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Outcomes that matter.

CSO Philosophy

CSO will promote interventions that measurably improve the lives of patients. We will promote effective treatments but we will also challenge interventions that might cause more harm than good. CSO welcomes engagement from all stakeholders-especially patient advocacy groups. CSO will educate and empower the next generation of oncologists to push our field to do better for patients. We will work toward equitable access to affordable high-quality care. Improvements in the generation, interpretation, and communication of evidence will help close these gaps and move our field closer to a future in which a patient’s outcome is not determined by where they live, what they can afford, or the strength of a marketing campaign. The CSO initiative’s core mission is to ensure that cancer care and innovation is focused on outcomes that matter to patients rather than the commercial bottom line.

Problem Statement

Oncology needs a recalibrated approach that is more patient-centred and delivers equitable cancer care. An approach that prioritizes:

  • patients’ needs with treatments that improve survival and quality-of-life
  • patient informed decision making
  • making treatments accessible to all patients 

Cancer treatment decisions are increasingly complicated. While some cancer treatments provide large benefits, many new approved treatments do not help patients live longer or better (1,2).

All cancer treatments have side-effects, can cause substantial financial burden, and can result in lost time for patients spent in hospital rather than with friends and family.

Cancer systems now face a troubling paradox. In some circumstances there is substantial overuse of treatments with very small benefits, while at the same time many patients worldwide lack access to effective treatments which can make a meaningful difference in their lives.

Commercial interests, rather than patient interests, often drive cancer care and research. New cancer medicines now cost on average US$200 000 per year per patient, including those that do not help patients live longer or have better lives (4,5).

A substantial proportion of industry revenue is used for marketing campaigns to influence patients, policy makers, and oncologists irrespective of clinical need (6). Industry marketing
campaigns and media reports often hype marginal treatments, which contributes to overuse of cancer treatments with small or negligible benefits (7). These marginal treatments are not benign – they cause toxic side effects and financial burdens, negatively impacting patients quality of life.

How have these problems arisen in modern cancer care?

  • Over the past few decades cancer clinical trials have shifted from predominantly publicly funded studies designed to answer questions important to patients, to industry funded trials designed to achieve regulatory approval or commercial advantage (1).
  • The goal of improving and lengthening the lives of patients and that of making a profit for are often not aligned.
  • Industry’s control of the research agenda has created a system that is predominantly focused on new cancer medicines at the expense of investigating new approaches to surgery, radiotherapy, palliative care, and prevention.
  • This model is problematic. Surgery and radiotherapy cure many more patients than cancer medicines yet receive much less funding for research and delivery of care. Moreover, in low-middle income countries most patients are diagnosed with incurable disease yet do not have access to adequate pain relief and palliative care.
  • Another problem is the lack of clear communication regarding the magnitude of benefit and risks associated with therapies. When facing terminal cancer it is difficult for both oncologists and patients to balance hope with reality when discussing prognosis and treatments. Patients and clinicians often feel compelled to do something when faced with progressive disease, even if that something has minimal benefit and causes toxicity. Clear and compassionate communication is necessary to ensure that patients make informed treatment choices.

Patients deserve better information and better care. To achieve this, paradigm shifts will be needed in education research design and investment, policy, media and communication, and delivery of care (8). In April, 2023, global oncologists and patient advocates met at Queen’s University (Kingston, ON, Canada). The objectives of this meeting were to establish core tenets to guide development of a patient-centred Common Sense Oncology movement, develop goals and an action plan, and disseminate CSO guiding principles so that oncology trials and treatments are focused on outcomes that matter.


