methods for cancer outcomes research at the macro, meso, and micro levels, by i capitalizing on modern psychometric methods to strengthen the scientific basis for assessing patient-reported outcomes like HRQOL, and ii accelerating progress in creating electronically oriented cancer information and surveillance systems that can capture, store, and link patient-level data rapidly and accurately while meeting confidentiality and privacy concerns.
Understanding the importance of, and the challenges in identifying the specific impacts of, cancer outcomes research on clinical practices policies, on cancer care delivery in the community, and ultimately on health outcomes. Such research would augment outcomes research on other conditions 2.
A comprehensive discussion of this important, underemphasized component of the cancer outcomes research agenda is beyond the scope of this paper and would merit its own book or monograph.
But to illustrate how one might begin to trace the dynamic linkages from outcomes of research investigations to policies to practices to outcomes, we develop a brief case study involving screening mammography for breast cancer. Emphasizing, in conclusion, that the enduring charge and challenge of cancer outcomes research is to facilitate the delivery of the right information, at the right time, to the right decision makers across the arenas of application.
We need a broader, deeper understanding of where this is being accomplished, where it is not, and how to do better. Approaches To Expandingthe Rangeof Cancer-Related Outcomesin Population Surveillance A comprehensive assessment of the progress being made to reduce the burden of suffering and death due to cancer requires tracking population trends in cancer incidence, survival, and key patient-centered outcomes such as HRQOL, satisfaction with care, and economic burden; see Clauser in this Monograph 3.
At the moment, we know much more about progress in the United States to reduce cancer-related mortality than the suffering felt by those living with a cancer diagnosis.
In what follows, we discuss several possible approaches for expanding the range of outcomes that might be routinely tracked and analyzed in cancer surveillance, focusing on the patient-centered measures noted above. As noted, the general intent of such macro-level studies is to apprise decision makers of important trends, which then would indicate the kinds of meso-level investigations needed to develop a deeper understanding of factors influencing cancer-related outcomes and how to improve them.
HRQOL Although a rich mixture of generic and cancer-specific HRQOL measures are now widely used in clinical trials and observational studies as indicated in the following section on meso-level applicationsin the United States, there has been no corresponding effort to measure the HRQOL of persons with cancer on a population-wide basis 3.
The opportunities and challenges of accomplishing this goal have recently been noted by experts collaborating within the National Coordinating Council for Cancer Surveillance 5. As HRQOL measures have been applied more widely in macro-level studies in Europe and Canada than in the United States 3we turn briefly now to how such efforts might be accelerated in this country.
Broadly speaking, this will require making better use of existing data, collecting additional data in a strategic fashionor both. Because different approaches are required for HRQOL measures that attempt to incorporate population-representative preferences for alternative health outcomes versus HRQOL measures derived from non-preference-based psychometric scaling techniques 3we discuss these two broad categories in turn.
Respondents self-identifying with cancer would receive both generic and cancer-specific modules, and indeed could be administered cancer disease site-specific questions e.
Collect and analyze HRQOL data on nationally representative samples of cancer patients and survivors drawn from the rolls of population-based cancer registries The task for cancer outcomes research is to probe the anatomy and physiology of how decision-relevant information is produced and used in each case.
Clinical Policy Formation Guidelines [e.g., as produced by the National Comprehensive Cancer Network () ]. Unlike most editing & proofreading services, we edit for everything: grammar, spelling, punctuation, idea flow, sentence structure, & more.
Get started now! Gates of Vienna News Feed 1/17/ Tonight’s news feed is unusually fat, due to the inclusion of last night’s items, which were never used because of the Blogger outage. Yesterday a group of Al Qaeda terrorists assaulted a natural gas plant in Algeria and killed two foreigners while taking 41 other hostage.
An investigation of the International Cycling Union found it broke its own rules and allowed doping to flourish, Election Immigration Drugs Special Coverage.
Search Form Comments. Sports. Objectives: To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during These will be the people President George Bush will trust when he pushes more Medicare patients into HMOs where they will get drug coverage.
The companies have been accused of, and have generally denied, taking payments from drug manufacturers in return .