Statistical Tool in Integrated Oncology: Propensity Score Methods

Abstract

Cancer is a good example where randomized experiments may not be good enough to evaluate effectiveness of care. On one hand, care is a process in a dynamic system, spanning from primary prevention through long-term survival and end-of-life care, involving multiple steps and interfaces that need to proceed smoothly in contracts to a reductionist approach which focuses on improvements in specific technical aspects of care and not the system. The totality of the diagnostic and treatment advances brought by the reductionist approach is less than the integrated care that is desired [1]. On the other hand, cancer patients turn to complementary and alternative medicine, influenced by cultural beliefs, expectations, and family and social support, in hopes of improving clinical outcomes controlling symptoms, and enhancing quality of life [2,3]. Such complementary and alternative therapies include acupuncture, yoga, hypnosis, meditation, guided imagery, biofeedback, aromatherapy, herbal remedies, massages integrated in to the conventional care [2,4]. Existing evidence suggest that the use of alternative medicines instead of conventional treatment is associated with worsened survival [5]. To help patients make informed decisions and improve quality of care, practicing oncologists and health care professionals need to have evidence on how multiple level of influence impact quality of care in addition to the benefit and risk of the different alternative therapies in an integrated healthcare system.