Decision-making In Oncology Research Articles

Decision-making in childhood cancer: parents' and adolescents' views and perceptions.

Few studies have addressed the way in which families of children with cancer make treatment decisions, and how we can meet parents' and young peoples' decisional involvement needs. We aimed to explore parents' and adolescents' views and perceptions of making medical decisions in pediatric oncology. We conducted semi-structured interviews with 25 parents of children diagnosed with cancer in the past 12months, and 5 adolescents diagnosed in the past 12months. Our interview schedule was underpinned by Elwyn and Miron-Shatz's decision-making model. The model acknowledges the deliberation (process of coming to a decision) and determination (making a choice) phases of decision-making. We conducted a thematic analysis. Our findings indicate that information provision is not enough to facilitate parents' decision-making involvement. Many parents sought additional information to meet their individual needs and preferences. While many parents and young people desired decisional involvement, they trusted the doctors to make treatment decisions. Feelings of distress, inadequacy, and lack of choice impacted decision-making participation. Regardless, many parents in our study were satisfied with treatment decisions, but this was largely dependent on positive treatment outcomes. Our study contributes to understanding how families of a child with cancer make treatment decisions. Families tend to rely on doctors to make treatment decisions, but often seek additional information to help them feel involved in the decision process. Findings highlight that decision-making in pediatric oncology should focus on involving families in the deliberation phase, rather than just determination of choice.

Communicating prognosis to women with early breast cancer \u2013 overview of prediction tools and the development and pilot testing of a decision aid

BackgroundShared decision-making in oncology requires information on individual prognosis. This comprises cancer prognosis as well as competing risks of dying due to age and comorbidities. Decision aids usually do not provide such information on competing risks. We conducted an overview on clinical prediction tools for early breast cancer and developed and pilot-tested a decision aid (DA) addressing individual prognosis using additional chemotherapy in early, hormone receptor-positive breast cancer as an example.MethodsSystematic literature search on clinical prediction tools for the effects of drug treatment on survival of breast cancer. The DA was developed following criteria for evidence-based patient information and International Patient Decision Aids Standards. We included data on the influence of age and comorbidities on overall prognosis. The DA was pilot-tested in focus groups. Comprehension was additionally evaluated through an online survey with women in breast cancer self-help groups.ResultsWe identified three prediction tools: Adjuvant!Online, PREDICT and CancerMath. All tools consider age and tumor characteristics. Adjuvant!Online considers comorbidities, CancerMath displays age-dependent non-cancer mortality. Harm due to therapy is not reported.Twenty women participated in focus groups piloting the DA until data saturation was achieved. A total of 102 women consented to participate in the online survey, of which 86 completed the survey. The rate of correct responses was 90.5% and ranged between 84 and 95% for individual questions.ConclusionsNone of the clinical prediction tools fulfilled the requirements to provide women with all the necessary information for informed decision-making. Information on individual prognosis was well understood and can be included in patient decision aids.

Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature.

Shared decision-making (SDM) is a strategy to facilitate patient-centered care and is increasingly important in oncology, where patients are faced with complicated treatment decisions that require them to weigh efficacy and safety, quality of life, and cost. Understanding the contributors to the use of SDM may provide insight to its further implementation. Therefore, the objective of the study was to examine the patient-related barriers/facilitators to SDM in oncology care. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was executed. A search strategy composed of cancer, decision-making, and patient-centered terms was conducted utilizing PubMed, EBSCO MEDLINE, Scopus, CINAHL, and the Cochrane Library databases between January 2007 and November 2017. Full-text, US-based, English language articles describing the patient perspective of SDM in oncology care were included. Relevant data from articles were reviewed in a qualitative synthesis. From 3435 potential citations, a total of 35 articles were included. The most common cancers studied were breast (n = 22; 62.9%) and prostate (n = 9; 25.7%). The identified themes for barriers to SDM were uncertainty in the treatment decision, concern regarding adverse effects, and poor physician communication. Themes for facilitators for SDM included physician consideration of patient preferences, positive physician actions and behaviors, and use or encouragement of support systems. As SDM gains use within oncology practice, understanding key influences will allow for more effective implementation of strategies to increase patient engagement and improve care and value in the treatment process.

