Comparative Effectiveness Research in Integrative Oncology

Over the last decade, there has been an increasing interest in comparative effectiveness research (CER). The Institute of Medicine defined CER as "the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels" (1). A broad spectrum of research methods can be used to reach these aims, which include retrospective analyses of electronic health records as well as pragmatic trials (2). CER also plays a role in complementary and integrative medicine, which includes methods such as acupuncture and herbal medicine. The 2009 strategic recommendations for CER were developed from a complementary and integrative medicine stakeholder symposium that took place in the United States (3). Those included that CER should be prioritized, stakeholders should be engaged in research, studies should focus more on effectiveness than on efficacy, and effectiveness guidance documents (EGDs) should be used to guide future research. The movement started in the United States, but the methods were also introduced into European and Asian countries. However, the impact that CER has had so far is highly dependent on the cultural context and health systems involved.