Department of Health Services Administration and Policy, Temple University College of Public Health, Philadelphia, PA, USA.
Moncrief Cancer Institute and Division of Community Health Sciences, University of Texas Southwestern Medical Center, Fort Worth, TX, USA.
Lancet Oncol. 2017 Jan;18(1):e51-e59. doi: 10.1016/S1470-2045(16)30563-0.
Although the number of cancer survivors has increased substantially in the past two decades, the evidence base regarding the effectiveness of cancer survivorship programmes is inadequate. Survivorship programmes tend to evaluate their effectiveness by assessing changes in patient-reported outcomes, symptoms and health status, knowledge, and receipt of cancer surveillance in programme participants. However, more comprehensive and high-quality evaluations of survivorship programmes are needed, including assessments using a broader set of measures. These expanded evaluations can include assessments of programme structure; long-term outcomes, such as survival, quality-adjusted life-years, and functional status; receipt of social support, nutritional, rehabilitative, and fertility preservation services; programme value, including costs and avoidance of inappropriate resource utilisation; and ability of programmes to increase access to needed survivorship care services and health equity. In this Series paper, we provide examples of assessment measures for currently used survivorship programmes, discuss the rationale for and potential benefits of expanded types of evaluation measures, and identify how these measures correspond to several evaluation frameworks. We conclude that use of a common, expanded set of measures to facilitate broad comparisons across survivorship programmes and thorough and systematic evaluations will help to identify the optimal programmes for individual survivors, improve outcomes, and prove the value of survivorship care.
尽管在过去的二十年中，癌症幸存者的数量大幅增加，但关于癌症生存者计划有效性的证据基础还不够充分。生存者计划倾向于通过评估患者报告的结果、症状和健康状况、知识以及在计划参与者中接受癌症监测的变化来评估其有效性。然而，需要对生存者计划进行更全面和高质量的评估，包括使用更广泛的评估措施。这些扩展的评估可以包括对计划结构的评估；长期结果，如生存、质量调整生命年和功能状态；获得社会支持、营养、康复和生育保存服务；计划价值，包括成本和避免不当资源利用；以及计划增加获得所需生存护理服务和健康公平的能力。在本系列论文中，我们提供了当前使用的生存者计划评估措施的示例，讨论了扩展类型的评估措施的原理和潜在益处，并确定了这些措施如何与几个评估框架相对应。我们得出结论，使用一套通用的、扩展的措施来促进生存者计划之间的广泛比较以及全面和系统的评估，将有助于确定对个体幸存者最佳的计划，改善结果，并证明生存护理的价值。
