Importance

Quality of life (QoL) is an important consideration in cancer medicine, especially because drugs are becoming more costly and may only result in modest gains in overall survival. However, there has been no descriptive analysis for the points at which QoL is measured in cancer trials.

Objective

To estimate the prevalence of studies that measure QoL at different points and see how many studies measure QoL for the entirety of a patient's life.

Design, setting, and participants

This cross-sectional analysis includes all articles on oncology clinical trials in the 3 highest-impact oncology journals, published between July 2015 and June 2018, that reported QoL outcomes.

Main outcomes and measures

Data were abstracted on when QoL was assessed and the characteristics of these studies.

Results

For all 149 studies that met inclusion criteria, QoL assessment was high during treatment (104 articles [69.8%]), during follow-up (81 articles [54.4%]), and after the end of the intervention (68 articles [45.6%]). In 5 of the 149 studies (3.4%), QoL was assessed until death, including in only 1 of the 74 studies on metastatic or incurable cancers. Among these 5 studies, only 1 (20%) used a drug intervention, 1 (20%) used a behavioral intervention, and 2 (40%) used a radiation intervention; only 1 of 5 was in the metastatic setting. The number of studies that reported a positive QoL outcome (ie, QoL outcome was more favorable in the intervention group than in the control group) was between 42 of 81 articles (51.9%) and 16 of 28 articles (57.1%) for most QoL assessment points but only 1 of 5 articles (20%) for studies measuring QoL until death.

Conclusions and relevance

This study found that most clinical trials assessed QoL during the treatment or intervention and often during a given amount of follow-up but infrequently assessed QoL on disease progression and rarely followed QoL until the end of the patient's life. Most studies reporting QoL until the end of life reported worse QoL outcomes for the intervention group than the control group. Future research and policy recommendations should consider not just short-term QoL outcomes but QoL outcomes throughout the patient's cancer care.

This study uses public employee salary data from 14 US public medical schools and the Open Payments database from the US Centers for Medicare & Medicaid Services to examine the ratio of academic oncologists’ reported salaries to their general payments from the medical industry.

Background

Public perception of whom to blame for health care costs varies. Whether there is a mismatch between the causes of rising health care costs and the blame attributed to potential culprits has emerged as a topic of debate. We sought to compare the allocation of blame for rising health care costs in lay media articles and academic literature with actual health care spending in the United States.

Methods

We performed a cross-sectional systematic analysis of published lay media and academic articles. On April 10, 2018, 200 PubMed (academic) and 200 Google News (lay media) articles were collected through searches using the terms "healthcare costs" and "health care costs." Articles were included if they criticized high cost of health care in the US. We calculated descriptive statistics for area(s) of health care blamed for high costs, publication type, and primary author affiliation.

Results

PubMed articles named 47 potential drivers of high cost and Google News articles named 225. Among PubMed articles, environment, lifestyle, and medical problems (n = 15/47; 32%) were the most commonly cited source of high cost of health care, followed by 'no group singled out' (n = 14/47; 30%), and drugs or devices (n = 8/47; 17%). Among Google News articles, insurers (n = 63/225; 28%) were most commonly cited as possible sources of high cost of health care, followed by 'no group singled out' (n = 46/225; 21%) and hospitals (n = 37/225; 17%).

Conclusions

Allocation of blame for high health care costs is not always in proportion with true health care spending, and certain health care drivers are under- and overrepresented by academic and lay media publications.

Background

Identifying ineffective practices that have been used in oncology is important in reducing wasted resources and harm. We sought to examine the prevalence of practices that are being used but have been shown in RCTs to be ineffective (medical reversals) in published oncology studies.

Methods

We cross-sectionally analyzed studies published in three high-impact oncology medical journals (2009-2018). We abstracted data relating to the frequency and characterization of medical reversals.

Results

Of the 64 oncology reversals, medications (44%) represented the most common intervention type (39% were targeted). Fourteen (22%) were funded by pharmaceutical/industry only and 56% were funded by an organization other than pharmaceutical/industry. The median number of years that the practice had been in use prior to the reversal study was 9 years (range 1-50 years).

Conclusion

Here we show that oncology reversals most often involve the administration of medications, have been practiced for years, and are often identified through studies funded by non-industry organizations.

The ability to identify medical reversals and other low-value medical practices is an essential prerequisite for efforts to reduce spending on such practices. Through an analysis of more than 3000 randomized controlled trials (RCTs) published in three leading medical journals (the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine), we have identified 396 medical reversals. Most of the studies (92%) were conducted on populations in high-income counties, cardiovascular disease was the most common medical category (20%), and medication was the most common type of intervention (33%).