Patient Preferences for Multiple Myeloma (MM) Treatment: Interim Analysis of a Discrete Choice Experiment

Background: The growing importance of patient preferences in treatment decision-making in oncology is evidenced by the expanding role of patient-reported experience in both regulatory and reimbursement considerations of value. While recent introduction of new treatments for multiple myeloma (MM) have demonstrated longer time to progression and improved survival, specific regimen options still vary with respect to efficacy, safety, and dosing. Therefore, patients and providers must consider the trade-offs inherent in making treatment decisions. However, a lack of evidence exists describing patient reported preferences within the context of currently available regimens. To address this gap, this interim analysis of an ongoing study was conducted to examine patient preferences for MM treatments.Methods: A sequential mixed methods design, which incorporates both qualitative and quantitative phases, was utilized for this study. The qualitative phase identified content and language, via semi-structured interviews, to elucidate how patients understand and construct treatment-related factors, such as overall survival (OS), progression free survival (PFS), dosing, and tolerability. Results from the qualitative phase were subsequently used to inform the development of the quantitative survey. The online survey was sent to adults diagnosed with MM, who had received or were currently receiving first-line therapy (FL), second-line therapy (1PL), or third-line therapy (2PL) at the time of the survey (target N=200). Patients were recruited from targeted panels, advocacy partnerships, patient communities, and physician referrals from May to June 2018. The survey utilized a Discrete Choice Experiment (DCE) methodology to assess preferences and willingness to accept trade-offs among hypothetical treatments that varied on levels of specific attributes. Treatment attributes and levels were identified through literature review, current treatment guidelines, and clinical input. In the quantitative survey, patients were asked to rate the levels of each treatment attribute (based on a 5-point Likert scale, ranging from 1=very bad to 5=very good) and select which regimen they prefer when presented with two different hypothetical regimens (fixed choice exercise - Table 1) to identify trade-offs that patients were willing to make when selecting treatments. Descriptive statistics were used to characterize the interim survey data. Full DCE results, which will model additional treatment scenarios, will be based upon the complete sample.Results: In this interim analysis (n=74), the mean age was 63 years and 51% were male. The average time since diagnosis was 70 months. Twenty-five patients were on FL, 25 were on 1PL and 24 were on 2PL. Mean duration of most recent/current treatment at the time of survey completion was 16 months for FL, 15 months for 1PL, and 11 months for 2PL. On average, patients in earlier lines of therapy (FL and 1PL) indicated greater importance of OS than 2PL patients. The importance of tolerability was also greater for patients in earlier lines of therapy (FL and 1PL vs. 2PL). Results of the fixed choice exercise available at the time of this analysis are shown in Table 2. When efficacy (OS and PFS) were comparable, 92% of patients preferred the treatment profile with a lower dosing frequency over a 1 year period (21x) despite a longer infusion time (>5h) compared to a treatment profile with higher dosing frequency (78x) and shorter infusion time (<2h).Conclusion: Results from this interim analysis suggest that patient preferences for MM treatments may vary by treatment history. Additionally, when efficacy is similar, a significant number of patients place greater importance on dosing frequency than on the duration of treatment administration. Patients may consider treatment options holistically - e.g., convenience is not simply “chair-time,” but rather also includes frequency of outpatient visits. This study provides insight into how patients with MM value and assess meaningful “benefit-risk” when making treatment decisions, which can be useful for facilitating physician-patient communications and shared decision making. Analysis of the complete study population and DCE will provide additional results on the relative importance of specific treatment attributes and preference for hypothetical treatment regimens that were not available for this analysis. [Display omitted] DisclosuresMcKay:Janssen Scientific Affairs,LLC: Employment. Maiese:Janssen Scientific Affairs,LLC: Employment, Equity Ownership. Chiarappa:Janssen: Employment. Cambron-Mellott:Kantar Health: Employment. Maculaitis:Kantar Health: Employment. Alunni:Kantar Health: Employment. Raje:BMS: Consultancy; Celgene: Consultancy; Janssen: Consultancy; Merck: Consultancy; Takeda: Consultancy; AstraZeneca: Research Funding; Research to Practice: Honoraria; Medscape: Honoraria; Amgen Inc.: Consultancy.

