- Most oncologists still rely on clinical trial data when making treatment decisions, overlooking insights from real-world evidence, a Fox Chase Cancer Center study found.
- Real-world studies have the capacity to assess long-term outcomes and demonstrate how treatments perform in routine clinical practice.
- Researchers urge the oncology community to balance both approaches to better guide patient care and future clinical trial design.
PHILADELPHIA (November 4, 2025) — In medical research, real-world evidence provides important insights about how diseases like cancer respond to treatment in actual clinical settings. Still, oncologists may overlook this data in favor of randomized, controlled clinical trials when making treatment decisions. That’s the finding of a national survey conducted by a team of researchers.
The recently published paper highlights a crucial knowledge gap in how oncologists apply the latest discoveries in cancer research to patient care.
“Real-world evidence looks at outcomes in practical settings, community settings, so it is valuable information,” said Wencesley Paez, MD, MS, Director of Clinical Research Operations at the Office of Clinical Research at Fox Chase Cancer Center and a co-author on the study. “This highlights the importance of not overlooking this information.” Paez conducted the study with researchers from the School of Medicine and Health Sciences at George Washington University.
Key Findings
- Trials guide initial treatment: Nearly all the oncologists surveyed relied primarily on randomized controlled trials to guide first-line therapy decisions.
- Real-world evidence used downstream: Clinicians were more likely to incorporate real-world evidence later in the course of treatment, such as when adjusting treatment regimens or managing comorbidities.
- Generational divide: Oncologists who had been in practice for 20 years or more were much more likely to rely exclusively on data from randomized, controlled trials.
- Research experience matters: Providers with prior research experience in real-world evidence were more likely to consider it in their decision-making.
- Reliability questioned: Concerns about the limitations of real-world evidence, such as the potential for bias, was a key reason providers were reluctant to use it more.
The Case for Real-World Evidence
Although randomized, controlled trials have long been considered the gold standard for medical research, they have limitations. They typically study treatment outcomes in highly controlled scenarios and often exclude patients with specific comorbidities, for example.
“There are some schools of thought that argue, this data is noteworthy, but does it really apply to the patient populations we serve?” Paez said. “That’s where real-world evidence comes in.”
Importantly, real-world studies may do a better job at capturing long-term outcomes than controlled trials, which often track patients for five years or less, said Paez. Real-world studies usually involve analyzing large volumes of patient data from electronic medical records, potentially tracking outcomes over years or decades.
However, real-world evidence also has limitations, Paez noted, including the potential for bias, unknown variables, and lack of standardized methodological practices.
Rethinking Randomized Trials
In addition to raising awareness among oncologists, the findings should inspire reflection within Fox Chase’s Office of Clinical Research, Paez said.
“We have to get creative. We still have to rely on data from randomized controlled trials, but we should also be open-minded about how real-world evidence can play a role.”
In the larger research community, the survey points to an opportunity to improve standardization of real-world studies to make data more reliable, he added.
The paper, “Acceptance and Utilization of Real-World Evidence Among Cancer Care Physicians in the USA: A National Survey,” was published in Pharmaceutical Medicine.