On November 21st The Economist newspaper declared War on Cancer for the third time in London, drawing world experts in oncology policy, clinical practice, and innovation together in the unique and fitting venue of the Honorable Artillery Company. With over 200 known types of cancer and each patient’s unique physiology leading to huge variations in treatment response, the War on Cancer event reminded attendees that cancer is always personal.
The day began with a keynote from those with direct experience of cancer treatment. The audience was challenged to consider what lessons could be learnt from the overall treatment journey experienced by patients and to really imagine what being ‘cured’ looks like to a patient. Later in the morning the theme was extended with a panel discussion on genuinely patient-centered care, which weighed how to achieve totally integrated community and hospital care without risking the bankrupting of entire healthcare systems. The panel also emphasized that gains from improved patient care pathways and survival rates even stretch beyond an individual’s well being, with the startling statistic that decreasing cancer death rates by only 1% can lead to at least a 1.6% increase in the economic productivity of a nation.
The remainder of the morning session tackled innovation in the care continuum with lively discussions in key areas of patient-centric models, innovations in surgery, radiotherapy and diagnostics, as well as the role of precision medicine. A recurring theme developed, highlighting the huge potential for improved patient outcomes driven by better and smarter data sharing. Such innovation is particularly important for rare cancers, where limited expertise can be pooled nationally and internationally to enable treatment breakthroughs that would otherwise remain completely unknown.
Other speakers championed how critical it is that we routinely collect patient data as standard in order to better understand cancers’ progression, and to better capture underrepresented groups—who are often the very populations with the worst prognosis and quality of previous care. Many participants reinforced the need to also incorporate socioeconomic factors into the vast constellation of a patient profile. One example being the relatively simple problems of treatment adherence and patient mobility, which have been shown to alter survival rates by factors that the pharmaceutical industry could only dream of!
Other contributors reminded the audience that often the majority of patient data for both diagnosis and monitoring progression must be gathered outside of the hospital, bringing the dual challenges of transparency and consistency, along with the need to sensitively integrate technology into patients’ lifestyles.
Many of the technological advances discussed focused on earlier detection and diagnosis of cancer. Liquid and breath biopsies were showcased, both of which offer the possibility of detecting cancers when entirely asymptomatic and with minimal patient discomfort—and all with a corresponding 10x improvement in treatment response and a 10x reduction in overall treatment cost. But, there was also a warning that new technology is not a panacea: in less economically developed nations there is often an over-investment in pharmaceuticals as a result of local skills shortages, which has led to less effective, less efficient, and more expensive care for patients. The morning sessions were brought to a close with the challenge that rewarding innovation is important, but that given the stakes, we must be cautious of not just rewarding mediocrity.
Discussions turned to the opportunities and challenges of digital health in cancer diagnosis and treatment. A later session began with the compelling charge that “the future is here…but it is not evenly distributed”, and the claim that empowering patients with software may hold the key to exponential improvements in care. Fierce debate ensued as discussion turned to balancing the shift of power from clinicians to their patients in healthcare systems that are often fundamentally resistant to change.
Speakers from a number of big-data projects also explored the analysis of the vast data-streams generated from a patient’s treatment, and emphasized the possibilities of using AI to improve both diagnostic accuracy and access throughout the world. Such data-driven precision also challenges the rather murky definition of what constitutes a cure for a cancer patient, and opens up new avenues for understanding the maturation and evolution of cancer as a highly complex disease.
The event was brought to a close with discussions focusing on policy to achieve the outcomes that patients both need and want. The importance of treatment quality was emphasized along with the need to see palliative care as more than just a last resort—or worse still, being willing to treat cancer patients to death with increasingly potent medications.
After a day showcasing the latest technological and pharmaceutical breakthroughs along with visions of the role AI and robotics may play, the audience was reminded that ultimately “healthcare professionals are the brokers of compassion; using medicine and care to relieve suffering.” The importance of early engagement with treatment from both patients and their families was also reinforced with startling findings linking home-based care to longer life expectancies and fewer days spent in the ICU. The day was brought to a close by asking: what is currently standing in the way of prioritizing that which matters most to patients in their treatment? A question with an answer as complex as the disease itself.
Cancer treatment is highly variable and highly personal, and outcomes too often vary for reasons linked to geography and income, rather than medicine. The Economist’s War on Cancer challenged participants to grapple with the role that exciting new technology and pharmaceuticals will play in the treatment journey of cancer patients, while also reminding us that care, community involvement, and our own mortality cannot be ignored for a disease that impacts so many.
Link: War on Cancer 2017…
