Delphi‐panel analysis of appropriateness of high‐dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer

Gale, Robert Peter; Park, Rolla Edward; Dubois, Robert W.; Bitran, Jacob D.; Buzdar, Aman U.; Hortobagyi, Gabriel; Jones, Stephen E.; Lazar, Gary; Spitzer, Gary; Swain, Sandra M.; Vaughn, Clarence B.; Vogel, Charles; Martino, Silvana

doi:10.1034/j.1399-0012.2000.140107.x

Cited by 19 publications

(13 citation statements)

References 24 publications

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“…It has been demonstrated that appropriateness guidelines developed using this method are reproducible, 10 are consistent clinically, 11 and are correlated with clinical outcomes. 12 Oncology applications have included breast cancer, 13 melanoma, 14 colorectal cancer, 9,15 and hematologic malignancies. [16][17][18][19] Literature Review…”

Section: Methodsmentioning

confidence: 99%

Treatment of patients with metastatic renal cell cancer

Halbert

Figlin

Atkins

et al. 2006

Cancer

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BACKGROUND.New developments in the treatment of patients with metastatic renal cell cancer (MRCC) have suggested a need to reevaluate the role of systemic therapies. The authors convened a panel of medical and urologic oncologists to rate the appropriateness of the main options.METHODS.The authors used the RAND/University of California‐Los Angeles Appropriateness Method to evaluate systemic therapy options and cytoreductive nephrectomy. After a comprehensive literature review, an expert panel rated the appropriateness of systemic options (108 permutations) and cytoreductive nephrectomy (24 permutations) for patients with MRCC.RESULTS.The appropriateness evaluation indicated that 27.3% of permutations were rated “appropriate,” 46.9% were rated “inappropriate,” and 25.8% were rated “uncertain.” There was a high rate of agreement (95%). Sunitinib and sorafenib were rated appropriate for patients with low‐to‐moderate risk regardless of prior treatment. Temsirolimus was rated appropriate for first‐line therapy for higher risk patients. Interferon‐α and low‐dose interleukin‐2 were rated inappropriate or uncertain. In patients who received prior immunotherapy, cytokines were rated inappropriate. In all permutations for evaluating systemic therapy, enrollment into an investigational trial was considered appropriate, treatment with bevacizumab was uncertain, and thalidomide was inappropriate regardless of risk status or prior therapy. For good surgical risk patients with planned immunotherapy, nephrectomy was rated appropriate in patients who had limited metastatic burden regardless of tumor‐related symptoms and in symptomatic patients regardless of metastatic burden. Only the most favorable combination of surgical risk, metastatic burden, and symptoms generated an “appropriate” rating for patients with planned targeted therapy.CONCLUSIONS.The current results begin the process of defining an appropriate role for cytokines, newer targeted therapies, and surgery in the treatment of MRCC. Cancer 2006. © 2006 American Cancer Society.

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Section: Methodsmentioning

confidence: 99%

Treatment of patients with metastatic renal cell cancer

Halbert

Figlin

Atkins

et al. 2006

Cancer

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“…There are also several Delphi consensus studies of transplants. [66][67][68][69][70][71] It is interesting and informative to consider whether these diverse consensus techniques reach similar conclusions and then to compare these conclusions to those of meta-analyses of RCTs and ODBs. An example is the previously discussed issue of the possible efficacy of autotransplants vs chemotherapy in persons with AML in first remission.…”

Section: Expert Opinion In Transplantsmentioning

confidence: 99%

Are there roles for observational database studies and structured quantification of expert opinion to answer therapy controversies in transplants?

