Skip to main content

Advertisement

Log in

Outcomes Research in Surgical Oncology

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: There have been significant developments and advances in the area of outcomes research in the past 25 years. Unfortunately, many surgical oncologists may not have a clear concept of outcomes research and the methodology involved.

Methods: A literature-based review article was done that included an overview of outcomes research, and study design and types, outcome measures, outcome instruments, and sources of outcome data were examined. In addition, we reviewed small area variation(volume outcome analysis as well as quality-of-life studies and their applications in surgical oncology clinical investigation. Specific examples from surgical oncology were identified.

Results: As the costs of health care have increased, so has the emphasis on measuring outcomes of medical and surgical care to determine the quality and appropriateness of care. Marked variations in a variety of outcomes after oncological procedures have been attributed to individual surgeon and institution characteristics. Because much of the clinical surgical oncology literature deals only with the traditional mortality and morbidity outcomes, a more comprehensive examination of patient outcomes is required to fully evaluate the impact of patient management decisions. Health-related quality of life can be measured and analyzed in several ways and decisions regarding the use of such methodology are dependent on multiple factors.

Conclusions: Surgical oncologists should recognize that the true value of their interventions requires systematic and comprehensive examination of patient outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

REFERENCES

  1. Oxford English Dictionary. Oxford: Oxford University Press, 1999.

  2. Kane RL. Approaching the outcomes question. In: Kane R, ed. Understanding Health Care Outcomes Research. Gaithersburg, MD: Aspen Publications, 1997:1–16.

    Google Scholar 

  3. Donabedian A. Evaluating the quality of medical care. Milbank Memorial Fund Q 1966;XLIV:166–206.

    Google Scholar 

  4. World Health Organization. World Health Organization Constitution. Geneva: World Health Organization, 1948.

  5. Karnofsky DA, Abelman WH, Craver LF, Burchenal JH. The use of nitrogen mustards in palliative treatment of carcinoma. Cancer 1998;1:632–56.

    Google Scholar 

  6. Gill TM, Feinstein AR. A critical appraisal of the quality of quality-of-life measurements. JAMA 1994;272:619–26.

    CAS  PubMed  Google Scholar 

  7. Relman AS. Assessment and accountability: the third revolution in medical care. N Engl J Med 1996;319:1220–1.

    Article  Google Scholar 

  8. Ellwood PM. Shattuck lecture: outcomes management: a technology of patient experience. N Engl J Med 1988;318:1549–56.

    Article  PubMed  CAS  Google Scholar 

  9. Woolf SH. Practice guidelines: a new reality in medicine: recent developments. Arch Intern Med 1990;150:1811–8.

    PubMed  CAS  Google Scholar 

  10. Drummond MF, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programs. New York: Oxford University Press, 1987.

    Google Scholar 

  11. Soloniuk L, McPeek B. Do the pluses outweigh the minuses? Theor Surg 1988;2:209–14.

    Google Scholar 

  12. Iezzoni LI. Using administrative diagnostic data to assess thequality of hospital care. Int J Technol Assess Health Care 1990;6:272–81.

    PubMed  CAS  Google Scholar 

  13. Paul JE, Weis KA, Epstein RA. Data bases for variations research. Med Care 1993;31:S96–S102.

    Google Scholar 

  14. Cook DJ, Mulroy CD, Haynes RB. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 1997;126:376–80.

    PubMed  CAS  Google Scholar 

  15. Gerszten PC. Outcomes research: a review. Neurosurgery 1998;43:1146–56.

    PubMed  CAS  Google Scholar 

  16. Wennberg JE, Gittelson A. Small area variations in health care delivery. Science 1973;182:1102–8.

    PubMed  CAS  Google Scholar 

  17. Birkmeyer JD, Welch HG. A reader’s guide to surgical decision analysis. J Am Coll Surg 1997;184:589–95.

    PubMed  CAS  Google Scholar 

  18. Sox HC, Blatt MA, Higgins MC, Marton KI. Medical decision making. Boston: Butterworth, 1988.

    Google Scholar 

  19. Finlayson SRG, Birkmeyer JD. Cost-effectiveness analysis in surgery. Surgery 1998;123:151–6.

    PubMed  CAS  Google Scholar 

  20. Gold MR, Seigel JE, Russell LB, Weinstein MC. Cost-Effectiveness Analysis in Health and Medicine. New York: Oxford University Press, 1996.

    Google Scholar 

  21. Anonymous. Proceedings of the advances in health assessment conference: discussion panel. J Chron Dis 1987;40:S183–S191.

  22. Lohr KN. Outcome measurement: concepts and questions. Inquiry 1988;25:37–50.

    PubMed  CAS  Google Scholar 

  23. McDowell I, Newell C. Measuring Health: A Guide to Rating Scales and Questionnaires. New York: Oxford University Press, 1996.

    Google Scholar 

  24. Tarlov AR, Ware JE Jr, Greenfield S, Nelson EC, Perrin E, Zubkoff M. The medical outcomes study: an application of methods for monitoring the results of medical care. JAMA 1989;262:925–30.

