New commentary urges a rethink of quality of life metrics in cancer care economics in the context of EU HTA reform

As the cost of cancer care continues to climb worldwide, a newly published commentary by Eva Gamper et al.¹ calls for a critical reassessment of how health-related quality of life (HRQoL) data are applied in both clinical and economic decision-making in oncology.

Published in The Lancet Oncology, the article highlights a growing misalignment between HRQoL instruments used for clinical evaluation and those used in economic assessments—particularly in the context of the implementation and the entry into force of the EU HTA Regulation (EU-HTAR) since January 2025. This regulation aims to standardise health technology assessments (HTAs) across EU Member States, and to accelerate and broaden patient access to innovative, more effective treatments across Europe.

“We face a fundamental question,” the lead author, Eva Gamper, writes. “Should cancer-specific economic decisions rely on generic HRQoL tools that may not capture the full impact of disease and treatment? Especially when the clinical evidence does.”

The commentary distinguishes between:

• Cancer-specific HRQoL profile instruments, which generate detailed, domain-specific data essential for clinical decisions and regulatory evaluations in oncology;
• Generic preference-based measures (PBMs), which are commonly used in economic evaluations and enable cross-disease comparisons, which is crucial to guide national-level resource allocation.

While generic PBMs are widely accepted for their comparability, the authors caution they may lack the content validity necessary for treatment evaluation in oncology, potentially underrepresenting key aspects of cancer patients’ experience.

The publication emphasises that as cancer therapies evolve, so too must the tools used to evaluate their effectiveness. The authors spotlight a promising solution: cancer-specific PBMs developed by the Multi-Attribute Utility in Cancer Consortium in collaboration with the EORTC Quality of Life Group (QLG) and the Functional Assessment of Chronic Illness Therapy (FACIT) group.

These include:

• EORTC Quality of Life Utility-Core 10 Dimensions (QLU-C10D), derived from the EORTC QLQ-C30;
• Functional Assessment of Cancer Therapy – 8 Dimensions (FACT-8D), derived from the FACT-G.

Both instruments generate cancer-specific health utility scores and have demonstrated superior content validity compared to generic measures among cancer patients. They are supported by multiple national value sets and translations, making them highly applicable across different cancer populations and healthcare systems.

“Using QLU-C10D and FACT-8D allows health systems to integrate patient-centred insights into cost-effectiveness assessments—without additional burden,” Madeleine T. King, co-author, notes.

With the EU-HTAR poised to influence global HTA practices, the commentary argues that aligning clinical and economic HRQoL measures could strengthen future cancer care policy, funding, and patient outcomes.

The European Organisation for Research and Treatment of Cancer (EORTC) is a non-governmental, non-profit organisation, which unites clinical cancer research experts, throughout Europe, to define better treatments for cancer patients to prolong survival and improve quality of life. Spanning from translational to large, prospective, multi-centre, phase III clinical trials that evaluate new therapies and treatment strategies as well as patient quality of life, its activities are coordinated from EORTC Headquarters, a unique international clinical research infrastructure, based in Brussels, Belgium.

The EORTC Quality of Life Group (QLG) strives to improve health-related quality of life (HRQoL) of cancer patients, through dedicated research and the use of HRQoL measures within cancer clinical trials and clinical practice. HRQoL constitutes an important aspect of cancer research and care: it gives a voice to patients, putting their experience at the forefront. The QLG is part of the European Organisation for Research and Treatment of Cancer (EORTC).
For further information, please visit the QLG website: qol.eortc.org

Caroline Hance (EORTC QLG)
caroline.hance@eortc.org

¹ Gamper, Eva Maria et al. (2025) Shifting perspectives: a reflection on cancer-specific quality-of-life metrics in cancer care economics. The Lancet Oncology, Volume 26, Issue 5, 545 – 547. https://doi.org/10.1016/S1470-2045(25)00066-X