Engaging Multidisciplinary Stakeholders to Drive Shared Decision-Making in Oncology.

Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.

Treatment Recommendations in Oncology Visits: Implications for Patient Agency and Physician Authority

ABSTRACTAlthough oncology is a major site for clinician‒patient treatment negotiation requiring a careful balance of potentially competing viewpoints, little is known about how clinicians promote their treatment recommendations to patients and what the manner of promotion tells us about the oncologist‒patient relationship. Utilizing an already-established schema of coding treatment recommendations, I draw on 61 treatment recommendations to examine treatment decision-making in oncology. This paper investigates how physicians balance asserting their authority while at the same time attending to patient agency and involvement in decision-making. Taking this one step further, this paper explores how physicians negotiate decision-making with patients given that they occupy a liminal state between obligations to policy imperatives and commitments to their professional knowledge and technical expertise. How do they do this, and what accounts for this? To answer these questions, this paper analyzes the ways in which physicians present treatment recommendations and the treatment contexts in which they are made.

Heuristic value-based framework for lung cancer decision-making

Heuristics and the application of fast-and-frugal trees may play a role in establishing a clinical decision-making framework for value-based oncology. We determined whether clinical decision-making in oncology can be structured heuristically based on the timeline of the patient's treatment, clinical intuition, and evidence-based medicine. A group of 20 patients with advanced non-small cell lung cancer (NSCLC) were enrolled into the study for extensive treatment analysis and sequential decision-making. The extensive clinical and genomic data allowed us to evaluate the methodology and efficacy of fast-and-frugal trees as a way to quantify clinical decision-making. The results of the small cohort will be used to further advance the heuristic framework as a way of evaluating a large number of patients within registries. Among the cohort whose data was analyzed, substitution and amplification mutations occurred most frequently. The top five most prevalent genomic alterations were TP53 (45%), ALK (40%), LRP1B (30%), CDKN2A (25%), and MYC (25%). These 20 cases were analyzed by this clinical decision-making process and separated into two distinctions: 10 straightforward cases that represented a clearer decision-making path and 10 complex cases that represented a more intricate treatment pathway. The myriad of information from each case and their distinct pathways was applied to create the foundation of a framework for lung cancer decision-making as an aid for oncologists. In late-stage lung cancer patients, the fast-and-frugal heuristics can be utilized as a strategy of quantifying proper decision-making with limited information.

Abstract SY08-02: Reshaping cancer care delivery through multi-disciplinary molecular tumor boards

