• To be able to determine the highest-value agents or regimens ― the optimal combination of clinical benefit, toxicity and cost―for a specific clinical indication

  • Appreciation that there is broad array of single agents or combination therapies that have proven efficacy for the same disease scenarios

  • Awareness that there is variability in the quality of the evidence describing the clinical utility of cancer drugs

  • Awareness that there is variability in the relative effectiveness of these agents in the same adjuvant or advanced disease settings

  • Awareness that there are varying breadths and levels of toxicity associated with antineoplastic agents and combination therapies

  • Appreciation that these agents and their combinations vary widely in cost

  • Appreciation that the costs of medicines have very different impacts on healthcare budgets depending on country

  • Understanding of the multiplicity of factors underlying the rapidly rising costs of cancer care in one's own national environment and worldwide

  • Understanding of the specific role that new antineoplastic agents have in contributing to this rise

  • Familiarity with the approaches that health economists employ to quantify value, eg, determination of quality-adjusted life years (QALYs), cost-effectiveness ratios etc

  • Understanding of the mechanisms for financing healthcare in one's nation of residence

  • Familiarity with the approach that various nations use to perform health technology assessments

  • Familiarity with the formal value assessment tools that have been developed by ESMO, ASCO and the National Comprehensive Cancer Network (NCCN)

  • Familiarity with the pathways that have been and are under development to guide high-quality, cost-effective cancer care

  • Familiarity with the macroeconomics of cancer care

  • Familiarity with the tools designed to enable use of the value frameworks in shared decision-making with patients

  • Ability to apply one or several of the value assessment tools generated by ESMO, ASCO or NCCN to new cancer drugs or regimens that have been approved for use

  • Ability to use communication skills that facilitate conversations with patients and families about the cost of cancer care, and particularly as it relates to the expense that they are personally responsible for

  • Ability to use clinical and communication skills that enable communication at the end of life that emphasise when costly anticancer drugs are likely to be helpful, and when their use is likely to be counterproductive to the patients’ well-being