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Systematic review and consensus definitions for standardised endpoints in perioperative medicine: postoperative cancer outcomes

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posted on 2018-07-01, 00:00 authored by D J Buggy, J Freeman, M Z Johnson, K Leslie, B Riedel, D I Sessler, A Kurz, V Gottumukkala, T Short, N Pace, P M Myles, T J Gan, P Peyton, M Tramèr, A Cyna, G S De Oliveira, C Wu, M Jensen, H Kehlet, Mari BottiMari Botti, O Boney, G Haller, M Grocott, T Cook, L Fleisher, M Neuman, D Story, R Gruen, S Bampoe, L Evered, D Scott, B Silbert, D van Dijk, C Kalkman, M Chan, H Grocott, R Eckenhoff, L Rasmussen, L Eriksson, S Beattie, D Wijeysundera, G Landoni, B Biccard, S Howell, P Nagele, T Richards, A Lamy, M Lalu, R Pearse, M Mythen, J Canet, A Moller, T Gin, M Schultz, P Pelosi, M Gabreu, E Futier, B Creagh-Brown, T Abbott, A Klein, T Corcoran, D Jamie Cooper, S Dieleman, E Diouf, D McIlroy, R Bellomo, A Shaw, J Prowle, K Karkouti, J Billings, D Mazer, M Jayarajah, M Murphy, J Bartoszko, R Sneyd, S Morris, R George, R Moonesinghe, M Shulman, M Lane-Fall, U Nilsson, N Stevenson, W van Klei, L Cabrini, T Miller, S Jackson, B Alkhaffaf
Background: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, given the current equipoise in the existing literature, prospective, randomised, controlled trials are necessary to test this hypothesis. As such, a cancer subgroup was formed to derive endpoints related to research in onco-anaesthesia based on a current evidence base, international consensus and expert guidance.
Methods: We undertook a systematic review to identify measures of oncological outcome used in the oncological, surgical, and wider literature. A multiround Delphi consensus process that included up to 89 clinician–researchers was then used to refine a recommended list of endpoints.
Results: We identified 90 studies in a literature search, which were the basis for a preliminary list of nine outcome measures and their definitions. A further two were added during the Delphi process. Response rates for Delphi rounds one, two, and three were 88% (n=9), 82% (n=73), and 100% (n=10), respectively. A final list of 10 defined endpoints was refined and developed, of which six secured approval by ≥70% of the group: cancer health related quality of life, days alive and out of hospital at 90 days, time to tumour progression, disease-free survival, cancer-specific survival, and overall survival (and 5-yr overall survival). Conclusion: Standardised endpoints in clinical outcomes studies will support benchmarking and pooling (meta-analysis) of trials. It is therefore recommended that one or more of these consensus-derived endpoints should be considered for inclusion in clinical trials evaluating a causal effect of anaesthesia–analgesia technique on oncological outcomes.

History

Journal

British Journal of Anaesthesia

Volume

121

Issue

1

Pagination

38 - 44

Publisher

Elsevier

Location

London, Eng.

ISSN

0007-0912

eISSN

1471-6771

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2018. British Journal of Anaesthesia

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