Abstract Rapidly growing access to next-generation DNA sequencing technology has put the promise of precision oncology in reach, which is to individualize cancer care by matching molecular abnormalities found in a patient's tumor with specific treatments. As a result, clinicians strive to integrate molecular information into routine oncologic decision-making at accelerating pace. While some findings are associated with well-established treatment recommendations, such as KRAS mutations in colorectal cancer indicating lack of benefit of EGFR inhibitors, clinicians are frequently confronted with complex molecular findings that are difficult to interpret from a diagnostic and therapeutic perspective. In particular, tumors harboring multiple potentially targetable mutations or variants of unknown significance, pose challenges. Beyond this, perplexing complexities of cellular signaling networks dynamically responding to targeted therapies, intra-tumoral heterogeneity, as well as access to drugs as part of clinical trials or off-label use add to the difficulties in bringing precision oncology to patients. With the goal of assisting oncologists at the University of California San Francisco (UCSF) in addressing some of these challenges, we assembled the UCSF Molecular Tumor Board (MTB) in July of 2014. The Board constituents represent a wide spectrum of areas of expertise and include disease-area focused oncologists, pediatric oncologists, molecular pathologists, genetic counselors, pharmacists, clinical trialists, and molecular biologists. All patients undergoing molecular testing at UCSF are listed for possible MTB discussion by default unless the treating oncologist decides otherwise. The main source of molecular results is the UCSF500 test, a next-generation DNA sequencing targeted capture assay that is used to analyze paired tumor and normal DNA. On average, 22 cases are being discussed per month during initially weekly, now bi-weekly meetings. Approximately 20% of the cases are pediatric malignancies. As a result of differential utilization of the UCSF500 within the UCSF Comprehensive Cancer Center, CNS malignancies, colorectal, and neuroendocrine carcinomas as well as melanomas are the predominant tumor types discussed. In agreement with results published by other groups, pathogenic or likely pathogenic germline mutations are present in 15% of the cases, highlighting the importance of integration of genetic counselors in the process. Based on an in-depth analysis of 350 patients seen between April 2015 and November 2017, therapeutically actionable mutations were present in 67% of the cases. Molecularly targeted therapies were recommended in 73% of patients in this subset and recommendations to avoid particular therapies were made in 8%. In 21% of the cases with a recommendation for targeted therapies, clinical action was taken (e.g. drug prescription, clinical trial enrollment). In 62% of the cases with a recommendation, no action had been taken at time of data analysis, with the following reasons cited: patient performance status declined rapidly, patient continued standard therapy, patients declined MTB recommended therapy, or a plan is in place to take action in case of disease progression. Thus, only 16% of cases received treatment as recommended by the MTB. However, there was a trend that cases that were discussed at MTB had higher rates of clinical action taken compared to cases that were not discussed by the MTB. Overall, our experience with the UCSF Molecular Tumor Board is encouraging. Additional efforts need to be undertaken to further increase translation of molecular tumor board recommendations into clinical action. Citation Format: W. Michael Korn. Reshaping cancer care delivery through multi-disciplinary molecular tumor boards [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr SY08-02.

Data collection of patient outcomes: one institution's experience.

Patient- and provider-reported outcomes are recognized as important in evaluating quality of care, guiding health care policy, comparative effectiveness research, and decision-making in radiation oncology. Combining patient and provider outcome data with a detailed description of disease and therapy is the basis for these analyses. We report on the combination of technical solutions and clinical process changes at our institution that were used in the collection and dissemination of this data. This initiative has resulted in the collection of treatment data for 23 541 patients, 20 465 patients with provider-based adverse event records, and patient-reported outcome surveys submitted by 5622 patients. All of the data is made accessible using a self-service web-based tool.

Input of Psychosocial Information During Multidisciplinary Team Meetings at Medical Oncology Departments: Protocol for an Observational Study.

BackgroundMultidisciplinary team meetings (MDTMs) have become standard practice in oncology and gained the status of the key decision-making forum for cancer patient management. The current literature provides evidence that MDTMs are achieving their intended objectives but there are also indications to question the positive impact of MDTMs in oncology settings. For cancer management to be patient-centered, it is crucial that medical information as well as psychosocial aspects—such as the patients’ living situation, possible family problems, patients' mental state, and patients’ perceptions and values or preferences towards treatment or care—are considered and discussed during MDTMs. Previous studies demonstrate that failure to account for patients’ psychosocial information has a negative impact on the implementation of the treatment recommendations formulated during MDTMs. Few empirical studies have demonstrated the predominant role of physicians during MDTMs, leading to the phenomenon that medical information is shared almost exclusively at the expense of psychosocial information. However, more in-depth insight on the underlying reasons why MDTMs fail to take into account psychosocial information of cancer patients is needed.ObjectiveThis paper presents a research protocol for a cross-sectional observational study that will focus on exploring the barriers to considering psychosocial information during MDTMs at medical oncology departments.MethodsThis protocol encompasses a cross-sectional comparative case study of MDTMs at medical oncology departments in Flanders, Belgium. MDTMs from various oncology subspecialties at inpatient medical oncology departments in multiple hospitals (academic as well as general hospitals) are compared. The observations focus on the “multidisciplinary oncology consultation” (MOC), a formally regulated and financed type of MDTM in Belgian oncology since 2003. Data are collected through nonparticipant observations of MOC–meetings. Observational data are supplemented with semi-structured individual interviews with members of the MOC–meetings.ResultsThe protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology departments. Results of this study will particularly focus on the input of psychosocial information during MDTMs.ConclusionsThe concept of an MDTM should not merely be a group of care professionals who mostly work independently and occasionally liaise with one another. Interventions aiming to enhance the input of psychosocial information are crucial to ensure that MDTMs can benefit from their diverse membership to achieve their full potential. The findings from this study can be used to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.

