Navigation Links
Palliation is rarely a topic in studies on advanced cancer

End-of-life aspects, the corresponding terminology, and the relevance of palliation in advanced cancer are often not considered in publications on randomized controlled trials (RCTs). This is the result of an analysis by the German Institute for Quality and Efficiency in Health Care (IQWiG), which has now been published as final report.

Together with external experts, IQWiG analysed studies on four solid tumours as examples: glioblastoma, lung cancer, malignant melanoma, and pancreatic cancer. For this purpose, the research team evaluated publications on RCTs investigating the use of disease-modifying treatments such as chemotherapy or radiation therapy. Studies on purely symptomatic interventions (e.g. colostomies) were not included.

Only 40% of studies name superior treatment goals

The research team included a total of 100 study publications; 25 for each of the four indications. Even though the median survival time for these four types of tumours is usually 24 months at most, in the introductory description of the study setting, only 71% of the publications provided clear information on the advanced phase of disease.

A superior patient-relevant treatment goal was only named in about 40% of the publications. This does not refer to the study outcomes, but to what was clinically intended with the respective intervention and what patients could hope for. Most cases (30 out of 38) referred solely to an increase in life expectancy; two referred solely to quality of life or symptom control.

PROs are clearly underrepresented

Accordingly, the primary outcome recorded in the studies was almost exclusively overall survival or a surrogate parameter such as progression-free survival or tumour response.

Patient-reported outcomes (PROs), which also include quality of life, were not investigated as the primary outcome in any study. They were merely named as secondary or tertiary study outcomes, and only in 36, that is about a third, of the publications. In 31 cases results for PROs were reported in the primary publication. In the remaining five, these findings were presumably provided only in later publications, and thus generally in less prominent journals.

Weighing of benefit and harms not always comprehensible

In most publications authors addressed the benefit-harm ratio of the respective interventions. But the importance of side effects for patients was appropriately reflected and presented only in 22 out of 88 of these publications, and instead played down by certain formulations in 53. All authors drew a corresponding conclusion, but this was comprehensible on the basis of the study results reported beforehand for only 48 of the publications.

Terms are used differently

The report also aimed to clarify terms within the context of "curation" and "palliation". However, this was not possible as these were used inconsistently in the publications analysed and rarely defined.

For instance, the meaning of "salvage therapy" is unclear. "To salvage" means "to rescue", which could lead patients to assume that the treatment they are undergoing will "rescue", that is "cure" them. However, precisely this case is no longer realistic in the specific treatment situation.

Specific treatment situation not adequately represented

Stefan Lange, Deputy Head of IQWiG and one of the authors of the report, sums up: "Our investigation showed that the specific treatment situation of patients in whom the end of life is foreseeable is inadequately represented in publications.

And this deficit is serious, as physicians also refer to the results of clinical studies in their conversations with patients. Both can only conjointly make good decisions about treatment options if they receive complete and unbiased information on the expected benefit and harm.

This is particularly important in diseases that are expected to lead to death in the foreseeable future, especially as therapy usually places a burden on patients. Many of those involved, physicians, researchers and also industry representatives, repeatedly emphasize that quality of life is of paramount importance for this patient group. It is thus all the more incomprehensible that this aspect is still clearly neglected in studies."

Process of report production

The present final report was generated in collaboration with external experts within the framework of the general commission. To promote the Institute's scientific independence, the Federal Joint Committee (G-BA) awarded a general commission to IQWIG in December 2004 and extended it in 2006 to cover information on the quality and efficiency in the health care system. This allows IQWiG to independently select and work on topics. In contrast to other types of reports, no commenting procedure is held for these reports.

The executive summary provides an overview of the background, methods and further results of the report.


Contact: Dr. Anna-Sabine Ernst
Institute for Quality and Efficiency in Health Care

Related medicine news :

1. Despite clear benefits, heart failure clinics are rarely utilized
2. Hospital-acquired UTIs rarely reported in data used to implement penalties
3. Childrens headaches rarely indicate a need for eyeglasses
4. Kids Headaches Rarely Due to Vision Problems, Study Finds
5. Sex between monogamous heterosexuals rarely source of hepatitis C infection
6. Physician-Assisted Suicide Program Rarely Used, Study Finds
7. Potentially life-saving cooling treatment rarely used for in-hospital cardiac arrests
8. Children referred for chest pain rarely have cardiac disease
9. Linked to Liver Failure, Diet Supplement OxyElite Pro Recalled; Parker Waichman LLP Commends FDA for Invoking Rarely Used Enforcement Power in Letter to Supplements Maker
10. Hormone may help predict tubal ectopic pregnancy
11. Gene Signal presents data at ARVO 2012 showing topical aganirsen is active in retinal disease
Post Your Comments:
(Date:11/27/2015)... ... 2015 , ... The print component of “Supporting Our Caregivers” ... New York, Minneapolis, South Florida, with a circulation of approximately 250,000 copies and ... vast social media strategy and across a network of top news sites and ...
(Date:11/27/2015)... (PRWEB) , ... November 27, 2015 , ... A simply ... Jones, is an interesting show that delves into an array of issues that are ... that could benefit from open dialogue, this show is changing the subjects consumers focus ...
(Date:11/27/2015)... (PRWEB) , ... November 27, 2015 , ... Dr. ... Medical Associates, Inc. and Dr. Tucker Bierbaum with Emergency Medicine at St., ... observed that both STEMI and Sepsis conditions present in similar ways and require time-critical ...
(Date:11/26/2015)... ... November 26, 2015 , ... CognisantMD and Cambridge ... imaging in the Waterloo region. Using the Ocean Platform, family physicians can now ... their electronic medical record (EMR) without the need for redundant patient entry or ...
(Date:11/26/2015)... ... November 26, 2015 , ... ... opinion process, participated in the 61st annual Employee Benefits Conference. The Employee Benefits ... place Sunday, November 8th through Wednesday, November 11th, 2015. The conference was held ...
Breaking Medicine News(10 mins):
(Date:11/25/2015)... Nov. 26, 2015  The total global healthcare industry is ... 2015-2016. Latin America has the highest ... (excluding Japan ), is second with growth ... to face increased healthcare expenditure. In 2013-2014, total government funded ... 43.5% in 2008-2009 to 41.2% in 2013-2014. In real terms, ...
(Date:11/25/2015)... , Nov. 25, 2015 AAIPharma Services ... investment of at least $15.8  Million to expand ... Wilmington, NC . The expansion will provide ... meet the growing demands of the pharmaceutical and ... site expansion will provide up to 40,000 square ...
(Date:11/25/2015)... 2015 Kitov Pharma ceuticals ... a biopharmaceutical company focused on the development of therapeutic ... today announced the closing of its previously announced underwritten ... ), each representing 20 ordinary shares of the Company, ... ADSs and warrants were issued in a fixed combination ...
Breaking Medicine Technology: