Therapeutic innovation in oncology: What do you mean? What we cannot talk about, we must keep silent. L. Wittgenstein

Background The word “innovation” is widely used in healthcare, especially in oncology. Innovation has been reported to impact the drug evaluation process, but there is no consensus regarding the evaluation of innovation. This study aimed to examine perceptions and attitudes (perceived benefits and concerns) towards innovation in clinical practice and in evaluation of innovation. Patients and Methods : We performed a cross-sectional, online, anonymous, voluntary survey among members of French associations of oncologists, haematologists, pharmacologists and therapists as well as members of the drug evaluation service of the French Health Technology Assessment body. The onlinequestionnaire assessed respondent characteristics as well as their level of agreement with several statements regarding the definition, extent, and evaluation of innovations (Supplementary materials). Most of the items were scored on an 11-point Likert scale. To provide a broader understanding of the respondent profiles, principal component analysis and cluster analysis were performed. Results : A total of 114 participants completed the survey between April and June 2024, including 88 respondents in the oncology group and 26 respondents in the health authoritygroup. There were differences between groups in terms of age, sex, and profession. Three distinctive clusters of respondents were identified: one cluster of respondents looked for simplified evaluation of innovated drugs (all of whom in the oncology group), contrasted to one cluster stated that drug evaluation requires standard processes (almost 80% of whom were in the health authority group); and one cluster of respondents indifferent to the evaluation process (this group has equal distributions across the groups). Conclusion : Innovation is perceived as being associated with the concepts of novelty, advance, and improvement. However, there were differences between groups regarding the level of evidence required to evaluate innovations. Efforts should be done to merge, rather than to oppose, and quantify all different types of evidence, for the patient interest.