# Toxicity and quality of life are undervalued

Source: https://onco.cc/bottlenecks/b-toxicity-qol/  
OnCo record `b-toxicity-qol` (Bottleneck). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.

## Summary

Oncology trials are designed around survival and progression, and the harms and lived experience of treatment are secondary at best. Clinicians systematically under-report symptomatic toxicities compared with patients, quality-of-life data are collected in a minority of trials, analysed inconsistently, published late or not at all, and rarely influence approval, guidelines or price: more than half of EMA approvals in 2009-13 had no evidence of quality-of-life benefit at approval and most still did not years later. Chronic low-grade toxicity, which drives discontinuation of oral therapies, is invisible in the grade 3-4 tables that trials report. Immune-related adverse events, ADC-associated interstitial lung disease, and CAR-T neurotoxicity have created new categories of harm that patients must weigh against uncertain benefit. Patient-reported outcome instruments, standardised analysis, mandatory reporting and benefit frameworks that grade quality of life are the corrective tools.

## Fields

- Kind: Bottleneck
- Last checked: 2026-09-08
- Stage: people-culture
- Severity: major
- Metrics: Cancer drug indications approved by the EMA 2009-2013 with no evidence of quality-of-life or survival benefit at approval: 57% (Davis et al., BMJ 2017); Agreement between physician and patient reporting of symptomatic toxicities (anorexia, nausea, vomiting, constipation, diarrhoea, hair loss) in three randomised trials: Physicians under-reported all six symptoms (Di Maio et al., JCO 2015); Median overall survival with routine patient-reported symptom monitoring vs usual care during chemotherapy (randomised): 31.2 vs 26.0 months; not replicated (Basch et al., JAMA 2017; PRO-TECT, JAMA 2022, found no survival difference)
- Causes: Regulatory approval and pricing are based on efficacy endpoints, so sponsors invest little in quality-of-life measurement.; Clinician-graded adverse event scales miss what patients feel and ignore chronic low-grade toxicity.; Quality-of-life analyses are heterogeneous, unpublished or reported long after the primary paper.; Trial designs treat quality of life as exploratory rather than as a co-primary endpoint.; Toxicity management is under-resourced and supportive-care research is under-funded.

## Sources

- 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
- Davis et al., Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by EMA 2009-13 (BMJ 2017): https://doi.org/10.1136/bmj.j4530
- EORTC Quality of Life Group: https://qol.eortc.org/

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transplant](https://onco.cc/technologies/rejuv-tx-late-effects-overview/), [Limb salvage, amputation, and the rehabilitation that follows either](https://onco.cc/technologies/rejuv-recon-limb/), [Living with a stoma, and living after an amputation](https://onco.cc/technologies/rejuv-mind-body-after-stoma-and-limb-loss/), [Low-level light therapy (photobiomodulation) for hair](https://onco.cc/technologies/hair-photobiomodulation/), [Massage therapy in cancer care](https://onco.cc/technologies/massage-therapy-cancer/), [Measuring lymphoedema: tape, bioimpedance and the quality of life scales](https://onco.cc/technologies/rejuv-measure-lymphoedema/), [Measuring memory and concentration after treatment](https://onco.cc/technologies/rejuv-measure-cognitive-function/), [Memory, attention and learning after treatment of a childhood cancer](https://onco.cc/technologies/rejuv-paed-neurocognitive/), [Menopause brought on by cancer treatment, and the options for it](https://onco.cc/technologies/menopause-after-cancer-treatment/), [Mindfulness-based stress reduction and cognitive therapy](https://onco.cc/technologies/mindfulness-based-interventions/), [Minoxidil for persistent chemotherapy- and endocrine-therapy hair loss](https://onco.cc/technologies/minoxidil-chemotherapy-alopecia/), [Music therapy and music medicine](https://onco.cc/technologies/music-therapy-cancer/), [Nails after chemotherapy: lifting, ridges and discolouration](https://onco.cc/technologies/nail-changes-after-chemotherapy/), [Nerve damage from chemotherapy: what recovers, and what helps](https://onco.cc/technologies/cipn-recovery-and-treatment/), [Oral cryotherapy (ice chips) to prevent mucositis](https://onco.cc/technologies/oral-cryotherapy-mucositis/), [Partners and relationships after cancer: what the divorce data actually show](https://onco.cc/technologies/rejuv-life-partners-and-intimacy/), [Pelvic floor rehabilitation after prostate and rectal surgery and after pelvic radiotherapy](https://onco.cc/technologies/rejuv-rehab-pelvic-floor/), [Photobiomodulation (low-level laser) for oral mucositis](https://onco.cc/technologies/photobiomodulation-mucositis/), [Platelet-rich plasma for hair after cancer treatment](https://onco.cc/technologies/hair-platelet-rich-plasma/), [Platelet-rich plasma for survivors](https://onco.cc/technologies/rejuv-frontier-platelet-rich-plasma/), [Preventing graft-versus-host disease, and what prevention costs](https://onco.cc/technologies/gvhd-prophylaxis/), [PRO-CTCAE: side effects graded by the person having them](https://onco.cc/technologies/rejuv-measure-pro-ctcae/), [Probiotics for chemotherapy and radiotherapy diarrhoea](https://onco.cc/technologies/probiotics-treatment-diarrhoea/), [Protecting the heart during anthracycline treatment: dexrazoxane, beta blockers and ACE inhibitors](https://onco.cc/technologies/anthracycline-cardioprotection/), [Quality of life after transplant and cell therapy](https://onco.cc/technologies/rejuv-tx-quality-of-life/), [Rebuilding an immune system: the timeline, lineage by lineage](https://onco.cc/technologies/rejuv-tx-immune-reconstitution-timeline/), [Rebuilding the immune system after treatment](https://onco.cc/technologies/rejuv-frontier-immune-reconstitution/), [Recovery after pelvic exenteration](https://onco.cc/technologies/rejuv-recon-pelvic-exenteration/), [Reflexology](https://onco.cc/technologies/reflexology-cancer/), [Relaxation training and guided imagery](https://onco.cc/technologies/relaxation-guided-imagery/), [Scalp care during and after cancer treatment](https://onco.cc/technologies/scalp-care-cancer-treatment/), [Scalp cooling (cold caps: DigniCap, Paxman)](https://onco.cc/technologies/scalp-cooling/), [Scars, stiffness and contracture: shoulders, necks and jaws](https://onco.cc/technologies/rejuv-rehab-scar-contracture/), [Scrambler therapy (Calmare) for chemotherapy nerve pain](https://onco.cc/technologies/scrambler-therapy/), [Screening for distress: what the thermometer can and cannot do](https://onco.cc/technologies/rejuv-mind-distress-screening/), [Secondary T-cell malignancy after CAR-T, and what the FDA's 2024 action actually says](https://onco.cc/technologies/rejuv-tx-secondary-t-cell-malignancy/), [Senescent cells and p16 after chemotherapy](https://onco.cc/technologies/rejuv-age-senescent-cells-after-treatment/), [Sexual function and intimacy after cancer, for both sexes](https://onco.cc/technologies/sexual-function-after-cancer/), [Skin during and after radiotherapy: dressings, steroids and what lasts](https://onco.cc/technologies/radiation-skin-recovery/), [Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works](https://onco.cc/technologies/rejuv-mind-sleep-after-cancer/), [Sleep and circadian interventions in cancer](https://onco.cc/technologies/sleep-circadian-interventions/), [Sleeping tablets after cancer: what they do and what they do not](https://onco.cc/technologies/rejuv-mind-sleeping-tablets-after-cancer/), [St John's wort: an interaction to avoid](https://onco.cc/technologies/st-johns-wort-interaction/), [Stoma reversal after rectal cancer surgery: who gets the bowel joined up again](https://onco.cc/technologies/rejuv-recon-stoma-reversal/), [Supplements sold for hair growth after cancer treatment](https://onco.cc/technologies/hair-supplements-marketed/), [Swallowing therapy around head and neck radiotherapy](https://onco.cc/technologies/rejuv-rehab-swallowing/), [Tai chi and qigong](https://onco.cc/technologies/tai-chi-qigong/), [Teeth, jaws