This is a time of unprecedented hope in the development of treatments for cancer. For many patients, it can also be a time of despair and economic hardship. New drugs and treatment regimens proliferate faster than most physicians can keep pace with. Communicating choices among the options in disseminated cancer—fraught with difficulty at the best of times—can become almost impossible in a context of month-by-month change in complex treatment strategies and new subgroup classifications. And faced with the urgency of the task, the traditional methodology of randomized clinical trials may seem too slow and cumbersome.