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\subsection{\textbf{Keywords:}}  meta-analysis;oncology;quality; risk of bias;systematic review  \section{Introduction}  The use of systematic reviews and meta-analyses has become increasingly important in evidence-based medicine as clinicians seek out consistent and reliable information on treatments and care guidelines in medicine \cite{14764293}. Since systematic reviews synthesize evidence from multiple studies, clinicians are able to better understand the individual trials comprising the review as well as the efficacy of the therapy summarized across all available, relevant evidence. One essential feature that lends confidence to the findings of a review is an appraisal of the methodology among studies in a systematic review. In cases where systematic reviewers have concluded that primary studies are of high methodological quality or have low potential for biased outcomes, clinicians can have more confidence regarding the study outcomes. For example, Yang et al evaluated the toxicity and efficacy of chemotherapy plus cetuximab in relation to chemotherapy alone in patients with advanced non-small cell lung cancer. The systematic review was comprised of 4 trials. A risk of bias assessment of these trials was conducted, and the authors concluded that risk of bias was low for overall survival and one-year survival rates but high for all other outcomes due to a lack of blinding.  In part, the reasoning for reliance on systematic reviews and meta-analyses is that both are considered to be helpful due to pooling of results of multiple studies to provide a broader view of information of interest, and by broadening the pool of data, the idea is that bias would become less of an issue in studies \cite{7500513}. Quality assessment is a crucial component of any study, and consequences of inadequate quality reporting or evaluation within research studies, can lead to exaggerated treatment effects when bias of participants is not taken into account in study design \cite{gurusamy2009assessment}. Assessing benefits and harms of interventional procedures is crucial in clinical application of trials and it is of great value to determine whether studies are conducted after assessing bias or low quality of studies.   Many scales have been designed to address concerns about high risk of bias or low quality in earlier studies, however, recent evidence indicates scales may not be the best means of assessing quality measures, and rather certain design features should be viewed to give a clearer picture of bias in trials \cite{lohr1999assessing}.The Cochrane Handbook for Systematic Review of Interventions has been updated continually to address changes in assessment of quality \cite{higgins2011cochrane}. Similarly the Jadad grading scale has also been designed as a means of unifying quality measures amongst clinical trials \cite{jadad1996assessing}. The first major guideline for reporting in systematic reviews and meta-analyses came out in 1996 and was referred to as the Quality of Reporting of Meta-Analyses (QUORUM), and has been followed thereafter by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement \cite{shamseer2015preferred}. The \textit{Cochrane Handbook for Systematic Review of Interventions} have been update continually to address changes in assessment of quality \cite{Higgins_2011}. Similarly the \textit{Jadad} grading scale has also been designed as a means of unifying quality measures amongst clinical trials \cite{jadad1996assessing}.    
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