Evidence in oncology. The Janeway lecture 2000

Area of Science:

• Oncology
• Clinical Research
• Evidence-Based Medicine

Background:

• Historically, clinical decision-making in oncology relied on less rigorous evidence.
• The early 20th century saw a mindset of 'res ipsa loquitur' (the thing speaks for itself) in research.
• A misperception of limited progress masked incremental improvements in survival rates.

Discussion:

• The shift towards recognizing incremental progress necessitated more robust research methodologies.
• Prospective randomized comparative trials have become crucial for identifying subtle treatment benefits.
• The quality of evidence has significantly impacted patient care over the last 25 years.

Key Insights:

• Phase III comparative clinical trials provide the highest quality data in oncology.
• Compelling evidence often comes from trials with significant outcome differences or replicated findings.
• Meta-analysis can be useful but is secondary to high-quality trial data.

Outlook:

• Contemporary oncologic research increasingly emphasizes incremental progress.
• Future research must prioritize rapid progression to phase III trials, especially with molecularly targeted therapies.
• The evolution of evidence weighting is critical for advancing patient care and health policy.