Why RCTs are haute couture, but RWE is ready-to-wear: practical, diverse, and inclusive.

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Picture this: a stunning, designer gown strutting down the runway at Paris Fashion Week. It’s breathtaking, crafted with precision, tailored to perfection, and designed for maximum impact. But could you wear it to work? To the grocery store? On the subway?

Probably not… (unless, of course, that is your type of carrying on — which I am here for!)

Thinking about this through the lens of oncology evidence generation, randomized controlled trials (RCTs) are, without a doubt, the haute couture of medicine. They are rigorously designed to answer a very specific question under highly controlled conditions. In oncology, they’ve been essential in bringing life-extending and life-saving treatments to market. Without them, we wouldn’t have the therapies we rely on today.

But just like couture, RCTs aren’t designed for everyday wear or everyday patients. That’s where real-world evidence (RWE) steps in. Think of it as ready-to-wear fashion. It’s grounded in reality, built for variety, and reflective of how people actually live, move, and show up in the world.

Haute Couture: The Elegance and Limits of RCTs

RCTs are the cornerstone of evidence-based medicine. They are:

• Controlled to minimize bias and isolate the impact of a treatment
  
• Standardized to ensure reliability
  
• High-quality and often required by regulators to demonstrate safety and efficacy
  

In other words, RCTs answer the critical question: Can this treatment work under ideal conditions?

But ideal isn’t always real. RCTs often enroll highly selected patient populations, leaving out older adults, people with multiple comorbidities, and historically underrepresented racial and ethnic groups. In oncology, where patients are often navigating complex health and life circumstances, this gap becomes especially stark.

It’s not that RCTs aren’t valuable. They are indispensable. But they are just one piece of the evidence puzzle.

Ready-to-Wear: Why RWE is the Street Style We Need

Real-world evidence complements RCTs by providing insight into how treatments perform outside of clinical trial settings. Derived from electronic health records, cancer registries, insurance claims, and even patient-reported outcomes, RWE reflects the messiness and richness of everyday life.

Like ready-to-wear fashion, RWE is:

• Inclusive, reflecting real patients across age, race, gender, geography, and health status
  
• Pragmatic, capturing how treatments are actually used, including dose adjustments, treatment delays, and discontinuations
  
• Contextual, surfacing outcomes that matter to patients such as quality of life, side effects over time, and financial burden
  

RWE helps answer the real-world questions clinicians, patients, and policymakers are asking:

• Will this treatment work in my 72-year-old patient with diabetes and heart failure?
  
• Are there racial or socioeconomic inequities in outcomes or access?
  
• How does this therapy fit into the full cancer care journey?
  

Couture Meets the Sidewalk: A Complete Picture of Evidence

It’s not about choosing between RCTs and RWE. The future of cancer care and evidence more broadly depends on both.

• RCTs tell us whether a treatment can work under perfect conditions.
  
• RWE tells us how it performs in the real world, for the full range of patients we serve.
  

Just like the fashion industry benefits when haute couture inspires and coexists with ready-to-wear collections, healthcare improves when traditional trials and real-world studies work in tandem.

We need evidence that is:

• Gold-standard when necessary
  
• Practical when possible
  
• And always people-centered
  

Final Thought: Beyond the Ideal, Toward the Real

Real-world evidence doesn’t replace RCTs. It completes them. Because while we celebrate the precision and elegance of the runway, we live our lives on the sidewalk, in the clinic, at home.

To build more equitable, responsive cancer care, we must elevate the evidence that meets patients where they are. We must design for real life.

Because when it comes to evidence, as with fashion, style is only meaningful when it’s wearable.

Join the Movement

At Evidence in Style^TM science meets storytelling and cancer education gets a bold new look.

From fashion to film, real-world data to real life, we’re here to make complex cancer concepts accessible, memorable, and empowering.

Whether you’re a patient, a caregiver, a researcher, or just curious about cancer and how evidence actually works, this space is for you.

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