Because studies or clinical experiences are ranked both by strength of design and importance of endpoint, a given study would have a two-tiered ranking (e.g., 1iiA for a nonblinded randomized study showing a favorable outcome in overall survival and 3iiiDiv for a phase II trial of selected patients with response rate as the outcome). In addition, all recommendations must take into account other issues that cannot be so easily quantified, such as toxicity, width of confidence intervals of observations, trial size, quality assurance in the trial, and cost. Nevertheless, the PDQ ranking system provides an ordinal categorization of strength of evidence as a starting point for discussions of study results.