Kathy D. Miller, MD; Maurie Markman, MD; Ian F. Tannock, MD, PhD, DSc; Eric P. Winer, MD


June 11, 2013

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In This Article


Kathy D. Miller, MD: Hello. I am Kathy Miller, Associate Professor of Medicine at the Indiana University School of Medicine in Indianapolis. Welcome to Medscape Oncology Insights.

Today several colleagues and I will attempt to answer a very difficult question: What exactly is clinically meaningful benefit? I'm proud to be joined by Dr. Maurie Markman, President of Patient Oncology Services and the National Director for Medical Oncology at the Cancer Treatment Centers of America in Philadelphia; Dr. Ian Tannock, Professor of Medical Oncology at the University of Toronto, as well as Staff Physician and Senior Scientist at the Princess Margaret Cancer Center in Toronto; and Dr. Eric Winer, Professor at Harvard Medical School and Chief of the Division of Women's Cancers at the Dana-Farber Cancer Institute in Boston. Welcome to all of you.

In separate sessions of Medscape Oncology Insights, other colleagues talked about the rising cost of care. Ian, you have proposed using value-based pricing as a way of getting around that. But to do so, we have to decide what is value, what is meaningful to our patients? What is clinically meaningful benefit?

Only 2 Things You Can Do to Help Patients

Ian F. Tannock, MD, PhD, DSc: It doesn't matter whether you are an oncologist, a surgeon, or a kidney doctor; there are only 2 things that you can do to help patients: You either make them live longer or you make them live better. When we look at clinical trials, the ultimate endpoints are survival and some measure of quality.

Obviously there are some diseases that are chronic, and we want to get results quicker than we can if we use survival as the only endpoint. One of the problems that we have in oncology is that we have used "surrogate endpoints," like time to progression of the disease and time to relapse of cancer. Those may be valid, but they have to be shown to represent a substitute for those 2 basic things that we need to do [see that patients live longer and live better]. Often, the endpoint has not been validated as a substitute.


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