and facial growth after treatment in childhood](https://onco.cc/technologies/rejuv-paed-teeth-and-face/), [The cumulative dose that decides whether it comes back](https://onco.cc/technologies/rejuv-recovery-cumulative-dose/), [The exercise prescription after cancer: the dose the guidelines state](https://onco.cc/technologies/exercise-prescription-after-cancer/), [The heart after anthracyclines and chest radiotherapy in childhood](https://onco.cc/technologies/rejuv-paed-heart/), [The lungs after transplant: bronchiolitis obliterans syndrome](https://onco.cc/technologies/gvhd-lung-bronchiolitis-obliterans/), [Thinking and memory after cancer treatment: what is measurable, and what helps](https://onco.cc/technologies/cognitive-impairment-after-cancer-treatment/), [Vaginal oestrogen after breast cancer: what the evidence says, and where it disagrees](https://onco.cc/technologies/vaginal-oestrogen-after-breast-cancer/), [What actually works after treatment](https://onco.cc/technologies/rejuv-frontier-what-works/), [What comes back after treatment, treatment by treatment](https://onco.cc/technologies/rejuv-recovery-matrix/), [When steroids fail: ruxolitinib for steroid-refractory GvHD](https://onco.cc/technologies/gvhd-ruxolitinib-steroid-refractory/), [Where rehabilitation is commissioned, and who misses out](https://onco.cc/technologies/rejuv-rehab-commissioning-inequity/), [Wigs, cranial prostheses and head coverings](https://onco.cc/technologies/wigs-cranial-prosthesis/), [Yoga during and after cancer treatment](https://onco.cc/technologies/yoga-cancer/)
- companies: [EORTC](https://onco.cc/companies/curie-nki-eortc/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [International Society for Quality of Life Research](https://onco.cc/institutions/isoqol/), [Macmillan Cancer Support](https://onco.cc/institutions/macmillan-cancer-support/), [Marie Curie](https://onco.cc/institutions/marie-curie-uk/), [Multinational Association of Supportive Care in Cancer](https://onco.cc/institutions/mascc/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/), [UNC Lineberger Comprehensive Cancer Center](https://onco.cc/institutions/unc-lineberger/), [Wilmot Cancer Institute, University of Rochester](https://onco.cc/institutions/wilmot/)
- terms: [Alkylating agents and therapy-related myeloid neoplasms](https://onco.cc/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/), [Bipolar androgen therapy (BAT)](https://onco.cc/terms/bipolar-androgen-therapy/), [Bladder cancer after cyclophosphamide](https://onco.cc/terms/second-primary-bladder-after-cyclophosphamide/), [Choices made at the time of treatment that change the second cancer risk](https://onco.cc/terms/rejuv-second-choices-made-at-treatment/), [Cytokine release syndrome (CRS)](https://onco.cc/terms/crs/), [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [ICANS (neurotoxicity)](https://onco.cc/terms/icans/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Intermittent androgen deprivation (IAD)](https://onco.cc/terms/intermittent-androgen-deprivation/), [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/), [Nutrition impact symptoms](https://onco.cc/terms/nutrition-impact-symptoms/), [Objective response rate (ORR)](https://onco.cc/terms/orr/), [Overall survival (OS)](https://onco.cc/terms/os/), [Overtreatment](https://onco.cc/terms/overtreatment/), [Platinum drugs and PARP inhibitors: the newer leukaemia risk](https://onco.cc/terms/rejuv-second-platinum-and-parp-inhibitors/), [Progression-free survival (PFS)](https://onco.cc/terms/pfs/), [Topoisomerase II inhibitors and the shorter latency](https://onco.cc/terms/rejuv-second-topoisomerase-inhibitors-short-latency/)
- key papers: [Acalabrutinib plus bendamustine-rituximab in untreated mantle cell lymphoma](https://onco.cc/key-papers/paper-echo-acalabrutinib-bendamustine-rituximab-mantle-cell-jco-2025/), [Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study (QUASAR)](https://onco.cc/key-papers/paper-quasar-adjuvant-chemotherapy-vs-observation-lancet-2007/), [AFFIRM: increased survival with enzalutamide in prostate cancer after chemotherapy](https://onco.cc/key-papers/paper-scher-affirm-enzalutamide-nejm-2012/), [ASCENT: sacituzumab govitecan doubles survival in heavily pretreated metastatic triple-negative breast cancer](https://onco.cc/key-papers/paper-ascent-nejm-2021/), [ASCO 2021 guideline: how to recognise and manage the immune-related side effects of checkpoint inhibitors](https://onco.cc/key-papers/paper-asco-irae-guideline-jco-2021/), [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/), [Axicabtagene ciloleucel in relapsed or refractory indolent non-Hodgkin lymphoma (ZUMA-5): a single-arm, multicentre, phase 2 trial](https://onco.cc/key-papers/paper-zuma-5-axi-cel-indolent-lymphoma-lancet-oncol-2022/), [Basch: asking patients to report symptoms online during chemotherapy improved survival](https://onco.cc/key-papers/paper-basch-epro-survival-jama-2017/), [Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease](https://onco.cc/key-papers/paper-travis-breast-cancer-after-hodgkin-radiotherapy-jama-2003/), [Brentuximab vedotin combination for relapsed diffuse large B-cell lymphoma](https://onco.cc/key-papers/paper-echelon-3-brentuximab-lenalidomide-rituximab-dlbcl-jco-2025/), [Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk](https://onco.cc/key-papers/paper-van-nimwegen-cardiovascular-disease-after-hodgkin-jama-intern-med-2015/), [CARTITUDE-1: cilta-cel, a BCMA CAR-T, in heavily pretreated myeloma](https://onco.cc/key-papers/paper-cartitude-1-cilta-cel-lancet-2021/), [Cercek 2022: six months of dostarlimab alone made rectal cancer disappear in every patient with mismatch-repair deficiency](https://onco.cc/key-papers/paper-cercek-dostarlimab-rectal-nejm-2022/), [CheckMate 067 at ten years: nivolumab plus ipilimumab produces long-term survival in half of patients with advanced melanoma](https://onco.cc/key-papers/paper-checkmate-067-10-year-nejm-2025/), [CLEAR: lenvatinib plus pembrolizumab versus sunitinib as first treatment for advanced kidney cancer](https://onco.cc/key-papers/paper-clear-nejm-2021/), [COMFORT-I: ruxolitinib, the first JAK inhibitor, versus placebo for myelofibrosis](https://onco.cc/key-papers/paper-comfort-1-ruxolitinib-myelofibrosis-nejm-2012/), [COMMANDS: luspatercept versus epoetin alfa as first treatment for anaemia in lower-risk MDS needing transfusions](https://onco.cc/key-papers/paper-commands-luspatercept-mds-lancet-2023/), [DeLLphi-301: tarlatamab, a DLL3-targeting T-cell engager, in previously treated small-cell lung cancer](https://onco.cc/key-papers/paper-dellphi-301-nejm-2023/), [DESTINY-Breast03: trastuzumab deruxtecan beats T-DM1 as second-line treatment of HER2-positive metastatic breast cancer](https://onco.cc/key-papers/paper-destiny-breast03-nejm-2022/), [DESTINY-Breast04: trastuzumab deruxtecan works in HER2-low breast cancer, creating a new treatable group](https://onco.cc/key-papers/paper-destiny-breast04-nejm-2022/), [Duration of adjuvant chemotherapy for stage III colon cancer (the IDEA collaboration)](https://onco.cc/key-papers/paper-idea-duration-adjuvant-stage-iii-colon-nejm-2018/), [DYNAMIC: a blood test safely halved chemotherapy use after surgery for stage II colon cancer](https://onco.cc/key-papers/paper-dynamic-nejm-2022/), [Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial](https://onco.cc/key-papers/paper-eortc-h10-pet-adapted-early-hodgkin-jco-2017/), [ECHELON-1: brentuximab vedotin replacing bleomycin in first-line chemotherapy for advanced Hodgkin lymphoma](https://onco.cc/key-papers/paper-echelon-1-brentuximab-avd-nejm-2018/), [ELEVATE-TN: acalabrutinib, alone or with obinutuzumab, against chemo-immunotherapy in untreated CLL](https://onco.cc/key-papers/paper-elevate-tn-acalabrutinib-lancet-2020/), [EV-302: enfortumab vedotin plus pembrolizumab replaces chemotherapy as first treatment for advanced bladder cancer](https://onco.cc/key-papers/paper-ev-302-nejm-2024/), [FDA's Project Optimus manifesto: cancer drugs are approved at doses that are too high](https://onco.cc/key-papers/paper-drug-dosing-conundrum-nejm-2021/), [First-line lorlatinib or crizotinib in advanced ALK-positive lung