The quality of medical evidence in hematology-oncology

Djulbegoviĉ, Benjamin; Loughran, Thomas P.; Hornung, Carlton A.; Kloecker, Goetz; Efthimiadis, Efthimis N.; Hadley, Terence J.; Englert, Jennifer; Hoskins, Michelle; Goldsmith, George H.

doi:10.1016/s0002-9343(98)00391-x

Cited by 46 publications

(22 citation statements)

References 15 publications

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“…Category 1 recommendations were available most often for therapeutic decision making and were largely absent for screening or surveillance. These findings are similar to those previously reported by Djulbegovic et al, 8,9 who found that among 1,000 key decisions related to patients with cancer, only 24% could be supported by reliable evidence; these decisions were based on only a tiny fraction of articles published in the oncology literature.…”

Section: Lack Of a Strong Evidence Basesupporting

confidence: 91%

Counterpoint: Sowing the Seeds of Standardized Care to Reap Better Patient Outcomes

Jacobson

2012

JOP

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Medical oncology is at a critical crossroads. Our subspecialty emerged at a time when treatment of cancer was limited to surgical removal or radiation therapy for patients with localized malignancies. Patients were referred to medical oncologists with advanced-stage disease only, when other options had been exhausted. An empirical approach to care emerged. As new agents became available, they were tested across a broad range of cancers. In time, the benefits of combination chemotherapy were defined; chemotherapy became established as effective treatment of cancer in palliative, adjuvant and curative-intent settings. Again, largely through trial and error, and well-conducted clinical trials, effective therapeutic approaches emerged that successfully combined chemotherapy with radiation and/or surgery. Only in recent years has medical oncology begun to leave its early roots behind to enter the era of genomics and targeted therapies. 1 The empirical approach to medical oncology, and the relatively low penetration of clinical trials into practice enabled it to remain a craft or guild-based specialty. 2,3 Individual patients expected to be offered uniquely designed solutions in which the medical oncologist forged a pact with the patient to identify the very best combination of agents for their condition. As relapses occurred, medical oncologists were ready with alternative solutions, combining different agents, or recycling previously effective ones, until the patient was either too infirm for further treatment or toxicities became intolerable. The results of this approach have best been summarized by Smith and Hillner in their article, "Bending the Cost Curve in Cancer Care." 4 Cancer care costs have spiraled out of control, rising far more quickly than other health care expenses, greatly taxing insurers and employers, and frequently resulting in catastrophic financial consequences to patients, with little associated benefit. 5,6 Why Has Craft-Based Medical Oncology Practice Failed? Lack of a Strong Evidence BasePoonacha and Go 7 recently published an exhaustive review of 1,023 clinical practice guideline (CPG) recommendations from the National Comprehensive Cancer Network for 10 common malignancies. Level 1 recommendations (high-level evidence with strong consensus) were found in only 6% of the CPGs, ranging from 1% for colorectal cancer to 20% for kidney cancer. Category 1 recommendations were available most often for therapeutic decision making and were largely absent for screening or surveillance. These findings are similar to those previously reported by Djulbegovic et al,8,9 who found that among 1,000 key decisions related to patients with cancer, only 24% could be supported by reliable evidence; these decisions were based on only a tiny fraction of articles published in the oncology literature.

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Section: Lack Of a Strong Evidence Basesupporting

confidence: 91%

Counterpoint: Sowing the Seeds of Standardized Care to Reap Better Patient Outcomes

Jacobson

2012

JOP

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“…Furthermore, rigorous approaches have been recently developed to quantify the burden of disease for various conditions [18]. It is thus becoming evident that for several trivial issues, there is often a waste variety of expensive treatments, while for many serious conditions there is no effective intervention at all and little research is targeted at them [19,20]. …”

Section: Clinical Sciences: Maturing In Evidence Basementioning

confidence: 99%

Materializing research promises: opportunities, priorities and conflicts in translational medicine

Ioannidis

2004

J Transl Med

103

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There is considerable evidence that the translation rate of major basic science promises to clinical applications has been inefficient and disappointing. The deficiencies of translational science have often been proposed as an explanation for this failure. An alternative explanation is that until recently basic science advances have made oversimplified assumptions that have not matched the true etiological complexity of most common diseases; while clinical science has suffered from poor research practices, overt biases and conflicts of interest. The advent of molecular medicine and the recasting of clinical science along the principles of evidence-based medicine provide a better environment where translational research may now materialize its goals. At the same time, priority issues need to be addressed in order to exploit the new opportunities. Translational research should focus on diseases with global impact, if true progress is to be made against human suffering. The health outcomes of interest for translational efforts need to be carefully defined and a balance must be struck between the subjective needs of healthcare consumers and objective health outcomes. Development of more simple, practical and safer interventions may be as important a target for translational research as the development of cures for diseases where no effective interventions are available at all. Moreover, while the role of the industry is catalytic in translating research advances to licensed interventions, academic independence needs to be sustained and strengthened at a global level. Conflicts of interest may stifle translational research efforts internationally. The profit motive is unlikely to be sufficient alone to advance biomedical research towards genuine progress.

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“…Randomized controlled trials (RCTs) are considered the best tool for establishing effectiveness due to minimization of bias in evaluating new treatment strategies [1-3]. RCTs represent a key research activity with the potential to improve the quality of health care and control costs through careful comparison of alternative treatments [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…RCTs represent a key research activity with the potential to improve the quality of health care and control costs through careful comparison of alternative treatments [4,5]. However, the recent flood of available information in biomedical journals during the last years has raised problems in a variety of areas, such as publication or selection bias and retraction of invalid literature [1,6,7]. …”

Section: Introductionmentioning

confidence: 99%

Quality of reporting of randomized controlled trials in polycystic ovary syndrome

Partsinevelou

Zintzaras

2009

Trials

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BackgroundInadequate reporting of randomized controlled trials (RCTs) is associated with biased estimates of treatment effects. The reporting quality of RCTs involving patients with polycystic ovary syndrome (PCOS) is unknown. The purpose of this study was to assess the reporting quality of RCTs involving patients with PCOS using a standardized tool based on the Consolidated Standards of Reporting Trials (CONSORT) statement.MethodsWe searched PubMed database for English-language RCTs involving patients with PCOS. Quality of reporting was assessed using a 24-item questionnaire based on the revised CONSORT checklist. Reporting was evaluated overall, and for pre- and post-CONSORT periods. RCTs on PCOS associated with fertility and non-fertility disturbances were also evaluated separately.ResultsNine of the 24 items were reported in less than 50% of the studies, while a significant improvement (P < 0.05) was detected in 12 of 24 items (50%) over the two CONSORT periods. The RCTs on PCOS with reference to fertility seem to have adhered better to CONSORT statement than RCTs not associated to fertility.ConclusionThere is empirical evidence of suboptimal reporting quality of RCTs in PCOS. Endorsement of the CONSORT statement may optimize the reporting quality and enhance the validity of research.

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The quality of medical evidence in hematology-oncology

Cited by 46 publications

References 15 publications

Counterpoint: Sowing the Seeds of Standardized Care to Reap Better Patient Outcomes

Counterpoint: Sowing the Seeds of Standardized Care to Reap Better Patient Outcomes

Materializing research promises: opportunities, priorities and conflicts in translational medicine

Quality of reporting of randomized controlled trials in polycystic ovary syndrome

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