Abstract
Clinical scenarios associated with low therapeutic effectiveness (LTE) are especially complex and highly relevant in oncology. The objective was to test a methodological framework for creating consensual clinical recommendations for routine practice. The study was in three phases from Mars 2006 to January 2008: 1) Definition of LTE situations; 2) Preparation by 10 experts of a panel of LTE situations in cancers of breast, lung, head and neck, colon and rectum and brain; and 3) Development of a consensus on each situation and its optimal treatment by gathering agreement and disagreements (two-round Delphi method) from 68 practicing oncologists in Andalusian Community. Three major and three minor criteria were established for an LTE situation, defined when at least one major or two minor criteria were met. The expert group proposed 48 possible LTE clinical scenarios for breast (n = 7), lung (10), brain (11), head and neck (11) and colorectal cancers (9). Sixty-eight oncologists agreed to participate in the study; the response rate was 79% (from 34 medical and 17 radiation oncologists) In the first round (definition), maximum agreement was obtained with the LTE definition of 10 of the 48 scenarios; in the second round (treatment options), maximum agreement was obtained on the treatment of 3 of these 10 scenarios. Oncologists reached low levels of agreement on the definition of an LTE situation and on its treatment recommendations. This study proposes an approach to the improvement of cancer management in situations of high uncertainty.
Similar content being viewed by others
References
Kanavos P (2006) The rising burden of cancer in the developing world. Annals of Oncology 17(Suppl 8):viii15–viii23
McPherson K (1995) Como debería modificarse la política sanitaria ante la evidencia de variaciones en la práctica médica. Var. Pract Med 7:9–17
Thorsen T, Mäkelä M (1999) Changing professional practice. DSI. Denmark
Expósito J (1995) Las decisiones en oncología I y II. Oncología 18:375–381; 491–496
Meneu R (2003) El impacto de las tecnologías de información y comunicación en los profesionales y usuarios de la sanidad. In Ortún Rubio V (ed) Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Masson, Barcelona
Expósito J, Hernández, Fernández Feijoo A, Briones E (2003) Evaluación de las prácticas de los coste-efectividad de los tratamientos quimioterápicos en pacientes oncológicos avanzados. Informe de evaluación 2. Agencia de Evaluación de Tecnologías Sanitarias de Andalucía
Segarra (2003) La parte plana de la curva, donde el coste-efectividad encuentra la regla del rescate. In: Ortún Rubio V (ed) Gestión clínica y sanitaria. De la práctica diaria a la academia, ida y vuelta. Masson. Barcelona
Jovell A, Roig F (2001) The future patient. Literature review: Spain. Fundación Josep Laporte. Barcelona. Available via http://www.fbjoseplaporte.org/cast/formacio/recerca.htm#4. Accessed Oct 2008
Freid TR, Bradley EH, Allore H (2002) Understanding the treatment preferences of seriously ill patients. N Engl J Med 346:1061–1066
Ioannidis JPA, Pavlidis N (2003) Levels of absolute survival benefit for systemic therapies of advanced cancer: a call for standards. Eur J Cancer 39:1194–1198
Schneider EC, AM Epstein, Malin JL et al (2004) Developing a system to assess the quality of cancer care: ASCO’s National Initiative on Cancer Care Quality. J Clin Oncol 22:2985–2991
Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R (2002) Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ 324:1417–1421
Kataja VV, Colleoni M, Bergh J for the ESMO Guidelines Task Force (2005) ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of locally recurrent or metastatic breast cancer (MBC). Ann Oncol 16(Suppl 1):i10–i12
Blum JL, Jones SE, Buzdar AU et al (1999) Multicenter phase ii study of capecitabine in paclitaxelrefractory metastatic breast cancer. J Clin Onc 17: 485–493
Croles N, Smorenburg CH, van Groeningen CJ et al (2004) FOLFOX3 in heavily pretreated patients with metastatic colorectal cancer. Neth J Med 62: 242–245
Holen KD (2006) Target practice: figuring out which, when, and why to use systemic therapies for metastatic colon cancer, Cancer Invest 24:98–105
Ho C, Davies AM, Lara PN Jr, Gandara DR (2006) Second-line treatment for advanced-stage non-small-cell lung cancer: current and future options. Clin Lung Cancer 7[Suppl 4]:S118–S125
Felip E, Santarpia M, Rosell R (2007) Emerging drugs for non-small-cell lung cancer. Expert Opin Emerg Drugs 12:449–460
Maione P, Perrone F, Gallo C et al (2005) Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol 23:6865–6872
Hammond ME, Fitzgibbons PL, Compton CC et al (2000) College of American Pathologists Conference XXXV: solid tumor prognostic factors—which, how and so what? Summary document and recommendations for implementation. Arch Pathol Lab Med 124:958–965
Grunfeld EA, Ramirez A, Maher EJ et al (2001) Chemotherapy for advanced breast cancer: what influences oncologists decision-making? Br J Cancer 84:1172–1178
Martin RCG, McGuffin SA, Roetzer LM et al (2006) Method of presenting oncology treatment outcomes influences patient treatment decision-making in metastatic colorectal cancer. Ann Surg Oncol 13:86–95
Blazeby JM, Wilson L, Metcalfe C et al (2005) Analysis of clinical decision-making in multidisciplinary cancer teams. Ann Oncol 17:457–460
Beltz SE, Yee CG (1993) Pharmacoeconomics of cancer therapy. Cancer Control 5:415–424
Smith TJ, Hillner BE, Desch CE (1993) Efficacy and cost-effectiveness of cancer treatment: rational allocation of resources based on decision analysis. J Natl Cancer Inst 85:146–1474
What is a QALY? (2009) Hayward Medical Communications’ evidence-based medicine (EBM) What is…? series, 2nd edn. Available via http://www.whatisseries.co.uk/whatis/pdfs/What_is_a_QALY.pdf Accessed Apr 2010
Hillner BE (1998) Cost-effectiveness assessment of interferon alfa-2b as adjuvant therapy of high-risk resected cutaneous melanoma. Eur J Cancer 34[Suppl 3]:8–21
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Expósito, J., Bretón, J.J., Domínguez, C. et al. Controversies on the management of clinical situations with low therapeutic effectiveness in oncology. Clin Transl Oncol 12, 493–498 (2010). https://doi.org/10.1007/s12094-010-0542-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-010-0542-4