Devita, Hellman, and Rosenberg's Cancer

LWBK1006-10 LWW-Govindan-Review November 24, 2011 11:21

120 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

including symptoms and quality of life, are important end points for

clinical research. Increasing knowledge in this area can facilitate what

are often complex and not straightforward treatment decisions. In areas

of cancer treatment where cure is possible or clinical benefit is striking,

patient-reported outcomes may play less of a role.

Answer 10.7. The answer is A.

A useful instrument is sufficiently variable, internally consistent, and reli-

able. Subjectivity is not a desirable characteristic.

Answer 10.8. The answer is D.

Computerized adaptive testing will allow more precise measurement of

constructs such as quality of life, using fewer questions. Different instru-

ments are required in different research situations. Validation does not

guarantee accuracy. Translation into a new language frequently requires

repeat validation in the new language.

Answer 10.9. The answer is B.

“Utility” as used in health services research is synonymous with “prefer-

ence” and enables comparisons between specific disease states. For exam-

ple, living with chronic cancer pain can be compared with living in perfect

health and assigned a numeric score. These rankings can be established by

patients, families, health care workers, or others, and may vary between

groups.

Answer 10.10. The answer is C.

Health care expenditures in all areas have rapidly increased in the past

15 years, much faster than inflation, such that health insurance premi-

ums are no longer affordable for many parties. The rapid accumulation

of costs in the last year of life has generated considerable concern regard-

ing the benefit of many expensive treatments. Cancer treatments costs in

particular have increased, although they currently account for 5%, not

15% of overall medical expenditures, and 10%, not 30% of Medicare

treatments. However, these numbers are expected to escalate as Medi-

care assumes more pharmaceutical costs and the cost of cancer care and

the number of Medicare patients with cancer increases in concert with

the aging population.

Answer 10.11. The answer is A.

The purpose of CER is to understand the differences in outcomes associ-

ated with various treatments in real-world settings, hence the use of the

term “effectiveness” as opposed to “efficacy.” While this data can support

economic analyses, the primary objective is to maximize patient outcomes

regardless of cost. CER can be performed on prospectively collected data,

though frequently uses observational data.