Best supportive care in clinical trials: Review of the inconsistency in control arm design

Ryan Nipp, David Currow, N Cherny, F Strasser, Amy Abernethy, S. Yousuf Zafar

    Research output: Contribution to journalReview articlepeer-review

    17 Citations (Scopus)


    Best supportive care (BSC) as a control arm in clinical trials is poorly defined. We conducted a review to evaluate clinical trials' concordance with published, consensus-based framework for BSC delivery in trials.Methods:A consensus-based Delphi panel previously identified four key domains of BSC delivery in trials: multidisciplinary care; supportive care documentation; symptom assessment; and symptom management. We reviewed trials including BSC control arms from 2002 to 2014 to assess concordance to BSC standards and to selected items from the CONSORT 2010 guidelines.Results:Of 408 articles retrieved, we retained 18 after applying exclusion criteria. Overall, trials conformed to the CONSORT guidelines better than the BSC standards (28% vs 16%). One-third of articles offered a detailed description of BSC, 61% reported regular symptom assessment, and 44% reported using validated symptom assessment measures. One-third reported symptom assessment at identical intervals in both arms. None documented evidence-based symptom management. No studies reported educating patients about symptom management or goals of therapy. No studies reported offering access to palliative care specialists.Conclusions:Reporting of BSC in trials is incomplete, resulting in uncertain internal and external validity. Such studies risk systematically over-estimating the net clinical effect of the comparator arms.

    Original languageEnglish
    Pages (from-to)6-11
    Number of pages6
    JournalBritish Journal of Cancer
    Issue number1
    Publication statusPublished - 30 Jun 2015


    • health services research
    • palliative care
    • randomized controlled trial
    • Research design
    • symptom assessment


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