OBJECTIVES: It is increasingly recognised that conventional value assessments based on the ‘traditional’ QALY approach do not capture the full burden of the disease on patients, physicians, caregivers and healthcare systems. More recently, the ISPOR value flower put forward an alternative value framework, that would help achieve a more comprehensive assessment of new treatments. This review focuses on additional value elements in oncology.

METHODS: We carried out a systematic search (with a targeted selection of evidence) of English language publications (11 Nov 2021), last three years, no geographical restrictions. The searches were conducted in Medline, Embase, and Cochrane via the OVID platform. Abstracts and full texts that focused on unconventional value attributes were selected. We focused on oncology in general, while aware that each cancer type could be associated with disease-specific value aspects. Value aspects were classified into universal and cancer type-specific aspects, by patient characteristics, e.g., terminal and non-terminal patients; males and females; adults, adolescents and the elderly.

RESULTS: 3,633 abstracts were retrieved, and 90 full text articles were selected. Universal elements beyond those captured by existing utility instruments included: fear of progression, social distress and stigma, social support, body image, work/school reintegration, sexual functioning. Furthermore, cancer types are associated with specific aspects: e.g., fertility in female cancers, urinary function for male cancers. For adolescents, physical growth and social adjustment are important, for older patients, independence. For caregivers, universal value aspects include social support, family functioning, duration of care, cancer stage of their patient. In healthcare systems where (most) care is funded privately, financial security represents a value element. Additionally, informational needs are relevant for patients and their families.

CONCLUSIONS: There are various aspects that are valuable to cancer patients (both terminal and non-terminal) and caregivers that are not currently captured in utility measures, resulting in underestimating the value of new treatments.