Implementation of shared decision-making in oncology: development and pilot study of a nurse-led decision-coaching programme for women with ductal carcinoma in situ

BackgroundTo implement informed shared decision-making (ISDM) in breast care centres, we developed and piloted an inter-professional complex intervention.MethodsWe developed an intervention consisting of three components: an evidence-based patient decision aid (DA) for women with ductal carcinoma in situ, a decision-coaching led by specialised nurses (breast care nurses and oncology nurses) and structured physician encounters.In order to enable professionals to gain ISDM competencies, we developed and tested a curriculum-based training programme for specialised nurses and a workshop for physicians. After successful testing of the components, we conducted a pilot study to test the feasibility of the entire revised intervention in two breast care centres. Here the acceptance of the intervention by women and professionals, the applicability to the breast care centres’ procedures, women’s knowledge, patient involvement in treatment decision-making assessed with the MAPPIN’SDM-observer instrument MAPPIN’Odyad, and barriers to and facilitators of the implementation were taken into consideration. We used questionnaires, structured verbal and written feedback and video recordings. Qualitative data were analysed descriptively, and mean values and ranges of quantitative data were calculated.ResultsTo test the DA, focus groups and individual interviews were conducted with 27 women. Six expert reviews were obtained. The components of the nurse training were tested with 18 specialised nurses and 19 health science students. The development and piloting of the components were successful. The pilot test of the entire intervention included seven patients. In general, the intervention is applicable. Patients attained adequate knowledge (range of correct answers: 9–11 of 11). On average, a basic level of patient involvement in treatment decision-making was observed for nurses and patient–nurse dyads (M(MAPPIN-Odyad): 2.15 and M(MAPPIN-Onurse): 1.90). Relevant barriers were identified; physicians barely tolerated women’s preferences that were not in line with the medical recommendation. Classifying women as inappropriate for ISDM due to age or education led physicians to neglect eligible women during the recruitment phase.ConclusionDecision-coaching is feasible. Nevertheless, there are some indications that structural changes are needed for long-term implementation. We are currently evaluating the intervention in a cluster randomised controlled trial in 16 breast care centres.

Blood-based tumor biomarkers in lung cancer for detection and treatment.

The therapeutic landscape of lung cancer has expanded significantly over the past decade. Advancements in molecularly targeted therapies, strategies to discover and treat resistance mutations, and development of personalized cancer treatments in the context of tumor heterogeneity and dynamic tumor biology have made it imperative to obtain tumor samples on several different occasions through the course of patient treatment. While this approach is critical to the delivery of optimal cancer treatment, it is fraught with a number of barriers including the need for invasive procedures with associated complications, access to limited amount of tissue, logistical delays in obtaining the biopsy, high healthcare cost, and in many cases inability to obtain tissue because of technically difficult location of the tumor. Given multiple limitations of obtaining tissue samples, the use of blood-based biomarkers ("liquid biopsies") may enable earlier diagnosis of cancer, lower costs by avoiding complex invasive procedures, tailoring molecular targeted treatments, improving patient convenience, and ultimately supplement clinical oncologic decision-making. In this paper, we review various blood-based biomarkers including circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), tumor derived exosomes, tumor educated platelets (TEPs), and microRNA; and highlight current evidence for their use in detection and treatment of lung cancer.

Parents' and Physicians' Perceptions of Children's Participation in Decision-making in Paediatric Oncology: A Quantitative Study.

The goal is to present how shared decision-making in paediatric oncology occurs from the viewpoints of parents and physicians. Eight Swiss Pediatric Oncology Group centres participated in this prospective study. The sample comprised a parent and physician of the minor patient (<18 years). Surveys were statistically analysed by comparing physicians' and parents' perspectives and by evaluating factors associated with children's actual involvement. Perspectives of ninety-one parents and twenty physicians were obtained for 151 children. Results indicate that for six aspects of information provision examined, parents' and physicians' perceptions differed. Moreover, parents felt that the children were more competent to understand diagnosis and prognosis, assessed the disease of the children as worse, and reported higher satisfaction with decision-making on the part of the children. A patient's age and gender predicted involvement. Older children and girls were more likely to be involved. In the decision-making process, parents held a less active role than they actually wanted. Physicians should take measures to ensure that provided information is understood correctly. Furthermore, they should work towards creating awareness for systematic differences between parents and physicians with respect to the perception of the child, the disease, and shared decision-making.

Principles for ethical treatment decision-making in veterinary oncology.

Many owners of companion animals with cancer are overwhelmed by having to choose the "right course of action." With the aim of reducing the burden on owners who are forced to act as surrogates for their animals, this work discusses principles that apply to ethical treatment decision-making for animal patients with cancer. Four principles frequently used for ethical decision-making in human medicine will be considered for their potential applicability in veterinary medicine. As a result of these considerations, preliminary guidelines are presented, along which a decision-making discussion can be held. The deliberate integration of the non-maleficence and beneficence principles into the purely empirical facts of what is medically possible helps to maintain a moral perspective in specialized veterinary medicine. At the same time, such guidelines may contribute to individual decision-making in a way that animal patients neither have to endure unnecessarily severe side effects, nor that they are euthanized prematurely.

Universal Genomic Testing: The next step in oncological decision-making or a dead end street?

The concept of ‘personalised medicine’ aims at allocating patients to different treatment options based on individual characteristics to optimise treatment benefit and side effects. In oncology, personalised treatments coupled to biomarkers have led to the approval of targeted agents with high anti-tumour activity. However, these therapies are often limited to narrow, molecularly defined subsets of patients with a specific morphomolecular tumour profile. Recently, it became obvious that the same molecular alteration might drive oncogenesis in many different tumours, and it might be beneficial to target the alteration in a histology informed but entity-overarching way. Consequently, Universal Genomic Testing (UGT) of tumours encompassing panel sequencing to whole-exome and transcriptome sequencing is propagated to revolutionise oncology. This article will describe the developments leading to identification and application of potential biomarkers using UGT. On this basis, it will review the clinical evidence of this approach and summarise recommendations for the ongoing evaluation of UGT as the next step in oncological decision-making.

Doctor, Why Should I do this? The Role of Meaningfulness in Oncological Decision-Making

Adrian mole lives in multicultural, multi-faith post-colonial Britain, a Britain in which diversity in all its various shapes and forms is almost taken for granted. However, his confrontation with the possibility of prostate cancer reinforces what we know about White men’s relationship to serious illness in general and to prostate cancer in particular. We know prostate cancer is the most common cancer in men and accounts for approximately 25% of all male cancer diagnoses in the United Kingdom (UK) [1]. We know that the incidence of prostate cancer varies according to age, family history and also ethnicity. Research carried out in the US and the UK highlights that Black (African and Caribbean) men have disproportionately higher risk (one in four men as compared to one in nine White men) of prostate cancer than their White counterparts.

MTE22.01 Perspectives in Lung Cancer Imaging

MTE22.01 Perspectives in Lung Cancer Imaging

SC26.04 Novel Imaging Technique

SC26.04 Novel Imaging Technique

D03-B Decision-making in Pediatric Oncology: Prospective Survey Study with Parents and Physicians

D03-B Decision-making in Pediatric Oncology: Prospective Survey Study with Parents and Physicians

PCN237 - Review of Multicriteria Decision Analysis Application for Decision-Making in Oncology

PCN237 - Review of Multicriteria Decision Analysis Application for Decision-Making in Oncology