  1. Del Paggio JC, Berry JS, Hopman WM, et al. Evolution of the randomized clinical trial in the era of precision oncology. JAMA Oncol 2021; 7: 728–34.
  2. Michaeli DT, Michaeli T. Overall survival, progression-free survival, and tumor response benefit supporting initial US Food and Drug Administration approval and indication extension of new cancer drugs, 2003-2021. J Clin Oncol 2022; 40: 4095–06.
  3. Wells JC, Sharma S, Del Paggio JC, et al. An analysis of contemporary oncology randomized clinical trials from low/middle-income vs high- income countries. JAMA Oncol 2021; 7: 379–85.
  4. Del Paggio JC, Sullivan R, Schrag D, et al. Delivery of meaningful cancer care: a retrospective cohort study assessing cost and benefit with the ASCO and ESMO frameworks. Lancet Oncol 2017; 18: 887–94.
  5. Beasley D. New U.S. cancer drug prices rise 53% in five years -report. 2022. https://www.reuters.com/business/healthcare-pharmaceuticals/new-us- cancer-drug-prices-rise-53- five-years-report-2022-11-02/ (accessed June 13, 2023).
  6. Booth CM, Detsky AS. From the $80 hamburger to managing conflicts of interest with the pharmaceutical industry. BMJ 2019; 365: l1939.
  7. Rubagumya F, Galica J, Rugengamanzi E, et al. Media coverage of cancer therapeutics: a review of literature. J Cancer Policy 2023; 36: 100418.
  8. Gyawali B and Booth CM. Cancer treatments should benefit patients: a common-sense revolution in oncology. Nature Medicine 2022; 28(4): 617-620.

Mission Statement

To ensure that cancer care focusses on outcomes that matter to patients.

Our Vision

Patients have access to cancer treatments that provide meaningful improvements in outcomes that matter irrespective of where they live or their health system.

To realize this vision, we aspire that:

  • Patient outcomes that matter must be at the centre of every drug registration trial; and patient outcomes that matter should be the standard for every drug regulatory decision
  • Reporting of trials is transparent and uses language that can be understood clearly by oncologists and patients
  • Patients receive clear communication regarding treatment options that enables them to make informed decisions that are aligned with their personal goals and values
  • The only treatments that are registered, reimbursed, and recommended are ones that meaningfully improve patients’ lives
  • Common sense oncology that is grounded in evidence-based medicine and critical appraisal becomes a core curricular component for oncology training programs
  • Health systems invest in both developing new treatments and ensuring that patients have access to and benefit from proven effective treatments

Our Guiding Principles

  1. Access to quality cancer care is a basic human right—no patient should be denied access to effective therapy or forced into financial catastrophe to access meaningful cancer care
  2. Patient and societal needs should drive cancer research and delivery of care
  3. Patient and public involvement is essential when making policy decisions
  4. Patients should expect that recommended cancer treatments meaningfully improve their survival or quality of life
  5. Shared decision making between patients and oncologists should be based on patient values and grounded in evidence-based medicine and critical appraisal
  6. Cancer treatments should be fairly priced for the context in which they are used
  7. Equity in access to high quality care should be prioritized as much as innovation and new treatments
  8. Comprehensive patient-centred cancer care includes timely integration of psychosocial oncology, survivorship, and palliative care

CSO's Pillars of Work

As viewed through a lens of global health equity and value

1. Evidence generation: ensure that clinical trials use and report outcomes that matter to patients

The first pillar is evidence generation, which aims to ensure that clinical trials use and report outcomes that matter to patients. The randomised controlled trial (RCT) remains the gold standard to evaluate efficacy of new cancer therapies. Although meaningful improvements in patient outcome have come from pivotal trials, there are growing concerns about problems in design and reporting of some RCTs (9). This work stream will seek to offer solutions to improve trial design and reporting to ensure they prioritise outcomes that matter to patients.

2. Evidence interpretation; foster critical thinking by oncologists

The second pillar is evidence interpretation, which aims to foster critical thinking by clinicians. To assist patients in decision making, oncologists must be well- trained in critical appraisal. Individual oncologists and guideline committees should not recommend treatments that are based on poorly designed or poorly reported trials that show marginal benefits. This work stream will aim to empower oncologists to make sound clinical decisions aligned with outcomes that matter to patients.

3. Evidence communication: improve patient, public, and policy-maker understanding of cancer treatment options

The third pillar is evidence communication, which aims to improve patient, public, and policy maker understanding of cancer treatment options. The oncology clinical and research communities must communicate clearly with patients, the public, and policy makers. Lack of clear communication can lead to unrealistic expectations among patients and hype within oncology societies and the media; this in turn can drive promotion of treatments that provide marginal clinical benefits to patients (10). This work stream will look at ways of facilitating better informed decision making with patients; engagement with policy makers; and work with journalists to ensure that media reports are balanced, contextualised, and less sensational.

