[Radiotherapy in surgical and nonsurgical patients. Therapy expectations, quality of life and physician assessment]

Trends in clinical trials in surgical oncology: implications for outcomes research

Outcomes analysis is emerging as a crucial tool in understanding and improving health care. To this end, outcomes research is focused on methodologies for assessing the impact and quality of clinical services and the penetration of new findings. Clinical trials are an important mechanism for generating data to support outcomes research activities. In clinical trials in surgical oncology, there has been a general broadening of the spectrum of end points that are more focused on the needs of providing data to outcomes researchers. For example, in addition to traditional "mechanical" end points reflecting the physical dimensions of disability, awareness of the importance of end points related to quality of life has increased. Moreover, a variety of innovative study designs and methodologies have found more widespread use, including noninferiority trials, preresection staging designed to direct therapy more precisely, planned early reports of conditional results, prognostic studies, assessment of an event status at a point in time, and large simple trials. The goal of this article is to summarize and assess some of the trends in clinical trials in surgical oncology. Examples of ongoing studies or of trials in development from the American College of Surgeons Oncology Group are discussed.

Patient expectation and satisfaction in revision total hip arthroplasty

Sixty-six consecutive revision total hip arthroplasty patients were asked about their expectations regarding future pain and walking ability. Expectations were high, regardless of background factors: 92% expected to have much less pain, and 82% expected the same walking ability as after the primary arthroplasty or a much improved walking ability. Of the patients, 56% stated a non-surgeon-related origin of expectations, 7% were uncertain, and 37% said expectations derived from the surgeon. At 1 year, Harris hip score had increased from a median 45 to 77 points, but only 69% and 55% said that their expectations had been fulfilled to a very large or rather large extent regarding pain and walking ability. The only predictor of fulfilled expectations was absence of complications (odds ratio, 4.8; 95% confidence interval, 1.1-20.8). Patient satisfaction was only moderate; 63% were very or rather satisfied with a moderate correlation (0.46-0.47) between satisfaction and fulfilled expectations. Patients with a poor preoperative hip condition generally were more satisfied (odds ratio, 5.0; 95% confidence interval, 1.4-17.9), and the most important reason probably was an improved walking ability (r = 0.64). Patient dissatisfaction may originate from unrealistic expectations. At preoperative consultation, it is recommended that the surgeon discuss the revision patient's expectations, especially regarding future walking ability, and inform the patient about the fundamental prognostic differences between revision and primary hip arthroplasty.