Book Review

Outcomes Assessment in Cancer: Measures, Methods, and Applications

N Engl J Med 2006; 354:1214-1215March 16, 2006

Article

Outcomes Assessment in Cancer: Measures, Methods, and Applications
Edited by Joseph Lipscomb, Carolyn C. Gotay, and Claire Snyder. 662 pp. Cambridge, England, Cambridge University Press, 2005. $170. ISBN: 0-521-83890-8

Outcomes researchers strive to quantitate the end points of health care and to improve our understanding of the influences on these outcomes. There are many factors that point to important applications of outcomes research in oncology. Among them are the substantial morbidity and mortality associated with cancer; the limitations of the traditional end points of response rate and survival in describing the breadth of relevant outcomes in cancer care; the high financial costs; and the wide variations in practice. Different treatments may lead to similar tumor responses or survival outcomes yet vary in other end points, such as side effects and costs. Outcomes research also informs initiatives undertaken by the Institute of Medicine and other groups in recent years to evaluate and improve the quality and value of cancer care. This book, which reports the findings and recommendations of the Cancer Outcomes Measurement Working Group (COMWG), is therefore important and timely.

The COMWG was established by the National Cancer Institute in 2001 with the charge of “evaluating the state of the science in outcomes measurement and recommending approaches to improve the scientific quality and usefulness of measures.” Thirty-five experts were recruited to the working group, and they are the principal authors of the 28 chapters in this book. Four invited papers complete the text. To avoid confusion, the COMWG agreed on the following framework. The outcomes of prime interest were health-related quality of life, patients' perceptions of and satisfaction with care, and economic burdens of disease. The entire continuum of care, from prevention to the end of life, was considered. Data on patients with breast, colorectal, lung, or prostate cancer were emphasized.

Where appropriate, the chapters use similar formats, including a description of the strategy used to search the literature, and well-organized summary tables listing key attributes of described scales. With rare exceptions, the clinical examples are illustrative and relevant. There are important insights regarding the integration of outcome assessments into the design of clinical trials, including a description of circumstances in which the incorporation of such assessments may well be of limited usefulness. High-profile clinical topics, such as genetic susceptibility (testing for mutations in the BRCA1 and BRCA2 genes was used as an example) and survivorship (including input from patient advocates), are the focus of individual chapters. The assistance provided by informal caregivers is an important but easily underemphasized part of cancer care, and this topic receives a thoughtful review.

The book is well edited, and efforts were clearly made to facilitate cross-referencing among chapters. Given the framework and the way the book is organized, certain topics relevant to outcomes assessment receive less detailed or less coordinated attention and are not the subjects of dedicated chapters. For example, the impact on outcome of an important baseline factor such as the extent of comorbidity is noted, but the science and challenges of comorbidity measurement are not reviewed comprehensively.

The book highlights the availability of numerous quality-of-life questionnaires that have undergone careful methodologic development and delineates their varying strengths and limitations. The development of new scales is no easy matter in terms of the expertise or time required to create a final product. Furthermore, modern psychometric approaches, such as item-response theory and computer-adaptive testing, are expected to have a considerable impact on scale development in the future and should improve the efficiency of data gathering and cross talk among studies.

The book will be of particular interest to outcomes researchers and their students. However, its appeal is certainly not limited to this audience, as anyone who is concerned with cancer-care outcomes and their assessment will find many of the chapters informative and useful.

David G. Pfister, M.D.
Memorial Sloan-Kettering Cancer Center, New York, NY 10021
pfisterd@mskcc.org