Recently Published Projects

Published on October 06, 2021
Radiation Therapy for Brain Metastases
97 Studies • 4 Key Questions • 97 Extraction Forms
Project created on April 22, 2021
Last updated on October 06, 2021
Objectives: Objective. This evidence report synthesizes the available evidence on radiation therapy for brain metastases. Data sources. We searched PubMed®, Embase®, Web of Science, Scopus, CINAHL®, clinicaltrials.gov, and published guidelines in July 2020; assessed independently submitted data; consulted with experts; and contacted authors. Review methods. The protocol was informed by Key Informants. The systematic review was supported by a Technical Expert Panel and is registered in PROSPERO (CRD42020168260). Two reviewers independently screened citations; data were abstracted by one reviewer and checked by an experienced reviewer. We included randomized controlled trials (RCTs) and large observational studies (for safety assessments), evaluating whole brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) alone or in combination, as initial or postoperative treatment, with or without systemic therapy for adults with brain metastases due to non-small cell lung cancer, breast cancer, or melanoma. Results. In total, 97 studies, reported in 190 publications, were identified, but the number of analyses was limited due to different intervention and comparator combinations as well as insufficient reporting of outcome data. Risk of bias varied; 25 trials were terminated early, predominantly due to poor accrual. Most studies evaluated WBRT, alone or in combination with SRS, as initial treatment; 10 RCTs reported on post-surgical interventions. The combination treatment SRS plus WBRT compared to SRS alone or WBRT alone showed no statistically significant difference in overall survival (hazard ratio [HR], 1.09; confidence interval [CI], 0.69 to 1.73; 4 RCTs; low strength of evidence [SoE]) or death due to brain metastases (relative risk [RR], 0.93; CI, 0.48 to 1.81; 3 RCTs; low SoE). Radiation therapy after surgery did not improve overall survival compared with surgery alone (HR, 0.98; CI, 0.76 to 1.26; 5 RCTs; moderate SoE). Data for quality of life, functional status, and cognitive effects were insufficient to determine effects of WBRT, SRS, or post-surgical interventions. We did not find systematic differences across interventions in serious adverse events radiation necrosis, fatigue, or seizures (all low or moderate SoE). WBRT plus systemic therapy (RR, 1.44; CI, 1.03 to 2.00; 14 studies; moderate SoE) was associated with increased risks for vomiting compared to WBRT alone. Conclusion. Despite the substantial research literature on radiation therapy, comparative effectiveness information is limited. There is a need for more data on patient-relevant outcomes such as quality of life, functional status, and cognitive effects.
Published on October 06, 2021
Disparities and Barriers to Pediatric Cancer Survivorship Care
110 Studies • 5 Key Questions • 110 Extraction Forms
Project created on January 04, 2021
Last updated on October 06, 2021
Objectives: Objectives. Survival rates for pediatric cancer have dramatically increased since the 1970s and the population of childhood cancer survivors (CCS) exceed 500,000 in the US. Cancer during childhood and related treatments lead to long-term health problems, many of which are poorly understood. These problems can be amplified by suboptimal survivorship care. This report provides an overview of the existing evidence and forthcoming research relevant to disparities and barriers for pediatric cancer survivorship care, outlines pending questions, and offers guidance for future research. Data Sources. This technical brief reviews published peer-reviewed literature, grey literature, and key informant interviews to answer five guiding questions regarding disparities in the care of pediatric survivors, barriers to cancer survivorship care, proposed strategies, evaluated interventions, and future directions. Review Methods. We searched research databases, research registries, and published reviews for ongoing and published studies in CCS to October 2020. We used the authors’ definition of CCS; where not specified, CCS included those diagnosed with any cancer prior to age 21. The grey literature search included relevant professional and non-profit organizational websites and guideline clearing houses. Key informants provided content expertise regarding published and ongoing research, and recommended approaches to fill identified gaps. Results. In total, 110 studies met inclusion criteria. We identified 26 studies that assessed disparities in survivorship care for CCS. Key informants discussed subgroups of CCS by race or ethnicity, sex, socioeconomic status, and insurance coverage that may experience disparities in survivorship care and these groups that experience disparities were supported in the published literature. Key informants indicated that major barriers to care are providers (e.g., insufficient knowledge), the health system (e.g., availability of services), and payers (e.g., network adequacy); we identified 47 studies that assessed a large range of barriers to survivorship care. Sixteen organizations have outlined strategies to address pediatric survivorship care. Our searches identified only 27 published studies that evaluated interventions to alleviate disparities and reduce barriers to care. These predominantly assessed approaches that targeted patients. We found only eight ongoing studies that evaluated strategies to address disparities and barriers. Conclusions. While research has addressed disparities and barriers to survivorship care for childhood cancer survivors, evidence-based interventions to address these disparities and barriers to care are sparse. Additional research is also needed to examine less frequently studied disparities and barriers and to evaluate ameliorative strategies in order to improve the survivorship care for CCS.
Published on October 05, 2021
Blood Gas Analysis: Point of Care Testing (POCT) vs Central Laboratory
8 Studies • 5 Key Questions • 7 Extraction Forms
Project created on March 16, 2021
Last updated on October 05, 2021
Objectives: Background: A comparison of blood gas analysis by point of care testing (POCT) compared to central laboratory testing in terms of turnaround time and cost has not been thoroughly reported. Purpose: To summarize studies comparing result turnaround times between POC blood gas analysis and central laboratory analysis for hospitalized patients. Data Sources: PubMed, Cochrane Central register of Controlled trials, Medline Ovid, and Web of Science were searched for reports from randomized and nonrandomized controlled trials. Study Selection: Abstracts were screened to identify reports from trials comparing bedside/point-of-care blood gas analysis and blood gas analysis by central laboratory with adult participants; at least 10 participants per group; <20% drop out rate; and outcomes of turnaround times and/or cost. Data Extraction: Reviewers extracted data on study design, methods, sample characteristics, interventions, comparators, and outcomes.
Published on October 05, 2021
EBV Serology for NPC Screening
10 Studies • 1 Key Questions • 11 Extraction Forms
Project created on March 02, 2021
Last updated on October 05, 2021
Objectives: Systematic Review on the diagnostic accuracy of VCA IgA combined with EBNA-1 IgA when screening for nasopharyngeal carcinoma.
Published on October 05, 2021
Blood Stream Infections Outcomes-Oriented Scoping Review
77 Studies • 1 Key Questions • 187 Extraction Forms
Project created on November 13, 2019
Last updated on October 05, 2021
Objectives: Outcomes-oriented scoping review in support of the ASM RDx BSI systematic review