    Article  CAS  PubMed  Google Scholar 

  25. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). Med Care 1992;30:473–83.

    PubMed  Google Scholar 

  26. Roos LL, Sharp SM, Cohen MM. Comparing clinical information with claims data: some similarities and differences. J Clin Epidemiol 1991;44:881–8.

    PubMed  CAS  Google Scholar 

  27. Kiezak SM, Flanders WD, Kosinski AS, Shipp AS, Karp H. A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. J Clin Epidemiol 1999;52:137–42.

    Google Scholar 

  28. Newschaffer CJ, Bush TL, Penberthy LT. Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data. J Clin Epidemiol 1997;50:725–33.

    Article  CAS  PubMed  Google Scholar 

  29. Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW. Can comorbidity be measured by questionnaire rather than medical record review? Med Care 1996;34:73–84.

    PubMed  CAS  Google Scholar 

  30. Menck HR, Cunningham MP, Jessup JM, et al. The growth and maturation of the National Cancer Data Base. Cancer 1997;80:2296–304.

    PubMed  CAS  Google Scholar 

  31. Menck HR, Bland KI, Scott-Conner CEH, et al. The American College of Surgeons Commission on Cancer and the American Cancer Society: regional diversity and breadth of the National Cancer Data Base. Cancer 1998;83:2649–58.

    PubMed  CAS  Google Scholar 

  32. Wennberg JE, Gittelson A. Variations in medical care among small areas. Sci Am 1982;246:120–34.

    Article  PubMed  CAS  Google Scholar 

  33. Wennberg JE, Freeman JL, Culp WJ. Are hospital services rationed in New Haven or overutilized in Boston? Lancet 1982;23:1185–9.

    Google Scholar 

  34. Wennberg JE, Freeman JL, Shelton RM, Bubolz TA. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. N Engl J Med 1989;321:1168–73.

    Article  PubMed  CAS  Google Scholar 

  35. Hannan EL, O’Donnell JF, Kilburn H, Bernard HR, Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 1989;262:503–10.

    PubMed  CAS  Google Scholar 

  36. Pearce WH, Parker MA, Feinglass J, Ujiki M, Manheim LM. The importance of surgeon volume and training in outcomes for vascular surgical procedures. J Vasc Surg 1999;29:768–78.

    PubMed  CAS  Google Scholar 

  37. Sainsbury JRC, Rider L, Smith A, et al. Does it matter where you live? Treatment variation for breast cancer in Yorkshire. Br J Cancer 1995;71:1275–8.

    PubMed  CAS  Google Scholar 

  38. Sainsbury R, Haward B, Rider L, et al. Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet 1995;345:1265–70.

    Article  PubMed  CAS  Google Scholar 

  39. Matthews HR, Powell DJ, McConkey CC. Effects of the results of surgical experience on the results of resection for oesophageal carcinoma. Br J Surg 1986;73:621–3.

    PubMed  CAS  Google Scholar 

  40. Yeo CJ, Cameron JL, Maher MM. A prospective randomized controlled trial of pancreaticogastrostomy versus pancreaticojejunostomy. Ann Surg 1995;222:580–8.

    Article  CAS  PubMed  Google Scholar 

  41. Birkmeyer JD, Finlayson SRG, Tosteson ANA, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 1999;125:250–6.

    Article  CAS  PubMed  Google Scholar 

  42. Porter GA, Soskolne CL, Yakimets WW, Newman SC. Surgeonrelated factors and outcome in rectal cancer. Ann Surg 1998;227:157–67.

    Article  CAS  PubMed  Google Scholar 

  43. McCardle CS, Hole D. Impact of variability among surgeons on postoperative mortality and morbidity and ultimate survival. BMJ 1991;302:1501–5.

    CAS  PubMed  Google Scholar 

  44. Phillips RS, Hittinger R, Blesovsky L, et al. Local recurrence following curative surgery for large bowel cancer. Br J Surg 1984;71:17–20.

    PubMed  CAS  Google Scholar 

  45. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457–60.

    Article  CAS  PubMed  Google Scholar 

  46. Simons AJ, Ker R, Groshen S, et al. Variations in treatment of rectal cancer: the influence of hospital type and caseload. Dis Colon Rectum 1997;40:641–6.

    PubMed  CAS  Google Scholar 

  47. Holm T, Johansson H, Cedermark B, et al. Influence of hospitaland surgeon-related factors on outcome after treatment of rectal cancer with or without preoperative radiotherapy. Br J Surg 1997;84:657–63.

    Article  CAS  PubMed  Google Scholar 

  48. Armitage P, Berry G. Statistical Methods In Medical Research. London: Blackwell Science, 1997.

    Google Scholar 

  49. Wong JH, Lubkey TB, Suarez-Almazor ME, Findlay JM. Improving the appropriateness of carotid endarterectomy: results of a prospective city-wide study. Stroke 1999;30:12–5.

    PubMed  CAS  Google Scholar 

  50. Cella DF, Bonomi AE. Measuring quality of life. In: Pazdur R, Coia LR, Hoskins WJ, Wagman LD, eds. Cancer Management: A Multidisciplinary Approach. Huntington: RRR Inc., 1996:773–87.

