© 2004 by Oxford University Press
2004 © Oxford University Press
ARTICLE |
Abstract: Methods of the Evidence Report
Joseph Lau, MD, Department of Medicine, Tufts-New England Medical Center, Boston, MA
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INTRODUCTION |
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 TopNotes Introduction Literature SearchSelection CriteriaSummarizing the Literature |
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The Office of Medical Applications of Research (OMAR) at the National Institutes of Health (NIH) requested that the Agency for Healthcare Research and Quality (AHRQ), through its Evidence-Based Practice Center (EPC) program, produce an evidence report on the topic of Symptom Management in Cancer: Pain, Depression, and Fatigue for this State-of-the-Science Conference. The New England Medical Center EPC produced this evidence report based on a systematic review of the literature summarizing evidence in several key areas identified by the conference planning committee. The clinical conditions covered in this report include cancer-related pain, depression, and fatigue. The issues addressed for each of these conditions in this report include prevalence, assessment, and treatment.
Evidence reports review relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities. Public and private sector organizations may use the reports and assessments as the basis for their own clinical guidelines and other quality improvement activities.
The various combinations of symptoms and issues identified by the planning committee create nine distinct topics, several of which are very broad in nature and encompass many interrelated issues. Addressing each of the nine topics fully is beyond the scope of this evidence report. Supplementing the information in our evidence report, speakers will be invited to discuss topics of their expertise at the State-of-the-Science Conferences. This evidence report is structured according to the following topics: prevalence of cancer-related pain, prevalence of cancer-related depression, prevalence of cancer-related fatigue, assessment of cancer-related pain, assessment of cancer-related depression, assessment of cancer-related fatigue, treatment of cancer-related pain, treatment of cancer-related depression, treatment of cancer-related fatigue.
For some of these topics, in particular the treatment of cancer pain, there are multiple questions. Our EPC previously produced the evidence report on the Management of Cancer Pain based on a literature search conducted in December 1998. For the cancer-related pain topics, the results for the key questions addressed in the prior report have been thoroughly updated. At the request of the conference planning committee, we added two new topics to the treatment of cancer-related pain (oral mucositis and post-herpetic neuralgia) in this report. We have summarized the methodological approach and reported the new evidence. Readers are referred to the earlier evidence report for detailed information. New systematic reviews are also included for the symptoms of cancer-related depression and cancer-related fatigue.
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LITERATURE SEARCH |
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TopNotesIntroductionLiterature SearchSelection CriteriaSummarizing the Literature |
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Literature searches were conducted to identify studies published between 1966 and 2001. For cancer pain, we applied the same search strategy used in our previously published Management of Cancer Pain evidence report to identify new studies published from December 1998 through June 2001. The National Library of Medicine, as a partner in the State-of-the-Science conference process, with input from the EPC staff, performed the literature search for cancer-related depression and cancer-related fatigue. The searches were supplemented with reviews of bibliographies of selected references. We also identified published meta-analyses and used their data for selected topics.
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SELECTION CRITERIA |
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TopNotesIntroductionLiterature SearchSelection CriteriaSummarizing the Literature |
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We accepted all studies that addressed the issues of prevalence, assessment, or treatment in patients with a diagnosis of cancer who suffered from pain, depression, or fatigue due to cancer or treatment of cancer. We placed no restrictions on the patients' age, gender, ethnicity, and stage of the primary disease or presence of metastases.
For estimating the prevalence of cancer-related symptoms, we used only studies that assessed the prevalence of the symptom as the primary purpose of the study. For assessment, both retrospective and prospective studies were used, as well as randomized and nonrandomized trials and cross-sectional and longitudinal studies. Randomized controlled trials were used to analyze efficacy of interventions.
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SUMMARIZING THE LITERATURE |
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TopNotesIntroductionLiterature SearchSelection CriteriaSummarizing the Literature |
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We incorporated more than 200 English language articles in the evidence report. Specific inclusion criteria and methods of synthesis were developed for each of the topics. Relevant data from each article were abstracted into evidence tables. Information from the evidence tables was synthesized into summary tables describing the findings of each study.
The nine topics addressed in this evidence report are presented in the order of prevalence, assessment, and treatment. Each of these issues covers the symptoms of pain, depression, and fatigue. Evidence is summarized using three complementary approaches. Evidence tables provide detailed information about the characteristics and outcomes of all the studies examined. Information from the evidence tables was synthesized into summary tables describing the findings of each study. A narrative description of the studies along with an evidence-grading scheme accompanies the summary tables.
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NOTES |
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Reprinted from the program book of the National Institutes of Health State-of-the-Science Conference on Symptom Management in Cancer: Pain, Depression, and Fatigue, July 15-17, 2002; http://consensus.nih.gov/ta/022/programabstractbook.pdf.
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