There are many ways to measure how well a particular cancer treatment works. But how much do these outcomes reflect a patient’s actual wellbeing? Our Curious Dr. George asks Christopher M. Booth, MD, FRCPC, one of the founding leaders of the new international initiative “Common Sense Oncology” (CSO), how CSO is working to improve patient outcomes.
Curious Dr. George: The practice of clinical oncology is difficult, at best, dealing every day with patients with potentially lethal malignancies. Some segments of oncology seem to have lost their way, veering towards the money-driven medicine that tempts physicians in many countries. How does CSO endeavor to put the patient at the forefront in the drive to maximize survival and enhance quality of life in an equitable manner, whilst giving serious attention to cost?
Christopher M. Booth MD, FRCPC: The art of oncology involves compassionate care, clear communication, and treatment that offers meaningful benefits.
Over the last four decades, transformative advances in surgery, radiotherapy, and systemic therapy have led to improved survival and quality of life for patients. However, in the last decade, a worrisome trend has emerged: most new cancer medicines do not help people live longer or better lives. Rather, the majority of new treatments approved by the U.S. Food and Drug Administration (FDA) are based on delaying tumour growth on a CT scan—usually measured as progression-free survival (PFS). In some circumstances, improvements in PFS are known to translate into improved overall survival (OS); however, these are the exception rather than the rule.
Hence, contemporary oncology is faced with a major challenge: most of our older treatments improve OS and/or quality of life, but most new medicines do not. This worrisome trend in our field is not well appreciated by patients or policymakers because our field has been consumed by hype—even for treatments that only have small benefits. The recent shift in our field to new medicines with marginal benefits is important because these treatments come with substantial costs: clinical toxicity for patients, time toxicity for patients and families, and financial toxicity to patients, families, and the health system.
These problems have developed due to a complex convergence of hope and money. Physicians and patients inherently look for treatment to provide benefit in what can be an overwhelming emotional journey. In many circumstances, a natural tension arises between hope and reality; this tension is most acute in the context of incurable cancer. In parallel, massive financial forces are involved in modern cancer medicine. These financial forces shape the research agenda and delivery of care. The pharmaceutical industry now funds about 90% of cancer drug trials, and a substantial proportion of industry revenues are directed into mass-marketing campaigns designed to increase use of cancer therapies—even if they are associated with marginal benefits.
In response to these challenges, an international group of oncologists, academics, and patient advocates gathered at Queen’s University in Kingston, Canada, in April 2023 to launch CSO. This grassroots initiative seeks to ensure all patients have access to cancer treatments that improve outcomes that matter, such as OS and quality of life. CSO’s mission, vision, guiding principles and action plan were recently published in the academic journal Lancet Oncology and on the Common Sense Oncology website. CSO is an inclusive movement that welcomes engagement from all stakeholders in the global cancer system. The voices of patients and patient advocates have been a core component of CSO since its inception. CSO promotes informed decision making with patients and seeks to promote health justice through access to high-quality and affordable cancer care.
The vision of CSO is that patients have access to cancer treatments that provide meaningful improvements in outcomes that matter, irrespective of where they live or their health system. To realize this vision, CSO has launched three streams of work related to evidence generation, evidence interpretation, and evidence communication.
Through our evidence generation efforts, CSO will work to ensure that clinical trials measure and report the impact of new therapies on outcomes that matter to patients. Evidence interpretation will involve educational initiatives to increase critical appraisal and critical thinking skills among oncologists. Our evidence communication initiatives will seek to improve understanding of cancer treatment risks and benefits among patients, the public, the media, and policymakers.
One of the primary goals in launching CSO was to provide a forum for the oncology community to have candid conversations about the successes and failures within our field. CSO will celebrate well-conducted trials and treatments that measurably improve the lives of patients. However, the CSO community will also be willing to call out treatments that may cause more harm than good. Efforts to improve the generation, interpretation, and communication of evidence in our field will help move oncology closer to a reality in which all patients have access to high-quality treatment with meaningful benefits—regardless of where they live.
Dr. Booth is a medical oncologist and health services researcher at Queen’s University in Canada, where he holds the Canada Research Chair in Population Cancer Care. He can be reached at email@example.com.
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