LAUSR

There has been a significant movement toward increasing the patient’s voice in assessment of tolerability of cancer treatments [1]. Traditional assessment of tolerability has relied on clinician-rated toxicities, using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE). A recent white paper published by the Friends of Cancer advanced the ability to assess tolerability from the patient’s perspective: “The tolerability of a medical product is the degree to which symptomatic and non-symptomatic adverse events associated with the product’s administration affect the ability or desire of the patient to adhere to the dose or intensity of therapy. A complete understanding of tolerability should include direct measurement from the patient on how they are feeling and functioning while on treatment.”[2] This definition improves upon previous considerations of tolerability. Most importantly, it shifts focus to how a patient feels or functions in response to their treatments. It also implies that tolerability is assessed via patient report. We agree with and support this new, patient-oriented definition of tolerability, but we believe there are important opportunities to expand it. The Friends’ definition focuses exclusively on experience with treatment, which is critical but captures only what happens while the patient is on treatment. In addition, there is a need to capture what the patient is bringing to the table even before starting treatment that can indicate their tolerability. Our focus in this perspective is to reveal the importance of the patient disposition in addition to the patient experience in capturing treatment tolerability.