Background 

Combination therapies (CTs), defined as the use of two or more therapeutic modalities—such as chemotherapy, targeted therapy, immunotherapy, or antibody–drug conjugates—represent an increasingly recognised approach in oncology, including uro-oncology. Many CTs rely on biomarker or genomic testing to select patients most likely to benefit. Despite their growing role in clinical practice, several challenges persist, including complex regulatory pathways, cross-company collaboration barriers, and limited reimbursement frameworks that can hinder patient access. Moreover, there is limited evidence on how well cancer patients understand these treatment concepts and their implications for clinical decision-making. 

Objective 

To assess the level of awareness, understanding, and informational needs regarding combination therapies and biomarker-based treatment decisions among European cancer patients. 

Methods 

A 29-item anonymous questionnaire was co-developed with patient representatives and translated into five European languages. The survey was disseminated via the Cancer Patients Europe (CPE) network and public social media over 90 days, hosted on SurveyMonkey® to ensure anonymity and GDPR compliance. Data were analysed descriptively using frequency and percentage distributions. 

Results 

A total of 1,440 responses were collected from across Europe, primarily from France, Germany, Spain, Italy, and the United Kingdom. The majority were women (86%), aged >60 years (62%), and living in towns <50,000 inhabitants (60%). Seventy-eight percent were current cancer patients, and 19% survivors. 
Only 45% had heard of the term combination therapy, and nearly half (46%) had never been informed about CTs by their oncologist. One-third were unaware of potential side effects, and 16% could not identify benefits. Among perceived benefits, 59% prioritised improved survival, while only 6% cited reduced toxicity. Nevertheless, 71% expressed interest in receiving more information from their treating physician. 
Awareness of biomarker testing was also limited: 33% reported not having undergone testing, and only 40% of those tested knew that results guided treatment selection. Oncologists were the main information source (65%), whereas only 10% received information from patient associations. 

Conclusions 

European cancer patients, including those treated in uro-oncology, demonstrate low awareness of combination therapies and biomarker-guided treatment decisions. These findings reveal a critical gap in disease literacy and highlight the need for enhanced patient–clinician communication and education on precision oncology. As combination strategies become increasingly central to cancer management, ensuring that patients understand their rationale, risks, and benefits is essential for shared decision-making and equitable access to innovation.