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Many clinical studies evaluate the benefit of a treatment based on bothsurvival and other continuous/ordinal clinical outcomes, such as Quality ofLife scores. In these studies, when subjects die before the follow-upassessment, the clinical outcomes become undefined and are truncated by death.Treating outcomes as "missing" or "censored" due to death can be misleading fortreatment effect evaluation. We show that if we use the median in the survivorsor in the always-survivors as estimands to summarize clinical outcomes, we mayconclude that a trade-off exists between the probability of survival and goodclinical outcomes, even in settings where both the probability of survival andthe probability of any good clinical outcome are better for one treatment.Therefore, we advocate not always treating death as a mechanism through whichclinical outcomes are missing, but rather as part of the outcome measure. Toaccount for the survival status, we describe the survival-incorporated medianas an alternative summary measure for outcomes in the presence of death. Thesurvival-incorporated median is the threshold such that 50% of the populationis alive with an outcome above that threshold. Through conceptual examples andan application to a prostate cancer treatment study, we show that thesurvival-incorporated median provides a simple and useful summary measure toinform clinical practice.

The survival-incorporated median versus the median in the survivors or in the always-survivors: What are we measuring? And why?