Classically in cancer, physicians tended to talk about five-year survival but patients these days want to know more. However, it is difficult to arrive at a prognosis as it often changes as treatment progresses.
Factors around the tumour, patient and environment interact and change shape depending on the intervention, said Professor Mary Gospodarowicz, regional vice president of Cancer Care Ontario, Canada at the 5th ICON Conference held at Century City, Cape Town.
Research data used to determine outcomes carry their own problems: data accuracy is key, but some aspects of treatment side-effects are not available, cardiac toxicity is not reportable and cognitive impairment is difficult to measure.
She likened prognosis to weather forecasting, where shorter periods are more accurate, for example it’s easier to predict an acute toxicity response than five-year survival. In application of data, outcomes need to be matched to patients and it is difficult to apply population outcomes to an individual, especially in complex scenarios.
Despite the problems, outcomes need to be measured routinely to validate protocols, compare effectiveness, set standards, provide objective information for patients and define areas for improvement. Value has to be measured over the full cycle of the patient’s life so one needs to know how patients feel and function as they survive, she concluded.
Cost-effective radiotherapy studies
Professor Yolande Lievens from the University of Ghent, Belgium and past president of the European Society for Radiation and Oncology (Estro), discussed two projects developed by organisation, which are aiming to optimise utilisation of radiotherapy in a cost-effective way. The Hero (Health Economics in Radiation Oncology) project aims to provide a knowledge base and assess economic aspects of providing radiotherapy. It looks at resource availability, cost and radiotherapy needs across Europe. The Giro (Global Impact of Radiation Oncology) project uses the Hero data together with globally captured data, and aims to save lives and improve quality of life through data-driven and evidence-based innovation (a million lives in 20 years).
Lievens highlighted the finding in the Hero data that even in resource-rich countries, where availability of radiotherapy is extensive and cost is not an issue, there is still an enormous gap in treatment provision. Three out of every 10 patients do not receive the radiation treatment they need. In terms of the cost-effectiveness of providing radiotherapy, she pointed out that when determining costs of training and new equipment, the return on investment will be higher over 20 years.
It is also important to take into account the value of people being able to return to their work environment, so treatment has positive economic benefits and should not be viewed as a drain on health resources.
Regarding what evidence should be used to achieve outcomes, Lievens stressed the importance of collecting data from “real life” as opposed to randomised controlled trials. Evidence-based treatment development needs to take patient perception into consideration. It is hoped that by merging country-specific approaches with vertical disease-specific approaches, the Giro study will provide clearer understanding of patterns of care worldwide.
Lievens listed the critical steps of improving access to innovation identified by the European Cancer Organisation (ECCO):
- Greater involvement of patients and caregivers in defining and assessing innovations
- A whole-system, whole-patient approach to guide investment in innovation
- More efficient and harmonised evaluation of innovation
- Investment in real-world data to guide investment in innovation
- Promotion of an innovation culture within cancer care delivery
- A world vision (Lievens’s amendment) of innovation