Clin Cancer Res. 2014 Feb 12. [Epub ahead of print]

Turning the Tide Against Cancer Through Sustained Medical Innovation: The Pathway to Progress.

Abernethy A, Abrahams E, Barker A, Buetow K, Burkholder R, Dalton WS, Foti M, Frueh F, Gaynor RB, Kean M, Khan Z, Lessor T, Lichtenfeld JL, Mendelsohn J,Van't Veer L.

Author information

• Authors' Affiliations: Center for Learning Healthcare, Duke Cancer Center Research Program, Division of Medical Oncology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Personalized Medicine Coalition; and Pharmaceutical Research and Manufacturers of America, Washington, DC; Complex Adaptive Systems Initiative, School of Life Sciences, Arizona State University, Tucson, Arizona; M2Gen, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, Florida; American Association for Cancer Research, Philadelphia, Pennsylvania; Opus Three LLC, Rockville, Maryland; Clinical Development and Medical Affairs, Eli Lilly and Company, Indianapolis, Indiana; Feinstein Kean Healthcare, Cambridge, Massachusetts; Global Strategic Market Access and Policy, Celgene Corporation, Summit, New Jersey; American Cancer Society, Atlanta, Georgia; The Khalifa Institute for Personalized Cancer Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas; and Breast Oncology Program, Applied Genomics, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California.

Abstract

An ever-expanding understanding of the molecular basis of the more than 200 unique diseases collectively called cancer, combined with efforts to apply these insights to clinical care, is forming the foundation of an era of personalized medicine that promises to improve cancer treatment. At the same time, these extraordinary opportunities are occurring in an environment of intense pressure to contain rising healthcare costs. This environment presents a challenge to oncology research and clinical care, because both are becoming progressively more complex and expensive, and because the current tools to measure the cost and value of advances in care (e.g., comparative effectiveness research, cost-effectiveness analysis, and health technology assessments) are not optimized for an ecosystem moving toward personalized, patient-centered care. Reconciling this tension will be essential to maintaining progress in a cost-constrained environment, especially because emerging innovations in science (e.g., increasing identification of molecular biomarkers) and in clinical process (implementation of a learning healthcare system) hold potential to dramatically improve patient care, and may ultimately help address the burden of rising costs. For example, the rapid pace of innovation taking place within oncology calls for increased capability to integrate clinical research and care to enable continuous learning, so that lessons learned from each patient treated can inform clinical decision making for the next patient. Recognizing the need to define the policies required for sustained innovation in cancer research and care in an era of cost containment, the stakeholder community must engage in an ongoing dialogue and identify areas for collaboration. This article reflects and seeks to amplify the ongoing robust discussion and diverse perspectives brought to this issue by multiple stakeholders within the cancer community, and to consider how to frame the research and regulatory policies necessary to sustain progress against cancer in an environment of constrained resources.