# Aggregated single-patient crossover trials for symptom and supportive treatments

Source: https://onco.cc/ideas/idea-tr1-aggregated-n-of-1-supportive-care/  
OnCo record `idea-tr1-aggregated-n-of-1-supportive-care` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

For symptoms such as nausea, fatigue or neuropathy, each patient can alternate the drug and a placebo over several periods and learn what works for them. Pooling these single-patient crossover trials with Bayesian models also gives a population answer, in areas where conventional trials are rare.

## Summary

N-of-1 trials (multiple randomised crossover periods within one patient) with ePRO outcomes are aggregated across patients using Bayesian hierarchical models to estimate both population and individual effects. Suitable for chronic, stable symptoms and reversible treatments (antiemetics, neuropathic pain agents, appetite stimulants, sleep aids) where conventional RCTs are rare because there is little commercial incentive.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Aggregated N-of-1 designs will answer supportive-care questions with a fifth of the patients required by parallel-group trials and will give each participant a personal answer they act on.
- Rationale: Supportive care is under-researched relative to its impact on QoL. N-of-1 designs are statistically efficient for stable conditions and are inherently patient-centred.
- Proposed test: Run a platform of N-of-1 trials for three common symptoms in a survivorship clinic with a smartphone ePRO app and compare precision per patient with the literature.
- Maturity: speculative
- Actor: research

## Sources

- Bottleneck evidence (Trial design, endpoints and cost): Davis et al., Availability of evidence of benefits on survival and quality of life of cancer drugs approved by EMA 2009-13 (BMJ 2017): https://doi.org/10.1136/bmj.j4530

## Connected records

- technologies: [Exercise & lifestyle oncology](https://onco.cc/technologies/exercise-oncology/)
- bottlenecks: [Cachexia, toxicity and the limits of the patient](https://onco.cc/bottlenecks/b-cachexia-supportive/), [Trial design, endpoints and cost](https://onco.cc/bottlenecks/b-trial-design/)
- key papers: [Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13](https://onco.cc/key-papers/paper-davis-bmj/)

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