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The future of cancer: ‘Not beyond us,’ if we look behind us

The theme of this year’s World Cancer Day, February 4, is “Not Beyond Us,” meaning that solutions to cancer are within our reach. I agree. But I also think that as we continue to move forward, we must remember to look back. If we don’t, we risk losing the lessons from the past – lessons that offer clues to faster, better and more cost-effective solutions in the future. Here are some of those lessons:

Lesson 1: Cancer progress typically occurs in small but important steps.

If there’s anything we’ve learned from the history of cancer research, it’s that progress usually does not come in the form of dramatic developments, but rather as continuous innovation or small steps. Very rarely do we see improvements in leaps and bounds. Even recent breakthroughs in immuno-oncology are built on the successes and failures of the past.

{mosads}Over time, these steps led to multiple “a-ha” moments in cancer research, such as the discovery that cancer is not one but more than two hundred diseases.  In fact, we are beginning to understand cancer at the molecular level, offering the possibility of radical changes in oncology treatment development.

In return, new treatments brought about by continuous innovation have transformed the lives of millions of cancer patients. Since 1991, the cancer death rate in the U.S. has fallen by 20 percent. Since 1975, five-year survival has increased 21 percent for breast cancer, 36 percent for colon cancer, 50 percent for prostate cancer and 54 percent for lung cancer.

Lesson 2: Collaboration and reform are needed to offset threats to continuous innovation.

An aging population more likely to develop cancer – combined with rising prices for medicines and other new technologies – are placing an unsustainable financial burden on individuals, private and public insurance systems, and society as a whole.

As a result, the bar for innovation is rising and threatening to prevent the approval of new therapies that may contribute to continuous innovation. For example, the full clinical value of a new cancer therapy is often realized years after its initial FDA approval, as additional scientific trials and years of clinical practice produce newfound uses and benefits.

The drug research, development and commercialization process is far from perfect. In fact, it is in need of repair. But there is no quick fix. To move forward, we need all stakeholders, including policymakers, payers, patient advocacy groups, industry and researchers, to come together for positive change. Examples of needed change include:

  1. Reforming the cancer clinical research system and regulatory process. Changes that will allow faster recruitment of patients into clinical trials, greater use of adaptive trials, conditional approvals and better electronic sharing of real-world patient data will accelerate the cycle of continuous innovation.
  2. Alleviating the bias against medicines in the payment system. Insurance design favors reimbursement of hospital stays and other healthcare expenses compared with the cost of oncology drugs. This bias creates the impression that medicines are a disproportionate cause of high cancer treatment expenses when in fact their share of overall expenses has remained stable for many years.
  3. Reforming the reimbursement system. New pricing models, including pricing flexibility, would enable drug prices to rise and fall in response to new information.

Lesson 3: We need to harness historical evidence to protect innovation and speed reform.

Beyond collaboration, the way to reform is a broad willingness to change how we determine and reward value in cancer care, develop new treatments, and learn from our successes and failures. For this, all stakeholders require a deeper understanding of the innovations that have occurred and the gaps that still exist.

In response, timed to World Cancer Day, PACE (Patient Access to Cancer care Excellence) – a global collaboration aimed at improving the way decisions are made on cancer-related policy, new treatments and patient access – is launching a tool called the Continuous Innovation Indicators™ (CII). CII is the first evidence-based, customizable online database that enables cancer research and policy decision makers to “score” progress against a dozen major cancers in the last four decades – including some, such as testicular cancer, for which cures exist.

At the heart of the CII are thousands of pieces of evidence curated and coded by trained analysts from authoritative, published sources – such as clinical trial records and meta-analyses, observational studies and historical references.

CII is a kind of biographical database of individual cancers, looking at the progress of treatments to fight them, and it offers many lessons for what can be done better, faster and more cost-effectively in the future.

To learn more about the Continuous Innovation Indicators, visit learn more about World Cancer Day, visit

Crenshaw is vice president of Oncology for Eli Lilly and Company.


Copyright 2023 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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