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