Our Team

The CSO Movement was initiated with a planning meeting at Queen’s University in Kingston Canada in April 2023. This grass-roots movement is open to any clinician, health professional, patient, patient advocate, academic, editor, regulator, policy-maker or other stakeholder who is interested in promoting the values of high quality and compassionate cancer care.

CSO Organizers

CSO Organizing Committee April 2023

Chris Booth, medical oncologist, Queen’s University, Kingston, Canada

Aaron Goodman, hematologist/oncologist, University of California San Diego, San Diego, US

Bishal Gyawali, medical oncologist, Queen’s University, Kingston, Canada

Brooke Wilson, medical oncologist, Queen’s University, Kingston, Canada

Manju Sengar, hematologist/oncologist, Tata Memorial Centre, Mumbai, India

CSO Founding Members April 2023

CSO Lakeside Photo

Ophira Ginsburg, medical oncologist, National Cancer Institute, Bethesda, US
Manni Mohyuddin, hematologist/oncologist, University of Utah, Salt Lake City, US
Kevin Knopf, medical oncologist, Highland Hospital, Oakland, US
Michelle Tregear, patient advocate, National Breast Cancer Coalition, Washington, US
Sally Schott, patient advocate, Medford, Oregon, US
Bernard Marini, oncology pharmacist, University of Michigan, Ann Arbor, US
Daniel Goldstein, medical oncologist, Rabin Medical Center, Tel Aviv, Israel
Richard Sullivan, surgical oncologist, King’s College London, London, UK
Ajay Aggarwal, clinical oncologist, Guy’s and St Thomas Hospital, London, UK
Dario Trapani, medical oncologist, European Institute of Oncology, IRCCS, Milan, Italy
Winette van der Graaf, medical oncologist, Netherlands Cancer Institute, Amsterdam, Netherlands
Enrique Soto, medical oncologist, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
Felipe Roitberg, medical oncologist, Hospital Sírio-Libanês, São Paulo, Brazil
Ian Tannock, medical oncologist, Princess Margaret Cancer Centre, Toronto, Canada
Verna Vanderpuye, clinical oncologist, Korle Bu Teaching Hospital, Accra, Ghana
Fidel Rubagumya, clinical oncologist, Rwanda Military Hospital, Kigali, Rwanda
Chris Jackson, medical oncologist, University of Otago, Dunedin, New Zealand
Deme Karikios, medical oncologist, University of Sydney, Sydney, Australia
Kazunori Honda, medical oncologist, Aichi Cancer Centre, Nagoya, Japan
Bhawna Sirohi, medical oncologist, Balco Medical Centre, Raipur, India
CS Pramesh, thoracic surgeon, Tata Memorial Centre, Mumbai, India
Bishesh Poudyal, hematologist/oncologist, Civil Service Hospital, Kathmandu, Nepal
Sanjeeva Gunasekera, pediatric oncologist, National Cancer Institute, Colombo, Sri Lanka
Avram Denburg, pediatric oncologist, Hospital for Sick Children, Toronto, Canada
Elizabeth Eisenhauer, medical oncologist Queen’s University, Kingston, Canada
Scott Berry, medical oncologist, Queen’s University, Kingston, Canada
Nazik Hammad, medical oncologist, University of Toronto, Toronto, Canada
Fabio Moraes, radiation oncologist, Queen’s University, Kingston, Canada
David Collingridge, Editor-in-Chief, The Lancet Oncology, London, UK
Rachel Koven, patient advocate, Kingston, Canada
Chris Booth, medical oncologist, Queen’s University, Kingston, Canada
Aaron Goodman, hematologist/oncologist, University of California San Diego, San Diego, US
Bishal Gyawali, medical oncologist, Queen’s University, Kingston, Canada
Brooke Wilson, medical oncologist, Queen’s University, Kingston, Canada
Manju Sengar, hematologist/oncologist, Tata Memorial Centre, Mumbai, India