OBJECTIVES: Overall survival (OS) for cancer products is an important clinical endpoint to payers. This analysis examined the proportion of pan-Canadian Oncology Drug Review (pCODR) recommendations that lacked statistically significant OS data and the factors that may have influenced pCODR recommendations.  METHODS: Final pCODR recommendations and clinical guidance reports publicly accessible at www.cadth.ca and reimbursementdecisions.com were reviewed from 13 July 2011 to 30 November 2015.  RESULTS: Sixty-three recommendations were issued by pCODR; 48 (76%) were positive (i.e., without criteria/conditions, conditional on improved cost effectiveness, or restricted patient population) and 15 (24%) were negative (i.e., uncertain/insufficient clinical benefit and/or uncertain cost effectiveness). Among positive recommendations, 23 (48%) had statistically significant OS data and 25 (52%) did not assess or have statistically significant OS data. Among negative recommendations, 4 (27%) had statistically significant OS data and 11 (73%) did not assess or have statistically significant OS data. Ten (40%) positive recommendations without statistically significant OS data noted crossover as a potential confounder of OS, compared with only one (9%) among negative recommendations. A greater proportion of positive recommendations without statistically significant OS data (52%) had statistically significant progression-free survival (PFS) data than negative recommendations (45%). CONCLUSIONS: This study highlights that positive pCODR recommendations may be made in the absence of a clear OS benefit, likely due to crossover as a confounder and/or presence of strong PFS data. Further research may determine additional factors contributing to positive and negative pCODR recommendations despite unavailable OS data.