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However another problem still persists and that is the inclusion of high risk of bias or low quality studies was not the only problem in these studies, but rather the problem was that out of the included articles further analysis was not conducted to address additional bias or low quality. The completeness of quality measure reporting in oncology journals appears to be lower compared to reports in related fields such as orthodontics in which PRISMA results were 64\% compared to the quality assessment found in oncology journals of 50\% \cite{tunis2013association}. The use of high risk of bias or low quality appears to not be the focus in the assessment of quality in oncology journals. The variety of quality assessment scales also indicates a problem in reporting consistently and makes comparison amongst similar studies problematic \cite{Balk_2002}.   Another point of interest was that despite presence of high quality bias or low quality studies being included in the data set, most oncology journals did not conduct further analysis to address increased bias, and it is possible that due to varied criteria of assessing quality, most studies lack a clear awareness of which types of tools to use \cite{chalmers1983bias}. Grading of scales proves to be a problem due to lack of consistent types of scales within papers \cite{J_ni_1999}.  Our study faced certain limitations, but also maintained strengths in evaluating quality of reporting. In addition, the articles pooled from our search were not distributed equally in number, which would indicate that the results refer to one particular journal rather than many. Our coding procedure also assessed over several years, so that the trend of reporting was not of primarily one year, but that of several years.  Narrative styles of presenting information for quality assessment were the most common means of describing quality measures. This result makes sense when considering that the scales and methods of assessing quality were made by authors or other authors independent descriptions of quality measures rather than a standardized format of grading or measuring quality \cite{Kamal_2014}. Using a narrative method would allow the author to be more descriptive than a figure or table as a form of presentation. The use of narratives for describing quality measures is the consequence of using a wide variety of quality assessment tools and scales.   The sporadic use of quality measures has detrimental effects on the validity of findings in oncology trial journals. Inconsistent reporting of quality assessment tools and scales results in misinterpretation of clinical trial information and thereby negatively impacts the patient.   In conclusion, the quality assessment in major oncology journals has room for improvement in particular with regards to the varied number of individual quality assessment tools for each study, which detract from the ability to compare data. Additionally scales for grading high risk of bias or low quality need to be more uniform to compare to other studies. In situations where high risk of bias is included, additional analysis is important to counter bias of results.  
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