In Cancer, Process Drives Progress

Feb 01, 2013


William Looney
TODAY'S MOST IMPORTANT PUBLIC HEALTH STORY is the advance in our understanding of the biology of cancer—a disease so deeply associated with major death and disability that the long search for a cure has been framed through the rhetoric of all-out war. What the new science is saying about cancer is something different. Cancer is not that monolithic curse of unrelenting discipline but rather a collection of small—even rare—conditions driven by the distinct characteristics of every individual's inherited DNA. Seen this way, it's probably a stretch to claim that success against cancer requires military style mobilization. In fact, a key question is whether the way we treat and manage cancer is appropriate to its changing scientific profile. Are we ready to leverage our mastery of the genetic codes for cancer with the treatment systems and standard of care that can really deliver personalized medicine to the patient?

This month's cover feature provides some thoughtful answers to this question, itself part of a larger dilemma facing the healthcare community. Providers and payers, not to mention patients, are wrestling with the issue of how quickly the practice of medicine, and the often cumbersome process of delivering and financing care, must accommodate to advances in medical innovation. Cancer care is on the front lines of this issue, so Pharm Exec convened a panel of oncology experts—drawn from industry, academia, and the nonprofit sector—to consider ways to balance the sometimes conflicting goals of quality, efficiency, cost, and outcomes in evaluating the growing number of treatment options available to patients.

The group's discussion emphasized the vital role that treatment guidelines and pathways play in providing a semblance of order to the cancer space. Concerns about pricing and costs are beginning to override the cancer community's traditional deference to physician judgment, which makes it more important that therapeutic decisions be grounded on good evidence. The best means to accomplish this is through flexible, independent, physician-led standards linked to consensus-based, transparent metrics around performance; in this latter case, while acknowledging there are choices to be made on costs, the reference point should always be the impact of a particular intervention on outcomes overall.