ArticleAnnals of oncology : official journal of the European Society for Medical Oncology2019
Interpretation of time-to-event outcomes in randomized trials: an online randomized experiment.
Article in Annals of oncology : official journal of the European Society for Medical Oncology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Pooled it
- Impact of Centralizing Esophageal Cancer Surgery at High-Volume Centers on Long-Term Survival: Individual Patient Data Meta-Analysis.Annals of surgical oncology · 2025Pooled it
- IPDMA - RADICAL - NSCLC: individual participant data meta-analysis and systematic review of radical local therapy for oligometastatic NSCLC.BMJ open respiratory research · 2025Pooled it
- Impact of Thoracic Duct Resection on Long-Term Survival After Esophagectomy: Individual Patient Data Meta-analysis.Annals of surgical oncology · 2024Pooled it
- Treatment Effect Measures for Culture Conversion Endpoints in Phase IIb Tuberculosis Treatment Trials.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Pooled it
- Causal AI-based clinical and radiomic analysis for optimizing patient selection in combined immunotherapy and SABR in early-stage NSCLC: a secondary analysis of the phase II I-SABR trial.Journal for immunotherapy of cancer · 2025Trial
- Physician Interpretation of Data of Uncertain Clinical Utility in Oncology Prescription Drug Promotion.The oncologist · 2021Trial
- Trial
- Bayesian two-sample survival probability curves with comparative summary measures and sensitivity analyses.Contemporary clinical trials · 2026Article
- Communicating Time-to-Event Treatment Effects in Randomized Trials: A Randomized Experiment among General Practitioners.Medical decision making : an international journal of the Society for Medical Decision Making · 2026Article
- Prognostic impact of recurrent laryngeal nerve palsy after esophagectomy: a systematic review and reconstructed individual patient data meta-analysis.Journal of thoracic disease · 2026Article
- Progression-Free Survival Effect Sizes in Randomized Controlled Trials of Targeted Cancer Therapies with Positive Outcomes.Acta haematologica · 2026Article
- Proportional Hazards Violations in Phase III Cancer Clinical Trials: A Potential Source of Trial Misinterpretation.Clinical cancer research : an official journal of the American Association for Cancer Research · 2024Article
- Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis.Journal of clinical medicine · 2024Review
- Regression models for average hazard.Biometrics · 2024Article
- Two-sample survival probability curves: A graphical approach for the analysis of time to event data in clinical trials.Contemporary clinical trials · 2022Article
- Life-Years Lost After Newly Diagnosed Atrial Fibrillation in Patients with Heart Failure.Clinical epidemiology · 2022Article
- Estimation and modeling of the restricted mean time lost in the presence of competing risks.Statistics in medicine · 2021Article
- Multivariate meta-analysis model for the difference in restricted mean survival times.Biostatistics (Oxford, England) · 2021Article
- Article
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9 authors.
Funding
Abstract
Background: Multiple features in the presentation of randomized controlled trial (RCT) results are known to influence comprehension and interpretation. We aimed to compare interpretation of cancer RCTs with time-to-event outcomes when the reported treatment effect measure is the hazard ratio (HR), difference in restricted mean survival times (RMSTD), or both (HR+RMSTD). We also assessed the prevalence of misinterpretation of the HR. Methods: We carried out a randomized experiment. We selected 15 cancer RCTs with statistically significant treatment effects for the primary outcome. We masked each abstract and created three versions reporting either the HR, RMSTD, or HR+RMSTD. We randomized corresponding authors of RCTs and medical residents and fellows to one of 15 abstracts and one of 3 versions. We asked how beneficial the experimental treatment was (0-10 Likert scale). All participants answered a multiple-choice question about interpretation of the HR. Participants were unaware of the study purpose. Results: We randomly allocated 160 participants to evaluate an abstract reporting the HR, 154 to the RMSTD, and 155 to both HR+RMSTD. The mean Likert score was statistically significantly lower in the RMSTD group when compared with the HR group (mean difference -0.8, 95% confidence interval, -1.3 to -0.4, P < 0.01) and when compared with the HR+RMSTD group (difference -0.6, -1.1 to -0.1, P = 0.05). In all, 47.2% (42.7%-51.8%) of participants misinterpreted the HR, with 40% equating it with a reduction in absolute risk. Conclusion: Misinterpretation of the HR is common. Participants judged experimental treatments to be less beneficial when presented with RMSTD when compared with HR. We recommend that authors present RMST-based measures alongside the HR in reports of RCT results.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.