Outcome Reporting in Onco-Anaesthesiology and Perioperative Medicine

Research in the field of cancer is of utmost importance for improving cancer management modalities. Various outcomes are defined apriori by researchers for the researches. The outcomes reported by researchers should be meaningful and hold direct clinical translational value.1-4 The research outcomes need to have endpoints that improve the quality of life, improve patient care, improve management modalities and thus directly reflect the patient's benefit.5-7 The research outcomes need to be defined consistently, objectively and entirely of clinical translation value and be able to be measured uniformly. In research, outcomes are framed as primary and secondary. Usually, the researcher proposes one primary outcome and maybe 1–3 secondary outcomes for a particular research question. The primary outcome is typically an endpoint that directly answers the research question, and the secondary outcome(s) are those endpoints that further interpret the primary research question about certain additional information of importance, such as adverse events and extra benefits.8 Clinical outcomes in research have been broadly classified as patient-reported, clinician-reported, observer-reported and performance outcomes. However, it is crucial to emphasise that patient-related outcomes remain essential. Identifying patient-related outcome measures for research in onco-anaesthesiology and perioperative medicine is crucial. Equally important is the need to define the appropriate selection of these outcome measures, considering various factors such as demography, geographical, financial and infrastructural limitations/availability. The patient-reported outcomes help ascertain the patient's symptom burden, treatment side effects and quality of life. This, in turn, helps measure the overall disease burden, treatment-related symptoms and global view of health and measures any changes in health while on the treatment. However, patient-related outcomes need to be individualised based on the patient's demography, disease and treatment modalities in clinical settings.9,10 In cancer-related studies, intermediate/surrogate outcomes, such as progression-free survival and disease-free survival, are parameters that substitute an actual patient-related clinical outcome. Most studies in onco-anaesthesiology and perioperative medicine are focused on surrogate markers, considering concrete, measurable data such as reduction in the opioid requirement, length of hospital stay or prolongation of analgesia, which has limited significance. While these outcomes may offer some advantages in treatment decision-making, their actual benefits are often a subject of debate or, at best, limited. Surrogate markers remain limited, especially when the surrogates are not a relevant predictor of the clinical outcome which is being extrapolated. Study outcomes must reflect clinically meaningful improvements in patient survival or quality of life. In the context of cancer patients, the focus should also be on return to intended oncologic treatment (RIOT), as timely continuation of intended cancer treatment can significantly improve patient outcomes. Broader inclusion of outcomes such as financial implications, RIOT and patient functional improvement, including patients' reported quality of life and satisfaction, is required. The cancer patients may have associated various comorbidities (related or unrelated to cancer or its treatment per se). The composite outcome comprising multiple variables appears more appropriate in real life from a patient's point of view. However, in such a scenario, the researcher must cautiously interpret the outcome, as variables in the composite outcome may have a variable event and may not necessarily improve all studied variables of the composite outcome. The need for core outcome sets must also be emphasised.11 In the absence of core outcome sets, research may not be inclusive for evidence synthesis, as important outcomes remain missing among the defined outcomes of particular research.11 The core outcome set is available to determine the suitability and appropriateness of outcome core sets.11,12 Sometimes, a standardised definition, including measurement timings, tools and techniques, is unavailable. Given the variable definition, it becomes too difficult to translate this research into clinical practice, mainly for evidence synthesis (meta-analysis and guideline/policy formulation). Moreover, composite outcome and core outcome sets need to be developed uniformly in onco-anaesthesiology and perioperative medicine for better clinical translational value by maintaining consistency and information quality. There is an utter need for a 'cancer-related outcome' repository for uniform reporting. The patient-centric, precision outcome is the need of the day.