July 15, 2026. Over the past years, BG Lab has continued to raise awareness on misleading terms used to downplay toxicities of cancer drugs in clinical trials and advocate for changes. In 2018, BG published in The BMJ as a postgraduate trainee, recording the prevalence of subjective terms often used to downplay toxicities in clinical trials (e.g. “acceptable” and “manageable”), and highlighting the importance of transparency to ensure patients fully understand the benefit and harm profile of a drug. In 2023, BG commented in a news article, “The Side Effect Roulette of Cancer Treatment” for Undark on how toxicity terms are subjective and vague: diarrhea may be reported as grade 3 in a clinical trial but indicated as being “tolerable,” yet several bowel movements per day over weeks is not something that is well-tolerated by patients. In 2025, BG, with Common Sense Oncology, published in The Lancet Oncology on principles for the design, analysis, and reporting of clinical trials. They drew attention to the limitations of the CTCAE, in that it only captures acute toxicities and misses the duration of toxicities, and underscore the need for patient-reported outcomes, measuring the duration of all toxicities, and identifying the impact on quality of life. However, most of this advocacy fell to deaf ears. Even when conferences published “language Guide”, they did not talk about such misleading language to describe toxicities that can lead to patient harm.
However, we are happy to finally see the needle moving somewhat. Thankfully, some journals are now taking a stance on using proper language to describe toxicities without using minimizing terms. Earlier this year, editors from The Lancet journal family published a commitment to ensure clinical trial reporting is more rigorous and transparent, including toxicity reporting: “An objective summary of grade 3–5 toxicity without the use of subjective terms that underplay the severity of the reported outcome.” This is a strong step in the right direction, and should push other journals to do the same. We thank the Lancet family of editors for this right courageous step.
Last month, Nature Medicine invited us to write a commentary on this topic, where BG outlines how grading of toxicities is not always informative without accounting for duration or patient preferences, and recommends using patient-reported outcome measures to describe toxicities without using downplaying terms. This was published together with another important article by Laura Book, who shares her perspective on this topic as a patient.
It was also encouraging to see that Science recently published an article sharing this message, based on BG’s Nature Medicine piece. And last week, Nature Medicine published a powerful editorial, “Oncology must confront hidden side effects,” about how the recording and managing of treatment-related toxicities has fallen behind compared to this innovative period of oncology research. All these concerns culminate in the main issue that what clinical trials report as “manageable” based on the current criteria may not actually be manageable for patients. Quality of life data may not be available for years after a new therapy is available, and factors such as impaired daily functioning and emotional well-being are not considered CTCAE toxicities. As such, patients (and clinicians) are unaware of some toxicities, compromising informed consent.
Overall, BG Lab has been advocating for change in this field for years; we are optimistic that these recent commitments from major journals like The Lancet family, Nature Medicine, and Science will be followed by other major journals that publish cancer clinical trials, as well as conferences like ASCO and ESMO. We should all take a stance and declare that the use of downplaying terms to describe toxicities is unacceptable, until these changes are implemented.
Dr. Bishal Gyawali 
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