The Latest Published Results of PCORI-Funded Studies

Surveillance for Recurring Colorectal Cancer

Colorectal cancer is the third-leading cause of adult cancer deaths in the United States, according to the American Cancer Society. For survivors, having tumors reoccur is a major concern, and clinicians recommend regular surveillance after treatment to look for any tumors that have regrown. What’s been unclear is how often this surveillance needs to be done. A PCORI-funded study by George Chang, MD, MS, of MD Anderson Cancer Center and colleagues suggests this is a case where somewhat less surveillance may be as good as, if not better than, more. 

The researchers analyzed information from more than 8,000 patients who previously had surgery to remove colorectal tumors. The team reported in JAMA that facilities that implement more-frequent follow-up failed to detect recurring cancers any sooner than facilities that do less-frequent surveillance. The team also found no link between the intensity of surveillance and overall survival, suggesting more-frequent surveillance provided no health benefit. Another study in the same issue of JAMA, a randomized trial, arrived at similar conclusions. Given this, an accompanying editorial in the journal suggested the need to reevaluate clinical guidelines on frequency of surveillance for tumor recurrence.

Can a Home-Based Exercise Program Help Patients with Peripheral Artery Disease?

In another JAMA article, researchers reported that a home-based exercise intervention did not significantly improve the distance that patients who have peripheral artery disease could walk. Peripheral artery disease is a narrowing of the arteries that decreases blood flow to the legs. It can cause pain during walking. More than 8 million Americans have the disease.

Walking on a treadmill with supervision from medical providers in a clinic or hospital setting is first-line therapy for patients with the condition, but some patients’ limited mobility can make it challenging to get to clinics for such therapy. In a PCORI-funded project, researchers led by Mary McDermott, MD, of Northwestern University, randomly assigned 200 patients to either nine months of usual care from their own physicians or a home-based exercise program. The latter group received a month of weekly in-person coaching and goal-setting visits at a medical center and eight months of telephone coaching. Those in the home-exercise group also wore a monitor that recorded physical activity. At the end of the study, patients who received the home-based program did no better than those who only received usual care.

JAMA deserves great credit for publishing these negative results. Such reporting aligns with PCORI’s dedication to transparency about our funded results, whether they are positive, negative, or inconclusive. It can be critical in helping patients and their clinicians make important choices, and it may guide future research to find other types of treatment that truly do work better than current practices.

More Effectively Treating Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) affects an estimated 6 percent of adults in the United States at some point in their lives. It can cause flashbacks of upsetting events and difficulty sleeping, among other symptoms. Treatment decision makers don’t always have access to the latest scientific results, so with PCORI funding, an Agency for Healthcare Research and Quality (AHRQ) Evidence-Based Practice Center reviewed PTSD treatment studies published since 2012 to update an earlier AHRQ systematic review. The update found strong support for the effectiveness of certain types of cognitive behavioral therapy in treating patients with PTSD.

Cognitive behavioral therapy is a type of talk therapy that focuses on helping patients become aware of negative thought patterns and beliefs and develop constructive ways of thinking. The review update found strong evidence that cognitive behavioral therapy—particularly exposure therapy, a form of cognitive behavioral therapy directed at lessening anxiety responses to fearful situations or objects—reduces PTSD symptoms. It also found moderate evidence that the antidepressant medications fluoxetine (Prozac), paroxetine (Paxil), and venlafaxine (Effexor) can help reduce PTSD-related symptoms.

This report is the first in a series of systematic reviews and review updates that PCORI is producing to rapidly get research results to people who can use them in healthcare decisions.

Facilitating Doctor-Patient Communication about Goals

Finally, a randomized trial led by J. Randall Curtis, MD, MPH, of the University of Washington offered important insight as we seek ways to better facilitate conversations between clinicians and patients with serious illnesses about goals of care.

Previous studies have linked such conversations to improving patients’ experiences with end-of-life care. In this latest study, published in JAMA Internal Medicine, researchers surveyed 537 patients about care goals and barriers to having goals-of-care conversations. Then, half of those patients’ 132 clinicians received the results of their patients’ surveys and strategies to overcome barriers in talking with patients. The team reported that the number of goals-of-care conversations between patients and clinicians was 31 percent in the usual care group and 74 percent in the group in which clinicians received more information.  

These publications are among more than 60 that have appeared in leading medical journals summarizing the primary comparative effectiveness research results of the studies we’ve funded. Summaries from 78 completed projects, meanwhile, are now available on our website in versions for professionals and the general public, the latter in both English and Spanish.

Needless to say, we’re excited about this record of achievement and look forward to even more important results becoming available in the coming months as we work to help patients and those who care for them make better-informed healthcare decisions.