Outcomes research in lung cancer.

BACKGROUND: Lung cancer is the leading cause of cancer death in the United States. Most therapeutic interventions for this disease achieve modest benefits, but at the expense of nontrivial toxicity and cost, making it an important area for outcomes analysis.
OBJECTIVE: The goal of the study was to audit the literature of outcomes pertaining to lung cancer. DATA SOURCES: The English language outcomes literature published during the period from 1990 through 2000 was systematically reviewed and analyzed. STUDY SELECTION: Papers had to contain original research in one of the following areas: quality of life, health economics, communication, decision making, quality of care, or patient satisfaction. DATA EXTRACTION: The literature was reviewed and analyzed by the author. DATA SYNTHESIS: The lung cancer outcomes literature is growing rapidly. Of the 199 studies examined, 106 (53%) dealt primarily with quality-of-life measurement, 69 (35%) examined costs, 11 (6%) dealt with communication and decision making, 11 (6%) assessed the quality of care, and two (1%) evaluated patient satisfaction. Most studies focused on the palliative phase of care. Women, the elderly, and minorities were generally well represented in these studies. The European Organization for Research and Treatment of Cancer QLQ-C30 with its LC13 module is emerging as the most commonly employed quality-of-life instrument in lung cancer studies. Economic studies vary widely in their quality. The literature is relatively sparse with respect to quality of care, communication, and decision making, however.
CONCLUSIONS: A substantial body of outcomes research has been published since 1990. Further work is needed in the area of methods development, in the assessment of the impact of new technologies, and in the monitoring of the quality of lung cancer care in vulnerable populations.