Value and Values in Cancer Care. Assessing the Benefit of Treatment in Patients with Advanced Cancer

Abstract

In recent years, the term “value-based healthcare” has been increasingly used in debates about costs and outcomes of health interventions in cancer care. This paper distinguishes 2 meanings of the term “value” and explores the relevance of both meanings of the word for assessing the “value” of cancer drugs. At the focus of the analysis are value judgments which form an integral part of the assessment of benefit of cancer drugs. The review concludes with a reflection on individual competences and systemic factors which are relevant to decision making about the value of treatment in situations of non-curative cancer.

Brazilian Red Propolis: Extracts Production, Physicochemical Characterization, and Cytotoxicity Profile for Antitumor Activity

“…About 21 million new cancers and 8.2 million cancer deaths worldwide are estimated until 2030 [2]. Surgery, radiotherapy, and chemotherapy are the most used approaches in the management and treatment of the disease [3]. Chemotherapy is commonly associated with the non-specific delivery of antineoplastic drugs capable of inhibiting mitosis, causing cell death and systemic toxicity.…”

What does “urgency” mean when prioritizing cancer treatment? Results from a qualitative study with German oncologists and other experts during the COVID-19 pandemic

“…a high chance of success, since in the former case an extremely high benefit may be expected in individual cases. The frameworks of the American Society of Clinical Oncology and the European Society for Medical Oncology concerning the benefit of diagnostic and treatment interventions and cancer drugs may provide a good evidence-based starting point regarding the respective decisions about prioritization (Cherny et al 2015 , 2017 ; Schildmann 2019 ; Schnipper et al 2012 ).…”

Maximizing the value of phase III trials in immuno-oncology: A checklist from the Society for Immunotherapy of Cancer (SITC)

“…From a patient perspective, value may include more difficult-to-quantify interactions between clinically meaningful benefit, out-of-pocket healthcare costs, and effects on quality of life (QOL). 39 40 Effective anticancer treatments also benefit society as a whole by allowing patients to return to being productive contributors rather than having prolonged chronic illness ultimately resulting in death. An added facet of value that may be considered by investigators is the potential for a trial to provide informative data on biomarkers of response and resistance or for patient selection in order to maximize likelihood of success for future studies.…”

“…In evaluating the landscape of competing trials to assess unmet need, it is important to consider the magnitude and type of efficacy expected for an investigational combination. Additionally, patient-centered concepts of value 39 40 should be taken into account such as the potential for an investigational combination to offer disease control and even treatment-free remissions, with fewer detrimental impacts on QOL compared with the standard of care option or to reduce direct and indirect aspects of the financial burden of cancer care.…”

“…However, it must be emphasized that a positive result in phase III does not guarantee meaningful benefit to patients. 39 148 149 For example, statistical significance does not always correlate with clinical significance. Furthermore, for studies designed with PFS as the primary endpoint, successful prolongation of PFS is not always associated with prolonged survival, 42 nor does not necessarily improve QOL.…”