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EDITORIAL
Year : 2012  |  Volume : 8  |  Issue : 3  |  Page : 335

The value of retrospective patient data in oncology


Department of Radiotherapy, AIIMS, Ansari Nagar, Delhi, India

Date of Web Publication17-Nov-2012

Correspondence Address:
G K Rath
Department of Radiotherapy, AIIMS, Ansari Nagar, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.103508

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How to cite this article:
Rath G K. The value of retrospective patient data in oncology. J Can Res Ther 2012;8:335

How to cite this URL:
Rath G K. The value of retrospective patient data in oncology. J Can Res Ther [serial online] 2012 [cited 2019 Nov 12];8:335. Available from: http://www.cancerjournal.net/text.asp?2012/8/3/335/103508

Oncology is perhaps one of the sub-specialties in medicine where treatment decisions are largely driven by quality evidence gleaned through prospective trials. The evolution of breast cancer management is a prime example where questions of great clinical relevance have been answered using a series of well designed clinical trials by the NSABP. [1] As such, data from well conducted phase III randomised controlled trials have become the foundation of clinical decision making in oncology. The argument for high quality data from such trials is therefore very strong.

However, there are a few points to consider. Is it always possible to conduct meaningful phase III trials? Do results from these trials reflect practice in the community? Are the results of all phase III trials applicable to different diverse populations? Are some clinical questions better studied by a retrospective cohort analysis? These are important questions for the clinician because the very basis of our treatment decisions and the way we counsel our patients is the data we have for the diseases in question. So how does retrospective patient data help us? Despite its shortcomings compared with prospective phase III trials, retrospective patient data has many advantages. Firstly, this data reflects community practice. This is by far one of the most important strengths of such an analysis. This data has the potential to truly reflect the impact of our interventions in an unselected population. It is a source of great clinical confidence for a physician, when he or she can see the results of their own practice in the community they serve. Secondly, a well conducted analysis of such data can capture long periods of time thus providing us with long term results which may be difficult for prospective trials. Of course, this entails maintaining the data consistently over long periods of time. Truly relevant results have been reported for diseases like prostate cancer using this methodology. [2] Such studies provide rare insights in to the long term results of various interventions for this malignancy which has a long natural history. Another advantage of long term data gathering and analysis is the opportunity to study temporal changes in outcomes as a function of more modern treatment. Thirdly, such analysis often helps fill the gap where it is difficult to conduct phase III trials, e.g. rare tumors or studies involving end of life issues. Last but not the least, retrospective data often helps generate a hypothesis for a phase III trial. Various analyses like those conducted by the Surveillance, Epidemiology and End Results data base (SEER) are instructive for clinical practice.

That having been said, what factors improve the quality of retrospective patient data? The maintenance of a good quality database is paramount to our efforts in generating good quality patient data. This is an endeavour which begins with each clinician realising his or her role while recording individual patient data and culminates in the preservation of large datasets for long periods of time. There are many important steps in between. For example, consistent data gathering is vital. A Performa based method is one good way of collecting data for specific cancers/systems. A major problem we face is the lack of reliable follow-up after treatment. A more active follow-up of patients using mail or telephone is another way of improving the quality of our data. Further efforts can then take the form of co-operative data pooling between institutions, the sharing of patient tissue and blood samples, etc. Electronic data recording and retrieval are integral to a good data source. This allows an easy recall of the relevant data for any analysis. In essence, while the quality of data in a retrospective analysis is deemed inferior compared with data from prospective trials, there is no reason why this should always be the case. Clearly, there is much scope for improvement.

In summary, when and where available, data form well conducted prospective phase III trials should be used to guide clinical decision making in oncology. This is by far the best standard for the practice of evidence based medicine. However, well conducted and well reported large retrospective patient data sets have their own advantages. This information has its own special place in the practice of evidence based medicine.

 
 > References Top

1.Mamounas EP. NSABP Breast cancer clinical trials: Recent results and future directions. Clin Med Res 2003;4:309-26.  Back to cited text no. 1
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2.Porter CR, Kodama K, Gibbons RP, Correa R Jr, Chun FK, Perrotte P, et al. 25-year prostate cancer control and survival outcomes: A 40-year radical prostatectomy single institution series. J Urol 2006;176:569-74.  Back to cited text no. 2
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