    Google Scholar 

  51. Campbell A. The Sense of Well-Being in America: Recent Patterns and Trends. New York: McGraw-Hill, 1981.

    Google Scholar 

  52. McHorney CA, Ware JE, Rachel JF, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care 1994;32:40–66.

    CAS  PubMed  Google Scholar 

  53. Revicki DA. Assessing health-related quality of life in clinical trials and practice settings: an overview. In: Perry MC, ed. Educational Book. Denver: American Society of Clinical Oncology, 1997:350–2.

    Google Scholar 

  54. Chambers LW. The McMaster Health Index Questionnaire: an update. In: Walker SR, Rosser RM, eds. Quality of Life Assessment: Key Issues in the 1990s. Dordrecht: Kluwer Academic, 1993:131–49.

    Google Scholar 

  55. Bergner M, Bobbitt RA, Carter WB, Gibson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981;8:787–805.

    Google Scholar 

  56. Hunt SM, McKenna SP, McEwan JA. A quantitative approach to perceived health status: a validation study. J Epidemiol Community Health 1980;34:281–5.

    Article  PubMed  CAS  Google Scholar 

  57. Parkerson GR, Broadhead WE, Tse CKJ. The Duke Health Profile: a 17-item measure of health and dysfunction. Med Care 1990;28:1056–69.

    PubMed  Google Scholar 

  58. Kaplan RM, Anderson JP, Wu AW, et al. The Quality of Well-Being Scale: applications in AIDS, cystic fibrosis, and arthritis. Med Care 1989;27:S27–S43.

    PubMed  CAS  Google Scholar 

  59. Nelson EC, Berwick DM. The measurement of health status in clinical practice. Med Care 1989;27:S77–S90.

    PubMed  CAS  Google Scholar 

  60. Spitzer WO, Dobson AJ, Hall J, et al. Measuring the quality of lifeof cancer patients: a concise QL-index for use by physicians. J Chron Dis 1981;34:585–97.

    PubMed  CAS  Google Scholar 

  61. Patrick D, Deyo R. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1990;28:1056–69.

    Google Scholar 

  62. Schipper H, Clinch J, McMurray A, Levitt M. Measuring the quality of life of cancer patients: the Functional Living Index-Cancer: development and validation. J Clin Oncol 1984;2:472–83.

    PubMed  CAS  Google Scholar 

  63. Finkelstein DM, Cassileth BR, Bonomi PD, et al. A pilot study of the Functional Living Index-Cancer (FLIC) scale for the assessment of quality of life for metastatic lung cancer patients: an Eastern Cooperative Oncology Group study. Am J Clin Oncol 1988;11:630–3.

    CAS  PubMed  Google Scholar 

  64. Burris JA 3rd, Moore MJ, Andersen J, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997;15:2403–13.

    CAS  PubMed  Google Scholar 

  65. Tannock IF, Osaba D, Stockler MR, et al. Chemotherapy with mitoxane plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative endpoints. J Clin Oncol 1996;14:1756–64.

    PubMed  CAS  Google Scholar 

  66. Torrance G, Feeny D. Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989;5:559–75.

    Article  CAS  PubMed  Google Scholar 

  67. Feeny D, Torrance G. Incorporating utility-based quality-of-life measures in clinical trials. Med Care 1989;27:S190–S204.

    PubMed  CAS  Google Scholar 

  68. Froberg DG, Kane RL. Methodology for measuring health-state preferences: I. Measurement strategies. J Clin Epidemiol 1989;42:345–54.

    PubMed  CAS  Google Scholar 

  69. Weeks J. Measurement of utilities and quality-adjusted survival. Oncology 1996;9:S67–S70.

    Google Scholar 

  70. Turner S. Quality-adjusted life years: cost-effective medical decision-making. J Cardiovasc Manag 1997;8:34–9.

    PubMed  CAS  Google Scholar 

  71. Mully A. Assessing patient’s utilities: can the ends justify the means? Med Care 1989;27:S269–S281.

    Google Scholar 

  72. Weeks JC, O’Leary J, Fairclough D, Paltiel D, Weinstein M. The “Q-tility index”: a new tool for assessing health-related quality of life and utilities in clinical trials and clinical practice (abstract). Proc Am Soc Clin Oncol 1994;13:436.

    Google Scholar 

  73. Weeks J. Assessing utilities for health states. In: Perry MC, ed: Educational Book. Denver: American Society of Clinical Oncology, 1997:353–5.

    Google Scholar 

  74. Pettiti DB. Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis. New York: Oxford University Press, 1994.

    Google Scholar 

  75. Temple LKF, Naimark D, McLeod R. Decision analysis as an aid to determining the management of early low rectal cancer for the individual patient. J Clin Oncol 1999;17:312–8.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Porter, G.A., Skibber, J.M. Outcomes Research in Surgical Oncology. Ann Surg Oncol 7, 367–375 (2000). https://doi.org/10.1007/s10434-000-0367-4

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-000-0367-4

Keywords

Navigation