cancer](https://onco.cc/key-papers/paper-shaw-crown-lorlatinib-crizotinib-nejm-2020/), [FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of TRIBE](https://onco.cc/key-papers/paper-cremolini-tribe-folfoxiri-bevacizumab-lancet-oncol-2015/), [Four versus six cycles of CHOP chemotherapy in combination with six applications of rituximab in patients with aggressive B-cell lymphoma with favourable prognosis (FLYER)](https://onco.cc/key-papers/paper-flyer-four-vs-six-cycles-r-chop-lancet-2019/), [GAP70+: a geriatric assessment before chemotherapy cut serious toxicity in older adults by a fifth](https://onco.cc/key-papers/paper-gap70-geriatric-assessment-lancet-2021/), [Hodi 2010: ipilimumab, the first checkpoint inhibitor, extends survival in metastatic melanoma](https://onco.cc/key-papers/paper-hodi-ipilimumab-melanoma-nejm-2010/), [IBIS-I: five years of tamoxifen keeps preventing breast cancer for at least 20 years](https://onco.cc/key-papers/paper-ibis-i-tamoxifen-lancet-oncol-2015/), [Ibrutinib and rituximab versus immunochemotherapy in patients with previously untreated mantle cell lymphoma (ENRICH): a randomised, open-label, phase 2/3 superiority trial](https://onco.cc/key-papers/paper-enrich-ibrutinib-rituximab-mantle-cell-lancet-2025/), [Ibrutinib plus bendamustine and rituximab in untreated mantle-cell lymphoma](https://onco.cc/key-papers/paper-shine-ibrutinib-bendamustine-rituximab-mantle-cell-nejm-2022/), [IMerge: imetelstat, a telomerase inhibitor, for transfusion-dependent lower-risk MDS after erythropoietin has failed](https://onco.cc/key-papers/paper-imerge-imetelstat-mds-lancet-2024/), [Improved survival with preoperative radiotherapy in resectable rectal cancer (Swedish Rectal Cancer Trial)](https://onco.cc/key-papers/paper-swedish-rectal-cancer-trial-preoperative-radiotherapy-nejm-1997/), [INDIGO: vorasidenib, the first targeted drug for IDH-mutant low-grade glioma](https://onco.cc/key-papers/paper-indigo-nejm-2023/), [INO-VATE: inotuzumab ozogamicin, a CD22 antibody-drug conjugate, versus chemotherapy for relapsed adult B-cell ALL](https://onco.cc/key-papers/paper-ino-vate-inotuzumab-all-nejm-2016/), [KEYNOTE-522: adding pembrolizumab before and after surgery in early triple-negative breast cancer](https://onco.cc/key-papers/paper-keynote-522-nejm-2022/), [KEYNOTE-564: a year of pembrolizumab after kidney cancer surgery](https://onco.cc/key-papers/paper-keynote-564-nejm-2021/), [Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell lymphoma treated with first-line R-CHOP](https://onco.cc/key-papers/paper-remarc-lenalidomide-maintenance-dlbcl-jco-2017/), [MagnetisMM-3: elranatamab, a second BCMA bispecific, with a switch to fortnightly dosing after response](https://onco.cc/key-papers/paper-magnetismm-3-elranatamab-natmed-2023/), [MajesTEC-1: teclistamab, an off-the-shelf BCMA bispecific antibody, in heavily pretreated myeloma](https://onco.cc/key-papers/paper-majestec-1-teclistamab-nejm-2022/), [MARIPOSA: amivantamab plus lazertinib versus osimertinib as first treatment for EGFR-mutated lung cancer](https://onco.cc/key-papers/paper-mariposa-nejm-2024/), [MOMENTUM: momelotinib versus danazol for myelofibrosis patients with anaemia after a prior JAK inhibitor](https://onco.cc/key-papers/paper-momentum-momelotinib-lancet-2023/), [monarchE: two years of abemaciclib after surgery in high-risk, hormone-receptor-positive early breast cancer](https://onco.cc/key-papers/paper-monarche-jco-2020/), [NADINA: two doses of ipilimumab plus nivolumab before surgery beat a year of nivolumab after surgery in stage III melanoma](https://onco.cc/key-papers/paper-nadina-nejm-2024/), [Nonoperative management of mismatch repair-deficient tumors](https://onco.cc/key-papers/paper-cercek-nonoperative-management-mismatch-repair-deficient-tumours-nejm-2025/), [Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results](https://onco.cc/key-papers/paper-habr-gama-nonoperative-stage-0-rectal-ann-surg-2004/), [Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA)](https://onco.cc/key-papers/paper-garcia-aguilar-opra-organ-preservation-jco-2022/), [Osimertinib