Building the evidence base for decision making in cancer genomic medicine using comparative effectiveness research.

Journal Article (Journal Article;Review)

The clinical utility is uncertain for many cancer genomic applications. Comparative effectiveness research (CER) can provide evidence to clarify this uncertainty. The aim of this study was to identify approaches to help stakeholders make evidence-based decisions and to describe potential challenges and opportunities in using CER to produce evidence-based guidance. We identified general CER approaches for genomic applications through literature review, the authors' experiences, and lessons learned from a recent, seven-site CER initiative in cancer genomic medicine. Case studies illustrate the use of CER approaches. Evidence generation and synthesis approaches used in CER include comparative observational and randomized trials, patient-reported outcomes, decision modeling, and economic analysis. Significant challenges to conducting CER in cancer genomics include the rapid pace of innovation, lack of regulation, and variable definitions and evidence thresholds for clinical and personal utility. Opportunities to capitalize on CER methods in cancer genomics include improvements in the conduct of evidence synthesis, stakeholder engagement, increasing the number of comparative studies, and developing approaches to inform clinical guidelines and research prioritization. CER offers a variety of methodological approaches that can address stakeholders' needs and help ensure an effective translation of genomic discoveries.

Full Text

Duke Authors

Cited Authors

  • Goddard, KAB; Knaus, WA; Whitlock, E; Lyman, GH; Feigelson, HS; Schully, SD; Ramsey, S; Tunis, S; Freedman, AN; Khoury, MJ; Veenstra, DL

Published Date

  • July 2012

Published In

Volume / Issue

  • 14 / 7

Start / End Page

  • 633 - 642

PubMed ID

  • 22516979

Pubmed Central ID

  • PMC3632438

Electronic International Standard Serial Number (EISSN)

  • 1530-0366

Digital Object Identifier (DOI)

  • 10.1038/gim.2012.16


  • eng

Conference Location

  • United States