Keeping the patient at the center of cancer innovation

As we recently saw at the annual meeting of the American Society of Clinical Oncology (ASCO), we are at a time of unprecedented opportunity in cancer research, and a time of unprecedented pressure on cancer treatment spending. The steps we take to spur continued research and address rising cost pressures will play a defining role in the future of cancer care.

Cancer survivorship is at an all-time high, thanks to scientific advances leading to ever more personalized cancer care. Yet cancer remains one of the most costly diseases in the United States. The dual challenge of supporting continued scientific progress against cancer and the growing economic burden of the disease is pushing the question of value to the forefront of national debate. A forum at the Institute of Medicine will take on this topic June 9, as will leaders from the cancer community at a major conference in Washington in October.

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Why has this debate emerged now? Scientific and technological advances are redefining how we classify, diagnose and treat cancer amid intense pressure to contain rising healthcare costs. In the past two years, 19 new cancer therapies have been launched in the United States, and almost 2,000 medicines are in development by the pharmaceutical and biotechnology industry. At the same time, the National Cancer Institute projects that national expenditures for cancer care will reach $157 billion by 2020, compared with $124 billion in 2010.

It is important for leaders from across the cancer community to engage in a dialogue on the cost and value of cancer care. As we do, it is vital to keep in mind two points that often get lost in the debate.

One is the need to keep the patient at the center. It’s easy to say, but far too often, the needs   of individual patients get lost in broad policy concepts and population averages. To the patients we encounter every week – the young father with lung cancer, the elderly woman with breast cancer, or any of the more than 1.6 million Americans expected to be diagnosed with some form of cancer this year, “value” and “cost” are very personal terms. We must ensure that as we examine the concept of value in cancer treatment, we do so in ways that honor and avoid subsuming the individual patient perspective. The truth is that the value equation (value = quality/cost) differs from individual to individual; at the personal level, value = (quality/cost) multiplied by appropriateness aligned with individual characteristics.

Second, we should recognize the role that innovation can play in actually helping us meet the challenge of sustaining high-value, personalized cancer care in the future. This may seem counter-intuitive in an environment saturated with headlines about the latest $100,000 targeted therapy. Many working in cancer recognize that we must continue to follow the science – accomplishing in oncology what has been achieved against other major public health problems, such as HIV/AIDS, in which scientific advances yielded major gains for patients and averted a predicted health spending crisis.  The only way we are going to deliver the right treatments to the right patients is by individualizing therapies; and this requires innovation.

How can this happen? The emergence of personalized medicine and health information technology are two big factors. Scientific advances allow us to diagnose disease more precisely and treat each patient with the appropriate therapy based on the molecular profile of his or her tumor. Targeted cancer therapies have already revolutionized the treatment of certain cancers, including chronic myelogenous leukemia and certain forms of lung cancer. New medications that harness the immune system to battle cancer were the darlings of this year’s ASCO meeting – yet another step in personalizing care. Further, we need information technology and data systems that allow us to accelerate the science and the matching of new treatments to individual patient characteristics, quickly, at point of care.

Continued investment in scientific research, along with the emergence of robust health information technology in oncology, promises a more patient-centered treatment system. Such a system can help ensure patients are treated only with the medicines they will benefit from, sparing side effects and expense for those who will not.  

The promise of these advances doesn’t mean we should not address cost – progress comes at a price. But it does mean that, as we work on this important issue, a focus on the patient and support for continued progress needs to be part of the equation.  Value = Quality/cost x appropriateness for the individual.

Finding meaningful, patient-centered solutions isn’t easy; it will take sustained commitment and collaboration across the cancer care ecosystem. Together we can turn the tide against cancer and deliver high-value, high-quality care to patients today and in the future.  

Abernethy is a clinical oncologist and professor of medicine at Duke University School of Medicine. She is currently director of the Center for Learning Health Care in the Duke Clinical Research Institute. She is also a member of the Institute of Medicine’s National Cancer Policy Forum. Kamal is a clinical oncologist and assistant professor of medicine at Duke University School of Medicine, and medical director for quality within the Duke Cancer Institute.