OBJECTIVES: As costs associated with oncology treatments continue to rise along with increased levels of innovation and effectiveness, health technology assessment (HTA) decisions continue to attract international attention. The objective of this analysis was to provide an update of the 2014 podium presentation[1] that evaluated patterns in oncology-based HTA decisions in selected countries. METHODS: HTA surveillance was conducted for Australia, Canada, France, Germany, and the United Kingdom (UK) from January 1, 2012 to October 31, 2015 (46 months). Oncology-based HTAs were evaluated by therapeutic area, decision, and rationale for the decision. Decisions were categorized as favorable, unfavorable, mixed (both favorable and unfavorable), and neutral (deferral).   RESULTS: CONCLUSIONS: Despite the perception of increased scrutiny by HTA agencies, as more cancer therapies are developed, the number of favorable and mixed decisions has increased, and the majority of decisions are considered favorable. However, as more therapies are rejected for providing insufficient benefit to justify the high cost of treatment, further emphasis on health economic and clinical data is warranted.