US Comparative Research Proposal Includes Multiple Oncology Studies

Nick Mulcahy

July 07, 2009

July 7, 2009 — A new report from the Institute of Medicine (IOM) proposes an initial 100 health topics, including a variety of oncology-related subjects, as priorities in comparative-effectiveness research in the United States.

Some of the proposed studies, including a comparison of the management of localized prostate cancer, include cost as a consideration.

The proposed comparative research is an outgrowth of the American Recovery and Reinvestment Act of 2009, which is federal legislation that called upon the IOM to draft the report. The report provides independent guidance to Congress and the secretary of the US Department of Health and Human Services on how to spend $400 million on research to compare health services and approaches to care, according to a statement from the National Academy of Sciences, of which the IOM is a part.

Comparative-effectiveness research weighs the benefits and harms of various methods in the prevention, diagnosis, treatment, or monitoring of clinical conditions to determine which work best for particular types of patients and in different settings and circumstances, according to the IOM report.

In the report, the 100 initial topics are listed by quartile, or groups of 25, with the first quartile considered the highest-priority group and the fourth quartile the lowest. However, the topics in each quartile are not ranked in any way by order of importance.

Among the oncology-related topics in the first quartile, and thus of paramount importance, are proposed studies that would compare the effectiveness of:

  • Management strategies for ductal carcinoma in situ (DCIS).

  • Management strategies for localized prostate cancer (eg, active surveillance, radical prostatectomy [conventional, robotic, and laparoscopic], and radiotherapy [conformal, brachytherapy, proton-beam, and intensity-modulated radiotherapy]) on survival, recurrence, adverse effects, quality of life, and costs.

  • Imaging technologies in diagnosing, staging, and monitoring patients with cancer, including positron-emission tomography (PET), magnetic resonance imaging (MRI), and computed tomography (CT).

  • Genetic and biomarker testing and usual care in preventing and treating breast, colorectal, prostate, lung, and ovarian cancer.

  • Upper-endoscopy utilization and frequency for patients with gastroesophageal reflux disease on morbidity, quality of life, and diagnosis of esophageal adenocarcinoma.

  • Interventions (such as community-based multilevel interventions, simple health education, usual care) to reduce health disparities in cancer and other conditions.

Oncology-related topics in the second quartile include proposed comparisons of the effectiveness of:

  • Robotic assistance surgery and conventional surgery for common operations such as prostatectomy.

  • Film-screen or digital mammography alone and mammography plus MRI in community practice-based screening for breast cancer in high-risk women of different ages, risk factors, and race or ethnicity.

  • New screening technologies (such as fecal immunochemical tests and CT colonography) and usual care (fecal occult blood tests and colonoscopy) in preventing colorectal cancer.

Oncology-related topics in the third quartile include a proposed comparison of the effectiveness of:

  • Different benefit design, utilization-management, and cost-sharing strategies in improving healthcare access and quality in patients with chronic diseases including cancer.

Oncology-related topics in the fourth quartile include proposed comparisons of the effectiveness of:

  • Surgical resection, observation, or ablative techniques on disease-free and overall survival, tumor recurrence, quality of life, and toxicity in patients with liver metastases.

  • Hospital-based palliative care and usual care on patient-reported outcomes and cost.

The new report from the IOM with the 100 health topics is an important step in what will be an ongoing process, suggested 1 of the report cochairs.

"This report lays the foundation for an ongoing enterprise to provide the evidence that healthcare providers need to make better decisions and achieve better results," said the report cochair Sheldon Greenfield, MD, Donald Bren Professor of Medicine and executive director of the Health Policy Research Institute at the University of California, Irvine.

The report is available for purchase here: Initial Priorities for Comparative Effectiveness Research.