Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium.
Department of Surgery, Sahlgrenska University Hospital, Goteburg, Sweden.
Lancet Oncol. 2019 Feb;20(2):e112-e123. doi: 10.1016/S1470-2045(18)30917-3.
Surgery and radiotherapy, two locoregional cancer treatments, are essential to help improve cancer outcomes, control, and palliation. The continued evolution in treatment processes, techniques, and technologies-often at substantially increased costs-demands for direction on outcomes that are most valued by patients, and the evidence that is required before clinical adoption of these practices. Three recently introduced frameworks-the European Society for Medical Oncology Magnitude of Clinical Benefit Scale, the American Society of Clinical Oncology Value Framework, and the National Comprehensive Cancer Network Blocks-which all help define the value of oncology treatments, were appraised with a focus on their methods and definition of patient benefit. In this Review, we investigate the applicability of these frameworks to surgical and radiotherapy innovations. Findings show that these frameworks are not immediately transferable to locoregional cancer treatments. Moreover, the lack of emphasis on patient perspective and the reliance on traditional, trial-based endpoints such as survival, disease-free survival, and safety, calls for a new framework that includes real-world evidence with focus on the whole spectrum of patient-centred endpoints. Such an evidence-informed value scale would safeguard against the proliferation of low-value innovation while simultaneously increasing access to treatments that show significant improvements in the outcomes of cancer care.
手术和放疗是两种局部癌症治疗方法，对于改善癌症的治疗效果、控制和缓解病情至关重要。治疗过程、技术和设备不断演变，成本大幅增加，因此需要明确患者最看重的治疗效果，并提供这些治疗方法应用于临床前所需的证据。最近引入了三个框架，即欧洲肿瘤内科学会临床获益量表、美国临床肿瘤学会价值框架和美国国家综合癌症网络模块，这些框架都有助于定义肿瘤治疗的价值，我们对这些框架的方法和患者获益的定义进行了评估。在这篇综述中，我们研究了这些框架在手术和放疗创新中的适用性。研究结果表明，这些框架并不能立即适用于局部癌症治疗。此外，这些框架缺乏对患者观点的重视，依赖于传统的基于试验的终点，如生存、无病生存和安全性，因此需要一个新的框架，该框架纳入了以患者为中心的整个结局范围的真实世界证据。这样一个基于证据的价值量表将防止低价值创新的扩散，同时增加对显示癌症治疗结局显著改善的治疗方法的可及性。
