Comparative Effectiveness In Surgical Oncology

Despite tremendous recent advances in the treatment of most malignancies, there remain several critical questions for each cancer. This particularly true for the surgical management of solid-organ malignancies. Comparative effectiveness is a relatively new term which encompasses the age-old concepts of how best to treat cancer patients. Comparative effectiveness is defined as the direct comparison of healthcare interventions to determine which work best for which patients when considering the benefits and risks. The Institute of Medicine has defined comparative effectiveness research(CER) as the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. CER is certainly best done with well-conducted randomized controlled trials. Unfortunately, clinical trials are not always feasible owing to the impracticality of conducting the trial, the considerable cost, and the time required to complete the trial. These challenges are even more pronounced with respect to surgical treatment. Thus alternative approaches may need to be considered in order to address pressing questions in the care of the oncology patient. These approaches may include well-conducted retrospective cohort studies from cancer registries and other data sources, decision and cost-effectiveness analyses, and other novel methodologies. This book lays out the current critical questions for each major malignancy and proposes approaches to gain answers to these pressing questions.

Clinical research presents health care providers with information on the natural history and clinical presentations of disease as well as diagnostic and treatment options. In today's healthcare system, patients, physicians, clinicians and family caregivers often lack the sufficient scientific data and evidence they need to determine the best course of treatment for the patients' medical conditions. Initial National Priorities for Comparative Effectiveness Research(CER) is designed to fill this knowledge gap by assisting patients and healthcare providers across diverse settings in making more informed decisions. In this 2009 report, the Institute of Medicine's Committee on Comparative Effectiveness Research Prioritization establishes a working definition of CER, develops a priority list of research topics, and identifies the necessary requirements to support a robust and sustainable CER enterprise. As part of the 2009 American Recovery and Reinvestment Act, Congress appropriated $1.1 billion in federal support of CER, reflecting legislators' belief that better decisions about the use of health care could improve the public's health and reduce the cost of care. The Committee on Comparative Effectiveness Research Prioritization was successful in preparing a list 100 top priority CER topics and 10 recommendations for best practices in the field.

This User’s Guide is a resource for investigators and stakeholders who develop and review observational comparative effectiveness research protocols. It explains how to (1) identify key considerations and best practices for research design; (2) build a protocol based on these standards and best practices; and (3) judge the adequacy and completeness of a protocol. Eleven chapters cover all aspects of research design, including: developing study objectives, defining and refining study questions, addressing the heterogeneity of treatment effect, characterizing exposure, selecting a comparator, defining and measuring outcomes, and identifying optimal data sources. Checklists of guidance and key considerations for protocols are provided at the end of each chapter. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews. More more information, please consult the Agency website: www.effectivehealthcare.ahrq.gov)

The Operation Primer provides excellent photographic step-by-step guidance to the surgical procedure. It has been produced to describe the operation in the simplest manner possible without over-simplifying. The core of the Operation Primer is the section on Nodal Points, where the key surgical steps are described in detail. This surgical guidebook provides essential reference material to surgeons wishing to update their knowledge in this specific area. The Operation Primer Video-assisted Thoracoscopic Lobectomy is specially created for surgeons wishing to familiarize themselves with minimally invasive, video-assisted thoracoscopic surgical techniques. VATS lobectomy is an accepted and safe procedure, and the oncological outcome is as good as with the traditional open approach. This operation primer is an excellent teaching tool, accurately describing the steps of this technique in a manner suitable for both beginners and experienced surgeons. It provides a detailed overview of patient preparation, key surgical steps, and common pitfalls of VATS lobectomy. This Operation Primer will provide surgeons with a reliable and systematic approach to performing VATS lobectomy.

Principles and Practice of Surgical Oncology uniquely emphasizes a multidisciplinary, integrated approach to the treatment of solid tumors. It presents treatment strategies that combine surgery with preoperative or postoperative adjunctive chemotherapy, hormonal therapy, and/or radiation therapy to achieve optimal outcome. The book features contributions from surgeons, basic scientists, pathologists, radiologists, radiation therapists, and medical oncologists and offers a comprehensive presentation of genetics, molecular biology, pathogenesis, and multimodal therapeutic approaches. A unique feature of the book is a commentary following each chapter, which describes alternative approaches and discusses controversial areas of current therapy. A companion Website will offer the fully searchable text with images.

Essential Surgery is part of a nine volume series for Disease Control Priorities which focuses on health interventions intended to reduce morbidity and mortality. The Essential Surgery volume focuses on four key aspects including global financial responsibility, emergency procedures, essential services organization and cost analysis.

Rising health care costs are a central fiscal challenge confronting the United States. National spending on health care currently accounts for 18 percent of gross domestic product (GDP), but is anticipated to increase to 25 percent of GDP by 2037. The Bipartisan Policy Center argues that "this rapid growth in health expenditures creates an unsustainable burden on America's economy, with far-reaching consequences". These consequences include crowding out many national priorities, including investments in education, infrastructure, and research; stagnation of employee wages; and decreased international competitiveness.In spite of health care costs that far exceed those of other countries, health outcomes in the United States are not considerably better. With the goal of ensuring that patients have access to high-quality, affordable cancer care, the Institute of Medicine's (IOM's) National Cancer Policy Forum convened a public workshop, Delivering Affordable Cancer Care in the 21st Century, October 8-9, 2012, in Washington, DC. Delivering Affordable Cancer Care in the 21st Century summarizes the workshop.

This issue of Surgical Oncology Clinics of North America, guest edited by Drs. Caprice C. Greenberg and Daniel E. Abbott, is devoted to Measuring Quality in a Shifting Payment Landscape: Implications for Surgical Oncology. Drs. Caprice C. Greenberg and Daniel E. Abbott have assembled expert authors to review the following topics: Implications of the Affordable Care Act or Surgery and Cancer Care; Repealing the Affordable Care Act and Implications for Cancer Care; Quality Measurement and Pay for Performance; Surgical Collaboratives for Quality Improvement; Big Data and Cancer Care; Cancer Care Delivery Research; Engaging Stakeholders and Patient Partners; Beyond Morbidity and Mortaility - Outcomes that Matter to Patients; Regionalization and its Alternatives; The Economics of the End of Life: Power of Attorney, Palliative Care, Utilization of Hospice; The Accountable Care Organization for Surgical Care; and more!