with or without chemotherapy in EGFR-mutated advanced NSCLC](https://onco.cc/key-papers/paper-planchard-flaura2-osimertinib-chemotherapy-nejm-2023/), [Overdiagnosis and overtreatment of prostate cancer](https://onco.cc/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/), [Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer (MOSAIC)](https://onco.cc/key-papers/paper-mosaic-oxaliplatin-adjuvant-colon-nejm-2004/), [Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer](https://onco.cc/key-papers/paper-sandler-ecog-4599-bevacizumab-nsclc-nejm-2006/), [PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study](https://onco.cc/key-papers/paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019/), [PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group](https://onco.cc/key-papers/paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017/), [PIVOT: follow-up of prostatectomy versus observation for early prostate cancer](https://onco.cc/key-papers/paper-wilt-pivot-prostatectomy-observation-nejm-2017/), [Polatuzumab vedotin plus rituximab, gemcitabine, and oxaliplatin in relapsed or refractory diffuse large B-cell lymphoma: results from the phase III, randomized POLARGO trial](https://onco.cc/key-papers/paper-polargo-polatuzumab-r-gemox-dlbcl-jco-2026/), [Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer (Dutch TME trial)](https://onco.cc/key-papers/paper-kapiteijn-dutch-tme-preoperative-radiotherapy-nejm-2001/), [Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission](https://onco.cc/key-papers/paper-auperin-prophylactic-cranial-irradiation-sclc-nejm-1999/), [Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005](https://onco.cc/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/), [Randomized trial of TAS-102 for refractory metastatic colorectal cancer (RECOURSE)](https://onco.cc/key-papers/paper-mayer-recourse-tas-102-nejm-2015/), [Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT)](https://onco.cc/key-papers/paper-grothey-correct-regorafenib-lancet-2013/), [RELATIVITY-047: relatlimab plus nivolumab, the first LAG-3 checkpoint combination, in untreated advanced melanoma](https://onco.cc/key-papers/paper-relativity-047-nejm-2022/), [Rituximab after autologous stem-cell transplantation in mantle-cell lymphoma](https://onco.cc/key-papers/paper-lyma-rituximab-maintenance-after-transplant-mantle-cell-nejm-2017/), [Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial](https://onco.cc/key-papers/paper-prima-rituximab-maintenance-follicular-lancet-2011/), [SCALP: scalp cooling to prevent hair loss during chemotherapy for early breast cancer](https://onco.cc/key-papers/paper-scalp-trial-jama-2017/), [Second cancer risk up to 40 years after treatment for Hodgkin's lymphoma](https://onco.cc/key-papers/paper-schaapveld-second-cancer-risk-40-years-hodgkin-nejm-2015/), [SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up](https://onco.cc/key-papers/paper-bill-axelson-spcg-4-29-year-nejm-2018/), [SunRISe-1: TAR-200, a gemcitabine-releasing device placed in the bladder, for BCG-unresponsive non-muscle-invasive bladder cancer](https://onco.cc/key-papers/paper-sunrise-1-jco-2025/), [Sustained progression-free survival benefit of rituximab maintenance in patients with follicular lymphoma: long-term results of the PRIMA study](https://onco.cc/key-papers/paper-prima-final-rituximab-maintenance-follicular-jco-2019/), [SWOG 9346: intermittent versus continuous androgen deprivation in metastatic prostate cancer](https://onco.cc/key-papers/paper-hussain-swog-9346-intermittent-androgen-deprivation-nejm-2013/), [SWOG 9916: docetaxel and estramustine compared with mitoxantrone and prednisone for advanced refractory prostate cancer](https://onco.cc/key-papers/paper-petrylak-swog-9916-docetaxel-estramustine-nejm-2004/), [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/), [TAX 327: docetaxel plus prednisone or mitoxantrone plus prednisone for advanced prostate cancer](https://onco.cc/key-papers/paper-tannock-tax-327-docetaxel-prednisone-nejm-2004/), [Temel: early palliative care alongside chemotherapy improved quality of life, mood