  Many clinical studies evaluate the benefit of treatment based on both
survival and other clinical outcomes. In these clinical studies, there are
situations that the clinical outcomes are truncated by death, where subjects
die before their clinical outcome is measured. 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
to summarize clinical outcomes, we may conclude 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. We
use conceptual examples to show that the survival-incorporated median provides
a simple and useful summary measure to inform clinical practice.
