Balancing Hope and Transparency: Informed Consent in Modern Oncology

Oncology has undergone a revolution in the past two decades, with targeted therapies and immunotherapies extending survival in multiple cancer subtypes. Yet alongside these clinical advances, a profound ethical problem has emerged: how actual treatment benefits are quantified and communicated to patients. Clinical trials, regulatory approvals, and guidelines overwhelmingly emphasize hazard ratios (HR) and relative risk reductions (RRR). These metrics magnify population-level statistical significance while obscuring the modest absolute value and clinical significance of treatment for most individuals. Oncology can fulfill its duty of transparency by reframing consent around absolute outcomes, financial realities and patient values. This is not a diminishment of therapeutic progress—it is a commitment to honesty, alignment, and respect for the reasonable patient standard. Only by committing to this transparency can we ensure that the power of precision oncology genuinely serves the patient—empowering them to make choices that align with personal values in their unique pursuit of a life well-lived. The goal is not to diminish hope, but to ground it in honesty and ensure that optimism arises from a clear understanding of evidence.过去二十余年，肿瘤学（Oncology）领域迎来了革命性变革：靶向治疗（targeted therapies）与免疫治疗（immunotherapies）显著延长了多种癌症亚型（cancer subtypes）患者的生存期。然而，伴随这些临床进展而来的，是一道愈发凸显的伦理难题：如何准确量化治疗的实际获益，并将其告知患者。当前临床试验（Clinical trials）、监管审批（regulatory approvals）与诊疗指南（guidelines）均过度倚重风险比（hazard ratios, HR）与相对风险降低率（relative risk reductions, RRR）两类指标。此类指标虽能凸显人群层面的统计学显著性，却掩盖了多数个体接受治疗所能获得的微小绝对获益与临床意义。 肿瘤学领域可通过围绕绝对结局、经济现实与患者自身价值观重构知情同意流程，践行其应尽的透明化职责。这绝非对治疗进展的贬损，而是对诚实、共识与合理患者标准的恪守。唯有坚守这一透明化原则，我们才能确保精准肿瘤学（precision oncology）的价值真正服务于患者——赋能他们基于个人价值观做出契合自身独特人生追求的选择。我们的目标绝非削弱希望，而是让希望扎根于诚实的认知，并确保乐观源自对证据的清晰理解。