ASCO Releases an Updated Value Framework

The American Society of Clinical Oncology (ASCO)’s Value in Cancer Care Task Force has published an updated value framework that can help clinicians and patients assess the relative value of cancer therapies that have been compared in clinical trials.

The conceptual framework, published last year right after ASCO’s annual meeting, was aimed at easing the shared decision-making process for patients and oncologists as they weigh the numerous treatment options available to them. ASCO claims that its framework incorporates elements of clinics benefit, toxicity, and symptom palliation—all drawn from clinical trial data—to develop a net health benefit (NHB) score. Patients are also provided information on the cost of the regimens to help understand the financial impact of their treatment.

The revised framework, published today in the Journal of Clinical Oncology, defines value as a combination of clinical benefit, side effects, and improvement in patient symptoms or quality of life in the context of cost, according to an associated press release. The current updates are based on the feedback that ASCO received—from patients, patient advocates, physicians, representatives of the pharmaceutical industry, and other members of the cancer community—during a 60-day comment period following the release of the value framework.

The following are the major changes to the framework:

• ASCO has modified the NHB score to better reflect true differences between treatments. For example, to calculate the efficacy of a treatment, the framework now uses hazard ratios, rather than absolute survival measures. Hazard ratios provide a more complete assessment of the relative differences between therapies.
• All side effects, not just high-grade toxicities, will be used to calculate the NHB score, following patient recommendations. So, in addition to awarding bonus points for symptom palliation, additional points are given for improvement in quality of life.
• The revised framework will continue to only evaluate treatments that were studied head-to-head in prospective randomized clinical trials.
• The framework will continue to focus on cancer drugs, rather than other interventions, since drug costs are the most rapidly rising component of cancer care and among patients’ biggest concerns.
• While patient-reported outcomes (PROs) are important, and may be included in future versions of the framework, clinical trials are yet to adequately measure or report PROs. ASCO hopes to be able to consider these data as they are more rigorously collected and reported in future trials.

Speaking with Evidence-Based Oncology, ASCO’s CMO Richard Schilsky, MD, FACP, FASCO, said, “What we are planning to do later this year is to develop a software application that incorporates all the elements of the Value Framework into an easy-to-use software that can be used on a laptop or a tablet at the point of care, where doctors can actually use it to engage patients in a conversation [around value].” According to the press release, ASCO will work closely with stakeholders, particularly patient advocates, to help ensure that the tool fully considers the needs and preferences of patients. Once it is developed, physicians will be provided with educational resources so that they can best apply the tool in their discussions with patients.

Reference

Schnipper LE, Davidson NE, Wollins DS, et al. Updating the American Society of Clinical Oncology Value Framework: revisions and reflections in response to comments received [published online May 31, 2016]. J Clin Oncol. doi:10.1200/JCO.2016.68.2518.