Quality-adjusted survival reported in every trial publication and label

Report how long patients lived well, not only how long they lived. Methods exist (Q-TWiST) but are rarely used.

Quality-adjusted time without symptoms or toxicity (Q-TWiST) and related methods partition survival into time with toxicity, time without progression or toxicity, and time after progression, weighted by patient utilities. They are validated and occasionally reported but not standard. The proposal is that CONSORT-style reporting guidance, journals and regulators require a quality-adjusted survival analysis for every phase 3 oncology trial, using patient-reported utilities collected in the trial.

Hypothesis

Routine quality-adjusted survival reporting changes the ranking of regimens in a meaningful minority of trials and is adopted by guideline committees within five years.

Rationale

The data required (toxicity dates, progression, survival, utilities) are already collected; the analysis is cheap and directly comparable across trials.

What would test it

Reanalyse fifty recent phase 3 trials for Q-TWiST and compare rankings against those by hazard ratio; survey guideline committees on the added value.

Maturity

early clinical

Who has to act

research

Cost to try

Small (under $1M)

Years to first evidence

Bottlenecks it attacks

Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
Knowledge reaches practice too slowly · Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.

Connected

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Pages like this

not linked directly; found by shared links

terms

Hazard ratio (HR)Overall survival (OS)

bottlenecks

Knowledge reaches practice too slowly Toxicity and quality of life are undervalued