ASCO’s Value Framework a Powerful Tool for Shared Decision-Making

Neil B. Minkoff, MD

August 2015, Vol 6, No 7 - VBCC Perspectives

The American Society of Clinical Oncology (ASCO) is to be commended for its recently published statement on a conceptual framework to assess the value of cancer therapies.1 This marks an important, meaningful step forward as clinicians recognize the financial implications of choosing therapies.

The value framework does so in an elegant manner. By simplifying the approach to focus on the 3 main areas of efficacy, safety, and efficiency, the end result is likely to have more utility in patients’ understanding of the issues and to lead to greater shared decision-making, reinforcing that this framework is designed to be patient-centric and has the patient–physician relationship at its core.

Further work can be done regarding these patient-centric goals. Perhaps a group of patients who use these frameworks as part of their shared decision-making process can be followed longitudinally to see if they feel that their actual experience once therapy has begun matches the beliefs they held based only on the discussion with their clinical team and the use of the framework. That is, can the framework help guide cancer care in a way that matches patient expectation and experience?

The value framework may also become a powerful patient tool for education and empowerment. It would be a boon for patients to have access to these frameworks electronically in a manner that allows them to modify their acceptance of risk and other variables, and to see in real time what their treatment trade-offs are likely to be.

As stated in the article by Schnipper and colleagues, “Although not its underlying intent, ASCO recognizes that this work has the potential to influence policymakers and payers as they consider preferred management options and evaluate the relative value of new treatments introduced into the cancer marketplace. As it evolves, ASCO anticipates that the framework will play an increasingly important role in determining the value of new approaches to the treatment of cancer.”1

It is incumbent on ASCO to lead the way in educating payers of all types on how to responsibly use this tool. Furthermore, payers do not evaluate cancer therapies in a vacuum, and they often resort to adopting the use of medications based on their inclusion in oncology compendia. It would be revolutionary if ASCO’s value framework were used to influence compendia guidelines.

Finally, this effort and similar efforts in the cardiology community are to be applauded by all of us who deal in healthcare policy, and it will hopefully spur similar work in other complex and costly disease states for which there is little clinical or cost guidance, such as multiple sclerosis and inflammatory bowel disease.


  1. Schnipper LE, Davidson NE, Wollins DS, et al. American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 2015 Jun 22. Epub ahead of print.