Real-world evidence is no longer just a complement to clinical trials in oncology; it is increasingly central to understanding how cancer care happens in practice.
While real-world evidence has long been used to understand how treatments perform outside the controlled setting of clinical trials, its role is evolving. Increasingly, real-world data are helping researchers and care teams identify where gaps in care exist, why recommended treatments are not always adopted consistently, and which patients may need additional support.
This has the potential to be beneficial in oncology, which for years has faced a familiar gap: new treatments and guidelines move quickly, but implementation in the real world is often slow and uneven. The issue is rarely access to evidence. It is whether that evidence consistently makes it into routine clinical decisions.
By connecting treatment decisions, patient characteristics, patient-reported experiences, and outcomes over time through data collected during routine care, researchers can move beyond isolated snapshots to better understand how care is delivered in practice. The opportunity is no longer just to observe what happens in the real world, but to identify where interventions, workflow changes, or additional resources could help improve care and outcomes for patients.
This shift changes the kinds of questions we can answer, especially around how to improve care in practical settings.
Adopting new treatment options
In metastatic breast cancer, for example, HER2-low therapies have created new treatment options, but adoption in everyday practice is not uniform. At ISPOR 2026, an analysis of community oncology electronic health record (EHR) data from the iKnowMed oncology-specific EHR showed that while HER2 testing was nearly universal, treatment patterns still differed from recommended guidelines.[1]
What stood out was not a lack of knowledge, but how guideline changes are supported in practice. When clinicians had access to education and expert guidance delivered through podcasts and EHR-based on-demand peer-expert consultation, use of guideline-concordant treatment increased over time. When those tools were not used, practice patterns did not change. This suggests that simply publishing guidelines or increasing awareness is not enough. Whether information is integrated into the clinical workflow in a usable way appears to be a key driver of care changes. In a setting where clinicians are managing large volumes of complex data, particularly in oncology, information that is not seamlessly integrated is far less likely to influence decisions.
A similar pattern appears when looking at patient-reported outcomes.
Distress Score and Outcomes
At the same meeting, an analysis of more than 4,800 patients with metastatic breast, colorectal, and lung cancers was presented. In this study, patients regularly completed a simple distress thermometer screening tool, with data captured in the iKnowMed EHR, as part of routine care. While the National Comprehensive Cancer Network (NCCN) developed distress thermometers to help care providers rapidly identify specific challenges and personalize triage, the analysis found that distress scores were meaningfully associated with outcomes.[2]
Patients reporting higher distress were more likely to have worse overall survival, even after accounting for clinical factors, such as cancer type and other health characteristics. The screening scores also helped separate patients into higher- and lower-risk groups across cancer types. Improvement in distress scores was associated with better overall survival, while persistently high or worsening distress was associated with poorer outcomes.
Identifying options for improvement
Taken together, these findings point to a broader shift in oncology. Data collected during routine care are no longer just documenting what happened. They are increasingly helping identify where care could be improved and which patients may need more support.
Importantly, this does not replace clinical trials, which remain the gold standard for establishing whether treatments work. Real-world data extend the understanding cultivated during clinical trials into everyday practice, showing how treatments are used, where gaps exist, and how patient experiences relate to outcomes outside controlled study settings.
As oncology continues to move toward more personalized care, understanding what happens to patients between clinic visits will become increasingly important. The growing use of real-world data, including treatment patterns and patient-reported symptoms, is beginning to reshape how evidence is used in practice. The goal is simple: making sure that advances in cancer research translate into better care for patients in the real world.
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Reference
[1] Berini CR, Stevens LA, Guo J, et al. Improving real-world adoption of HER2-low therapies through targeted educational initiatives. Presented at: ISPOR 2026; May 2026; Philadelphia, PA, USA. Value Health. 2026;29(S6):HSD11. Ontada HER2 mBC Poster ISPOR 2026, Boston, MA, USA.
[2] Su Z, Aguilar K, Pasha S, et al. Distress thermometer scores and outcomes in metastatic breast, colorectal, and lung cancer: real-world evidence from a large US community oncology setting. Presented at: ISPOR 2026; May 2026; Philadelphia, PA, USA. Value Health. 2026;29(S6):PCR99. Poster ISPOR 2026, Boston, MA, USA.
Featured image courtesy © 2026 ISPOR / International Society for Pharmacoeconomics and Outcomes Research. Used with permission.
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