and survival in lung cancer](https://onco.cc/key-papers/paper-temel-early-palliative-care-nejm-2010/), [TRANSFORM: liso-cel CAR-T versus salvage chemotherapy and transplant in early-relapsing large B-cell lymphoma](https://onco.cc/key-papers/paper-transform-liso-cel-lancet-2022/), [TRANSFORMER: bipolar androgen therapy versus enzalutamide in asymptomatic metastatic castration-resistant prostate cancer](https://onco.cc/key-papers/paper-denmeade-transformer-bipolar-androgen-therapy-jco-2021/), [Trastuzumab deruxtecan (DS-8201) in patients with HER2-expressing metastatic colorectal cancer (DESTINY-CRC01)](https://onco.cc/key-papers/paper-siena-destiny-crc01-trastuzumab-deruxtecan-lancet-oncol-2021/), [TROPIC: prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel](https://onco.cc/key-papers/paper-de-bono-tropic-cabazitaxel-lancet-2010/), [Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer](https://onco.cc/key-papers/paper-leon-ferre-tils-tnbc-no-chemotherapy-jama-2024/), [Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide](https://onco.cc/key-papers/paper-turrisi-twice-daily-thoracic-radiotherapy-limited-sclc-nejm-1999/), [ZUMA-1: axicabtagene ciloleucel for refractory large B-cell lymphoma, the first CAR-T approved for lymphoma](https://onco.cc/key-papers/paper-zuma-1-axi-cel-nejm-2017/), [ZUMA-2: brexu-cel CAR-T for mantle cell lymphoma that has failed BTK inhibitors](https://onco.cc/key-papers/paper-zuma-2-brexu-cel-mantle-cell-nejm-2020/)
- cancers: [Desmoid tumour](https://onco.cc/cancers/desmoid-tumour/), [Ductal carcinoma in situ (DCIS)](https://onco.cc/cancers/ductal-carcinoma-in-situ/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Systemic mastocytosis](https://onco.cc/cancers/systemic-mastocytosis/), [Tenosynovial giant cell tumour (TGCT)](https://onco.cc/cancers/tenosynovial-giant-cell-tumour/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/), [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [Hormonal therapy roadmap: removing the ovaries → tamoxifen → oral degraders switched by a blood test](https://onco.cc/roadmaps/hormonal-therapy-roadmap/), [Lymphoma roadmap: from a jaw tumour in Uganda and the first human cancer virus to gene-expression subtypes, PET-adapted chemotherapy, CAR-T cells, bispecific antibodies and the genetics-directed trials now recruiting](https://onco.cc/roadmaps/lymphoma-roadmap/), [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/), [Recovery and rejuvenation roadmap: cure is not enough → survivorship gets a name → the cohorts that measured the cost → exercise proven as treatment → biological ageing measured and sold → repair, if anyone funds it](https://onco.cc/roadmaps/rejuvenation-roadmap/), [Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards](https://onco.cc/roadmaps/survivorship-roadmap/), [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- trials: [AHL2011](https://onco.cc/trials/ahl2011/), [Alliance/CALGB 50303](https://onco.cc/trials/calgb-50303/), [ARCHED](https://onco.cc/trials/arched/), [COG ACNS0331](https://onco.cc/trials/acns0331/), [ENRICH](https://onco.cc/trials/enrich/), [EORTC/LYSA/FIL H10](https://onco.cc/trials/eortc-h10/), [FLYER](https://onco.cc/trials/flyer/), [FORTplus](https://onco.cc/trials/fortplus/), [GHSG HD10](https://onco.cc/trials/hd10/), [GHSG HD16](https://onco.cc/trials/hd16/), [GHSG HD18](https://onco.cc/trials/hd18/), [LyMa](https://onco.cc/trials/lyma/), [POLARGO](https://onco.cc/trials/polargo/), [PRIMA](https://onco.cc/trials/prima-follicular/), [RADAR](https://onco.cc/trials/radar-hodgkin/), [REMARC](https://onco.cc/trials/remarc/), [SHINE](https://onco.cc/trials/shine/)
- people: [Bernard Fisher](https://onco.cc/people/bernard-fisher/), [Dame Cicely Saunders](https://onco.cc/people/cicely-saunders/), [Emil J Freireich](https://onco.cc/people/emil-freireich/), [Jimmie Holland](https://onco.cc/people/jimmie-holland/), [Kate Granger](https://onco.cc/people/kate-granger/), [Rose Kushner](https://onco.cc/people/rose-kushner/)

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JSON: https://onco.cc/api/v1/entities/b-toxicity-qol.json