# Quality-adjusted survival reported in every trial publication and label

Source: https://onco.cc/ideas/idea-moon-quality-adjusted-survival-standard/  
OnCo record `idea-moon-quality-adjusted-survival-standard` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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

## Summary

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed test: 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
- Actor: research

## Sources

- Bottleneck evidence (Toxicity and quality of life are undervalued): Di Maio et al., Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting (JCO 2015): https://doi.org/10.1200/JCO.2014.57.9334

## Connected records

- terms: [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Overall survival (OS)](https://onco.cc/terms/os/)
- bottlenecks: [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials](https://onco.cc/key-papers/paper-di-maio-j-clin-oncol/)

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