Economic and Quality of Life Outcomes in Oncology

This publication is the fourth in a series of quality of life symposia proceedings. The title of our first symposium, which took place in 1989, was "Quality of Life in Current Oncology Practice and Research." In the foreword to the first proceedings, we indicated that a gap in information and communication had evolved between social scientists (who developed quality of life measures) and clinicians. Our first symposium and its publication was designed to help fill this gap, bringing social scientists and clinicians together to encourage them to interact and combine their resources. As an appendix to the publication, we included quality of life measurement scales.

Over the last several years, a similar gap of communication and information has developed, this time between clinicians and social scientists on one hand and economists, health care administrators, and policy makers on the other. Our fourth symposium and these proceedings are intended to again help fill this gap with an interface that links the clinician/provider with those who study the economics of medicine and also with those who need to interpret the results of economic studies to make decisions about payment and policy making.

To this end, we have brought together clinicians, social scientists, economists, major health care plan administrators, attorneys, managed care and pharmaceutical company executives, as well as government administrators. As can be seen in the Table of Contents, a wide variety of subjects is presented by experts from different disciplines with a general focus on economic outcomes in cancer care.

Over the last 10 years, there has been a marked increase in the number of cancer clinical trials that include quality of life evaluations. We would like to believe that our first symposium and its publication contributed to some extent to that increase.

Similarly, economic endpoints or outcomes are currently part of very few ongoing clinical trials. We believe that this is partly due to lack of information about the nature of economic studies, available resources and tools, and methods of evaluating results on the part of clinicians. We hope that this publication will help increase the awareness of oncologists and others regarding the need for economic as well as quality of life measurements to be part of oncology research and practice decisions on an ongoing bases. Involvement by clinicians in the process of economic outcome evaluations is crucial if we are to intelligently participate in all aspects of health care delivery.

For many readers, these proceedings will provide rather interesting data ranging from cancer care expenditures in the nation to comparisons between costs of oncology therapies versus therapies in other specialties.

Many readers will be surprised when they are presented with comparisons of cost-effectiveness between a variety of cancer therapies (often perceived as toxic, costly, and ineffective) versus other accepted medical practices, such as the treatment of hypertension, hypercholesterolemia, or coronary artery disease.

Several papers define in detail the terminology used regarding economic outcomes, and an appendix presents updated available quality of life and utility measures.

The allocation of health care dollars will depend increasingly on a rational, comparative assessment of cost-effectiveness of alternative therapies. Measuring the effects of treatments on length of life is important but not enough to make decisions; the quality of life and the cost of the treatment are two other important aspects that need consideration. We hope these symposium proceedings will help facilitate the introduction of quality of life and economic outcome measures to research in oncology and its practice.