促进肿瘤学中先进放射技术的合理使用：国家癌症政策论坛研讨会总结
Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop.
作者信息
Smith Grace L, Ganz Patricia A, Bekelman Justin E, Chmura Steven J, Dignam James J, Efstathiou Jason A, Jagsi Reshma, Johnstone Peter A, Steinberg Michael L, Williams Stephen B, Yu James B, Zietman Anthony L, Weichselbaum Ralph R, Tina Shih Ya-Chen
机构信息
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, Los Angeles, California.
出版信息
Int J Radiat Oncol Biol Phys. 2017 Mar 1;97(3):450-461. doi: 10.1016/j.ijrobp.2016.10.042. Epub 2016 Nov 8.
PURPOSE
Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology.
METHODS AND MATERIALS
The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders.
RESULTS
Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided.
CONCLUSIONS
Discussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment.
目的
肿瘤学界的领导者们正在发出强烈呼吁，以促进癌症治疗决策中的“价值”。癌症治疗中的价值在选择治疗方法时要考虑临床疗效以及成本。为了探讨当前在肿瘤学中使用先进技术实现价值所面临障碍的可能解决方案，美国国家科学院、工程院和医学院的国家癌症政策论坛于2015年7月举办了一次研讨会，主题为“肿瘤学中放射治疗和手术先进技术的合理使用”。本报告总结了与放射肿瘤学相关的讨论内容。
方法和材料
该研讨会召集了包括肿瘤学家、研究人员、支付方、政策制定者和患者在内的利益相关者。发言者围绕关键主题进行了阐述，包括在放射肿瘤学中对先进技术使用进行价值讨论的基本原理、先进放射技术价值的科学证据的产生、科学证据和“市场”（或经济）因素对技术采用的影响，以及提高放射肿瘤学实践价值的新方法。发言之后是利益相关者之间进行对话的小组讨论。
结果
为先进技术的价值生成证据面临的挑战包括获取当代的、前瞻性的、随机的和具有代表性的比较疗效数据。提议的解决方案包括使用前瞻性登记数据；整合放射肿瘤学治疗、结果和质量基准数据；以及鼓励基于证据发展的保险覆盖。在实践中提高价值面临的挑战包括高价值治疗方法采用缓慢以及低价值治疗方法的停用。提议的解决方案侧重于让利益相关者参与反复的、协作的和基于证据的努力，以界定价值并促进放射肿瘤学实践的变革。提供了对所讨论挑战正在进行或已成功应对的近期实例。
结论
“价值”讨论在放射肿瘤学界已日益成为优先事项。放射肿瘤学界的从业者在促进以价值为导向的框架来进行放射肿瘤学治疗方面可以发挥关键作用。
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