of Veterans Affairs [VA] and several institutes within NIH) to take part in a larger comparative effectiveness study (U.S. Congress, 1994). AHCPR is, for example, supporting the Prostate Cancer Intervention Versus Observation Trial (PIVOT) in collaboration with NCI and VA. This randomized trial compares radical prostatectomy and palliative expectant management for the treatment of clinically localized prostate cancer. Information is being collected on patient outcomes such as functional status and quality of life. Costs and cost-effectiveness of alternative treatments are being assessed. Less than 5 percent of the total funding for this trial is from AHCPR.

Other Intraagency Agreements. In addition to the PIVOT trial, AHCPR sometimes transfers money to other agencies to support health services research. The Health Resources and Services Administration (HRSA), for example, received $100,000 to evaluate a multimedia education program on cervical cancer that was developed at NCI and the NLM for physicians, nurses, and other health care professionals. Funds were transferred to NCI to support an evaluation of minimal access surgery in cancer treatment (i.e., a comparative study of laparascopic versus open colectomy for the treatment of colon cancer). The assessment includes an analysis of cost-effectiveness. (AHCPR, personal communication to Maria Hewitt, December 1998).

Clinical Practice Guidelines. AHCPR no longer develops treatment guidelines, but it has recently issued guidelines on smoking cessation (1996) and the quality determinants of mammography (1994). In 1994, AHCPR published a practice guideline on cancer pain that will be updated with information forthcoming from an evidence practice center recently funded to review this topic. It has also recently issued a technical review of colorectal cancer screening (1998) (www.ahcpr.gov). AHCPR, in collaboration with the American Medical Association and the American Association of Health Plans, has developed a National Guideline Clearinghouse accessible by the Internet (www.guideline.gov). The website contains information on available guidelines, permits comparisons of guidelines recommendations, and facilitates communication among those involved in guideline development and dissemination (Stephenson, 1997). Of the first 414 guidelines accepted for inclusion, 45 relate to cancer (AHCPR, personal communication to Maria Hewitt, December 1998).

U.S. Preventive Services Task Force (USPSTF) and Put Prevention into Practice (PPIP). Since the 1980s, the USPSTF has evaluated scientific evidence for the effectiveness of clinical preventive services (e.g., screening tests, counseling, immunization, chemoprophylaxis) and produced age-and risk factor-specific recommendations for the services that should be included in a periodic health examination. PPIP is designed to help implement recommendations of the USPSTF. Roughly 20 percent of the services considered by USPSTF and PPIP relate to cancer detection or prevention.

Intramural Research Projects. Some of the research conducted by AHCPR staff concerns the quality of cancer care services (e.g., ''Drive-through mastectomy: How common and who's driving?'').

Basic Health Services Research. AHCPR supports research aimed at expanding the available array of quality measures. Some of these are not specific to cancer but could be relevant to cancer patients (e.g., quality measures for home and subacute care, health outcomes and quality-of-life meas-



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