On May 31, 2016, ASCO published an updated framework for assessing the relative value of cancer therapies that have been compared in clinical trials. The framework, published by Schnipper et al,1 defines value as a combination of clinical benefit, side effects, and improvement in patient symptoms or quality of life in the context of cost. The updated framework will be the basis for a software tool that doctors can use to assist shared decision-making with their patients. (Watch for an in-depth interview with Dr. Schnipper and more on the Value in Cancer Care Framework in the next issue of The ASCO Post.)
After publishing the initial version of the framework last year, ASCO invited public feedback during a 60-day comment period. More than 400 comments were submitted from patients, patient advocates, physicians, representatives of the pharmaceutical industry, and other members of the cancer community.
Changes to the Framework
Based on the feedback received, ASCO has made several changes to the framework:
- Most notably, ASCO modified the Net Health Benefit score—a weighted measure of a treatment’s benefits and side effects—to better reflect true differences between treatments. The framework also recognizes treatments that improve long-term disease control for a significant portion of patients. Additionally, the framework now considers all side effects in the Net Health Benefit score, not just the most severe, high-grade toxicities. This change reflects feedback from patients who emphasized that even mild side effects can have a major impact on quality of life. Therefore, in addition to awarding bonus points for symptom palliation, additional points are given for improvement in quality of life.
- The revised framework will continue to evaluate only treatments that were studied head-to-head in prospective randomized clinical trials. ASCO believes that head-to-head trials remain the only scientifically valid way to compare two treatments, given differences in trial designs, patient populations, cancer stages, and other factors.
- The framework will continue to focus on cancer drugs, rather than other interventions. Recognizing that the cost of drugs is only one component of overall cancer care costs, ASCO indicated that evidence shows drug costs to be the most rapidly rising component of cancer care and among patients’ biggest concerns—in large part because they pay a significant share of these costs through co-pays.
- Patient-reported outcomes are important and may be included in future versions of the framework.
Next Steps
In the coming months, ASCO will work to translate the framework into a user-friendly software tool for physicians to use with patients as part of broader discussions about treatment options. Importantly, recognizing that what individual patients care about most is highly personalized, the tool will allow scored categories for toxicity and length of survival to be weighted depending on a patient’s preference.
About ASCO’s Value Framework
The framework was developed and revised by ASCO’s Value in Cancer Care Task Force, a multidisciplinary group of physicians and other representatives of the oncology community (see members of the task force below). ■
Disclosure: For full disclosures of the authors, visit jco.ascopubs.org.
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