A year in the life of oncology health services research.

Abstract

6088 Background: We examined the body of oncology health-services research (HSR) published in 2009 in order to describe current research in three dimensions: a) the HSR domain of interest b) the place on the cancer care continuum that was studied and c) important elements of study design. Methods: We searched Medline using terms relevant to both HSR and cancer. 10,435 publications were identified, of which 8215 were excluded based on a title review. The remaining 2230 abstracts were reviewed (1117 were rejected as either not HSR or as descriptions of research methodology). Data regarding the HSR domain (access, quality, cost, well-being), place on the cancer continuum (from screening through palliation), and study design characteristics were abstracted by one of three reviewers (after 3 training rounds to minimize inter-observer variation). Results: Overall, 1113 research studies met eligibility criteria. The most commonly studied HSR domain was quality of care (n=719; 65%), with fewer studies on access to care (n=334; 30%), cost (n=77; 7%), or wellbeing of subjects (n=182; 16%). Regarding placement on the care continuum, treatment received the greatest attention (n=416; 37%), with fewer studies addressing survivorship (n=241; 22%) or screening (n=210; 19%) and even less focus on diagnosis/assessment (n=122; 11%), palliation (n=102; 9%), or prevention (n=53; 5%). Combining these dimensions of HSR: quality of treatment was most often studied (n=253; 23%); cost was the least studied HSR domain and was rarely assessed in the areas of prevention (n=5; 0.5%), or palliation (n=3; 0.3%). 835 studies were purely descriptive (75%); 278 (25%) evaluated an intervention designed to improve health services. The majority of studies were either retrospective (n=387; 35%) or cross-sectional (n=389; 35%); a minority used a randomized design (n=49; 4%). Study sample size varied widely, ranging from <100 subjects in 213 publications (19%) to >100,000 subject in 210 studies (19%). Conclusions: Based on studies published in 2009, the focus of HSR in oncology was on treatment quality, with less emphasis on access, cost, and other places on the cancer care continuum. Descriptive studies far outweigh controlled studies of interventions designed to improve health services.