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Improving Quality of Care for Cancer Patients

ACT: How can we improve shared decision-making practices as ways to improve the quality of care for cancer patients?

Buyse: Again, I think the method that we advocate and use at One2Treat, the generalized pay wise comparisons is a very natural way of establishing a dialog between the clinician, the oncologist, and the patient, because when the analysis is done on several outcomes, the clinician has to make sure that these outcomes resonate with patients—that they are meaningful outcomes for the patient. And so at the design of the trial, there will be a conversation between the oncologist and the patient to make sure that the analysis that will come later, that the analysis will really address the concerns and the questions that this particular patient has in mind. So in a sense, the interesting development that might happen is that we will not do a single analysis of the trial data anymore, we will be able to do an analysis that is patient-centric, that really addresses the preferences and the choices of a particular patient. Suppose, for example, that a patient is an elderly patient who has an advanced form of cancer. Unfortunately, the disease is incurable, maybe metastatic disease with very little chance of a response to treatment, so the choice for that patient will be: do I want to live six months of a very good life, or maybe 12 months of a life, but with a lot of toxicities and visits to the hospital, etc? Many patients will choose one option or the other depending on their own lifestyle and preferences. And it’s very subjective. It’s very difficult for the oncologist to exactly decide what is the fit for this particular patient. So, we believe that in the long term, patients should be empowered to have this shared decision making with their oncologist and be informed completely and even quantitatively, such that the analysis of the trial is done both ways. One way in which we prioritize the efficacy, what is the net benefit to the patient if we put the efficacy of the treatment first, and then the other question is, what is the net treatment benefit if we prioritize the safety? And then, depending on the preferences of the patient, one of the two treatment options will be better than the other, and that might be actually a different decision for different patients. So that, I think is essential in our approach is to say, well, there isn’t a single truth anymore. There is a truth, yes, qualitatively, based on the data from a trial—there is not one truth, but potentially a number of truths, depending, again, on the patient preferences. So different patients may end up receiving different treatments, and that’s exactly what should be happening.

Coppe: Which means that you may dream about an application on your smartphone in the future where you can just think about which kind of outcomes are the most relevant for you with regards to your own situation, and based on this kind of prioritization, you may expect to receive the right, appropriate treatment based on your willingness to go for one direction or the other. So that’s really what we mean about personalized medicine and personalized treatments. We are not too far away from this situation.