Gale

Eapen

Logan

et al. 2009

Bone Marrow Transplant

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Approaches to determine whether one transplant-related therapy is better than another include: (1) using experimental data, such as those from randomized controlled trials (RCTs); (2) using observational data, such as those from observational databases (ODBs) and (3) using conclusions from the structured quantification of expert opinion based on a consideration of evidence from RCTs, ODBs and other sources. Large RCTs are widely and appropriately regarded as the gold standard of clinical investigation. However, data from large RCTs are rarely available for transplant-related therapy questions. We discuss some of the limitations of RCTs in the transplant setting often including small size and short follow-up. These limitations are only partly solved by meta-analyses of RCTs. Data from high-quality ODBs are not only often useful in this setting but also have limitations. Biases may be difficult or impossible to identify and/or adjust for. However, ODBs have large numbers of diverse subjects receiving diverse therapies and analyses that often give answers more useful to clinicians than RCTs. Side-by-side comparisons suggest analyses from high-quality ODBs often give similar conclusions to meta-analyses of highquality RCTs. Meta-analyses combining data from RCTs and ODBs are sometimes appropriate. Quantitation of expert opinion, when of high quality, is also useful: experts rarely disagree under precisely defined circumstances and their consensus conclusions are often concordant with results of high-quality RCTs and ODBs. We suggest increased use of ODBs and expert opinion as reliable and effective ways to determine relative efficacies of new therapies in transplant settings.

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“…14 This index is a weighted sum of the median rating and the number 5; the effect of the weighting moves the index away from the median rating and towards 5 (the point at which the benefits and risk are deemed to be equal) as variation increases among the eleven ratings.…”

Section: Methodsmentioning

confidence: 99%

“…We first used recursive partitioning, a non-parametric method for exploratory data analysis and summarization to create a tree that shows graphically the best sequence of data splits to determine appropriateness and inappropriateness 14. We also developed a point system using the adjusted appropriateness index means for each value range of a variable.…”

Section: Methodsmentioning

confidence: 99%

For Which Glaucoma Suspects Is It Appropriate to Initiate Treatment?

2009

Ophthalmology

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Objective Because uncertainty exists about which glaucoma suspects should be treated, we sought to identify glaucoma suspects whom an expert panel could agree would be appropriate or inappropriate to treat. Design RAND/UCLA appropriateness method, a well-established procedure to synthesize the scientific literature with expert opinion to resolve uncertainty on a health topic. Participants Eleven-member panel composed of recognized international leaders in the field of glaucoma. Methods Based on a systematic review of the literature on potentially important factors to consider when deciding to initiate treatment, we initially created over 1000 scenarios of glaucoma suspects. The panel formally rated the appropriateness of initiating treatment for glaucoma suspects through a two-round modified Delphi method, a technique that preserves the confidentiality of individual panelists’ ratings but allows panelists to compare their own ratings to those of the entire panel. Main Outcome Measures Final ratings for scenarios were categorized as appropriate, uncertain, or inappropriate to treat according to typical pre-specified statistical criteria previously used in projects using the RAND/UCLA appropriateness method. Tools were developed to help clinicians approximate the panel ratings of glaucoma suspects. Results The panel chose age, life expectancy, intraocular pressure (IOP), central corneal thickness, cup/disc ratio, disc size, and family history as the variables to consider when deciding whether to treat glaucoma suspects. Permutations of these variables created 1800 unique scenarios. The panel rated 587 (33%) scenarios as appropriate, 585 (33%) as uncertain, and 628 (35%) as inappropriate for treatment initiation. Analysis of variance determined that IOP had greater impact than any other variable on panel ratings. We created a point system with 96% sensitivity and 93% specificity for predicting panel ratings of appropriateness for a glaucoma suspect. Conclusions An expert panel can reach agreement on the appropriateness and inappropriateness of treatment for glaucoma suspects.

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Delphi‐panel analysis of appropriateness of high‐dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer

Cited by 19 publications

References 24 publications

Treatment of patients with metastatic renal cell cancer

Treatment of patients with metastatic renal cell cancer

Are there roles for observational database studies and structured quantification of expert opinion to answer therapy controversies in transplants?

For Which Glaucoma Suspects Is It Appropriate to Initiate Treatment?

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