It was noted that increased collaboration among stakeholders will be required to keep these standards fresh and relevant,
with a pertinent example being the joint Value Pathways project just launched between McKesson Oncology Research and the leading
independent source of physician-led guidelines, the National Comprehensive Cancer Care Network (NCCN). The Value Pathways
are designed to assist oncologists in managing care for 19 cancer tumor types, but their real novelty is in addressing head
on the complex, sensitivity-laden notion of "value"—by building in a peer reviewed evidence rationale for every cost incurred.
While the growing sophistication of guidelines and pathways is a welcome trend, there are institutional challenges that threaten
to impair their effectiveness. These include the difficulty of compiling convincing clinical data on outcomes for many cancers;
reconciling the standardized protocol approach against the growing scientific capacity to deliver treatments tailored to an
individual's unique genetic profile; contradictory regulations, as represented by the actions of many US states to limit the
legality and scope of privately-sponsored guidelines; and the sheer proliferation of activity around guidelines, which ultimately
poses a redundancy problem. Again, the cancer community may be best positioned to resolve these roadblocks, since historically
it has moved further and faster than other specialties in relying on guidelines and other evidence-based tools to set the
standard of care for patients.
Such optimism is underscored by the group's conviction that many cancers are going to be not just treatable—but beatable—within
the next decade or so. Scientists are learning more about the special characteristics of cancerous stem cells, promising over
time a new way of avoiding tumor metastases. The fight against HIV is producing insights that may yield new immunotherapy
treatments for cancer, and there is a small but budding research agenda around cancer prevention, which could accelerate if
issues around securing a better return from investments in prevention are resolved.
Finally, the old adage that perception drives reality was reinforced through a survey conducted by Eli Lilly & Co. that found
more than half of patients today believe cancer is one disease—and thus can be defeated with one cure. Is it just a coincidence
that regulators still tend to address the approval process in the same way, with little if any focus on devising enhanced
registration benchmarks for very small drug indications? Cliché or not, the future of cancer is not macro, but micro.
Follow Bill on Twitter: