Conceptual image representing the balance between the benefits and harms of cancer drug trials.

Decoding Cancer Drug Trials: Are We Getting the Full Story?

Mira Elwood in Health & Wellness January 2026 • 4 min read.

"A deeper look into how cancer drug trials report adverse effects and why transparent communication is crucial for patients and healthcare professionals."

Imagine reading about a new breast cancer drug and feeling reassured by the phrase "acceptable adverse-event profile." Or perhaps you're considering a treatment for pancreatic cancer, comforted by the claim of a "manageable and mostly reversible safety profile." These are the kinds of statements that appear in reports published in top medical journals, influencing perceptions of new cancer treatments.

But what if these reassuring words don't tell the whole story? What if, behind the claims of 'tolerability' and 'manageability', lie significant risks and severe side effects that patients and their families should be fully aware of? A recent study has revealed a concerning trend in cancer drug trial reporting: the use of subjective terms that downplay the seriousness of adverse events.

This article dives into this critical issue, exploring how the language used in cancer drug trial reports can obscure the reality of treatment harms. We'll examine why transparency is essential, how these terms impact decision-making, and what can be done to ensure patients receive a complete and accurate picture of the risks involved.

The Problem with Downplaying: How Language Shapes Perception

Conceptual image representing the balance between the benefits and harms of cancer drug trials.

The study, conducted by Bishal Gyawali and colleagues, scrutinized phase II and III randomized trials published in 2016 across five leading medical journals: New England Journal of Medicine, Lancet, Lancet Oncology, Journal of the American Medical Association, and Journal of Clinical Oncology. These journals are influential in shaping medical practice, capturing most randomized trials of new cancer drugs.

Researchers looked for terms like "tolerable," "favorable," "acceptable," "manageable," "feasible," and "safe" used to describe adverse events. These terms, while seemingly innocuous, can create a misleading impression of a drug's risk profile.

Acceptable: Acceptable to whom? This raises the question of whose perspective is being prioritized. Were the patients themselves consulted on whether they found the toxicities acceptable?
Manageable:Serious events, including deaths, can never be considered 'manageable'. Even seemingly manageable toxicities can significantly burden patients and diminish their quality of life.
Feasible: What benchmark defines if a treatment is feasible? Simply stating that a treatment is 'feasible' might unduly influence a patient's consent without providing sufficient context.
Favorable toxicity profile: Favorable compared to what? Each patient has a unique threshold for enduring toxicities, making a universal declaration of 'favorability' inherently subjective.
Tolerable or well-tolerated: Ultimately, only the patient can determine whether a side effect is tolerable.
Safe:Any cancer treatment that has resulted in a treatment-related death should not be described as 'safe'.

The findings revealed that in 43% of the 122 trials reviewed, reports contained terms that downplayed harms. Even more concerning, a significant number of these studies lacked complete data on severe adverse events, serious events, or deaths, making it difficult to assess the true risk-benefit ratio of the treatments.

Toward Transparency: What Can Be Done?

The call for greater transparency in cancer drug trial reporting is not about discouraging drug development or alarming patients. It's about empowering informed decision-making. Medical journals can play a crucial role by discouraging subjective terms and demanding comprehensive harms data. Researchers should prioritize patient perspectives, collecting data on what toxicities patients themselves deem acceptable. Reporting quality of life (QoL) is also essential, providing an indirect yet valuable indicator of harms.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1136/bmj.k4383, Alternate LINK

Title: Reporting Harms More Transparently In Trials Of Cancer Drugs

Subject: General Engineering

Journal: BMJ

Publisher: BMJ

Authors: Bishal Gyawali, Tomoya Shimokata, Kazunori Honda, Yuichi Ando

Published: 2018-11-01

Everything You Need To Know

Why is the language used in cancer drug trial reports so important?

The language used significantly shapes perceptions of cancer treatments. Terms like 'acceptable adverse-event profile' or 'manageable safety profile' can reassure patients, but they might obscure the true extent of risks. Objective language is important for informed decision-making, allowing patients to fully understand the potential harms alongside the benefits. Without it, patients may not be fully aware or prepared for severe side effects. The study highlights how easily perceptions can be swayed, emphasizing the need for transparent communication.

What specific types of subjective terms are used to downplay adverse events in cancer drug trials?

Several subjective terms are commonly used in cancer drug trial reports that downplay harms. These include 'tolerable,' 'favorable,' 'acceptable,' 'manageable,' 'feasible,' and 'safe.' These terms are problematic because they are often used without sufficient context, making it difficult to assess the true risk-benefit ratio of treatments. The subjectivity of these words raises the question of whose perspective is being prioritized. For instance, declaring a treatment 'safe' when treatment-related deaths have occurred, or defining a treatment as 'manageable' without considering the burden on a patient's quality of life can be misleading.

What was the main finding of the study by Bishal Gyawali and colleagues regarding cancer drug trial reports?

The study by Bishal Gyawali and colleagues revealed that a significant number of cancer drug trial reports contain terms that downplay harms. Specifically, in 43% of the 122 trials reviewed across five leading medical journals, reports included subjective terms like 'tolerable,' 'favorable,' or 'manageable' to describe adverse events. Even more concerning, a significant number of these studies lacked complete data on severe adverse events, serious events, or deaths. This makes it challenging to accurately assess the true risk-benefit ratio of cancer treatments. This highlights how prevalent and problematic the use of subjective language is in the field.

What role do medical journals play in promoting greater transparency in cancer drug trial reporting?

Medical journals play a crucial role in promoting greater transparency by discouraging the use of subjective terms in trial reports and demanding comprehensive harms data. Journals can influence researchers to prioritize patient perspectives by requiring data on what toxicities patients themselves deem acceptable. The journals are influential in shaping medical practice, capturing most randomized trials of new cancer drugs. By setting higher standards for reporting, medical journals can ensure that patients and healthcare professionals receive a more complete and accurate picture of the risks involved in cancer treatments.

Beyond avoiding subjective language, what other information should be included in cancer drug trial reports to improve transparency and aid decision-making?

To improve transparency and aid decision-making, cancer drug trial reports should include comprehensive harms data, including all severe adverse events, serious events, and deaths. Patient perspectives on the acceptability of toxicities should be prioritized and directly incorporated into the reports. Additionally, reporting quality of life (QoL) is essential, as it provides a valuable indicator of harms that may not be captured by traditional adverse event reporting. Researchers should report on both the frequency and severity of side effects, enabling a more accurate and balanced assessment of the risk-benefit ratio. This would involve detailed data collection methodologies with direct patient input on impacts to their lives.