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The Cancer Letter Inc.
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Tel: 202-362-1809
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publication date: Jun 3, 2016
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ASCO Updates Value Framework 


The American Society of Clinical Oncology published an updated framework for assessing the relative value of cancer therapies that have been compared in clinical trials.

The framework 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. The update was published in the Journal of Clinical Oncology.

ASCO modified the Net Health Benefit score, the weighted measure of a treatment’s benefits and side effects, to better reflect differences between treatments: to calculate the efficacy of a treatment, the framework now uses hazard ratios, when available, rather than absolute survival measures. The framework also recognizes treatments that improve long-term disease control for a significant portion of patients, according to ASCO.

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.

The revised framework will continue to only evaluate treatments that were studied head-to-head in prospective randomized clinical trials, said ASCO President Julie Vose in a statement.

“Some commenters expressed interest in making cross-trial comparisons, and ASCO agrees such comparisons would be valuable,” Vose said. “However, 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. In addition, the framework will continue to focus on cancer drugs, rather than other interventions.”

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