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August 26, 2021

Has the Current Oncology Value Paradigm Forgotten Patients’ Time?Too Little of a Good Thing

Author Affiliations
  • 1Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, Ontario, Canada
  • 2Department of Oncology, Queen’s University, Kingston, Ontario, Canada
  • 3Department of Epidemiology and Biostatistics, University of California, San Francisco
JAMA Oncol. 2021;7(12):1757-1758. doi:10.1001/jamaoncol.2021.3600

The past decade has seen the approval of some very effective treatments for cancer. However, despite notable advances, many new cancer drugs are associated with small benefits and high costs. While these concerns have stimulated important conversations about value, discussions are largely restricted to the magnitude of clinical benefit and drug prices. In this commentary, we discuss how the current value paradigm undervalues patients’ time.

Net treatment benefit considers improvements in outcomes together with side effects and quality of life (QOL). The American Society of Clinical Oncology Value Framework1 and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale2 were designed to quantify the magnitude of benefit of new cancer medicines. These tools incorporate treatment intent, end points, and the extent to which outcomes are improved; side effects and QOL are also considered. We propose that existing value frameworks and clinical decision-making do not adequately account for the value of patient time, which is especially important near the end of life, when time is most scarce.

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