While the many scientific advances over the past 50 years have led to improved outcomes for millions of patients with cancer—increasing the number of survivors from just 3 million in the 1970s to nearly 14 million today—the next 20 years promise to bring even greater opportunities to improve the lives of people diagnosed with cancer. They will also bring unprecedented challenges, according to a report published by ASCO, Shaping the Future of Oncology: Envisioning Cancer Care in 2030.1
Key Drivers of Change
To help identify the issues that will have the greatest impact on oncology care and prepare oncologists and patients to meet these challenges, in 2011, ASCO’s Board of Directors sought the advice of physician volunteers from ASCO’s committees, as well as thought leaders in a variety of fields, including clinical research, information technology, and public health-care policy. As a result of those conversations, the Board identified the following three key drivers of change that will transform cancer care over the next 2 decades:
- “Big Data,” the transformation of cancer care through health information technology
- Cancer “panomics,” the complex combination of patient-specific characteristics that drive the development of cancer, response to therapy, and long-term toxicities. Improved appreciation of these factors and the growing understanding of the biology of cancer will finally make precision medicine a reality and take targeted therapy to an entirely new level.
- Delivering value. The unsustainable cost increases in new cancer agents and health care in general are leading to a growing focus on cost-effectiveness and “value” in health care.
“ASCO realized the impending challenges we face, such as physician shortages, increasingly complex health-care reimbursement, and the rising costs of health care. But what really began to concern us was the accelerated pace of the development and use of genomics and how we treat cancer. We began to see that the whole paradigm of the practice of oncology was rapidly changing,” said Michael P. Link, MD, Past President of ASCO and a leader in the development of ASCO’s Shaping the Future of Oncology vision statement.
“We thought it was important to anticipate how oncology care might change over the next 20 years, so we can be better prepared and more proactive,” he continued. Dr. Link is the Lydia J. Lee Professor in Pediatric Cancer at Stanford University School of Medicine.
Changing Role of Oncologists
In the area of Big Data, by 2030, ASCO anticipates that the field of oncology will be able to draw on advances in health information technology, including ASCO’s CancerLinQ, to bring together vast quantities of real-world data. Oncologists will be in a position to analyze and share data on all patients with cancer, including their molecular profiles, comorbidities, treatments, clinical outcomes, and long-term side effects.
In addition, the huge body of observational data will enable investigators to formulate immediate practice-changing conclusions. Clinical guidelines will be transformed into living, “crowd-sourced” documents that are more detailed and accurate.
Big Data and its ability to provide accurate clinical care decision support quickly will enhance oncologists’ ability to develop patient treatment plans, manage care teams, collaborate with primary care providers on how to manage the health of cancer survivors transitioned to their care, and guide treatment of complex cancer cases, according to the report.
“We anticipate the coming wave of cancer will outstrip the current oncology workforce capacity. Oncologists may need to reserve their focus for patients with difficult or complex cancers and transition more routine care to other members of the patient’s care team,” said Dr. Link.
Better Care Through Cancer Panomics
Panomics will be the driving force behind the majority of cancer care, enabling providers to personalize treatment for each patient. By 2030, according to the report, most cancers will be molecularly well understood and highly treatable, combination targeted therapy will be the standard of care for most cancers, and validated biomarkers will help identify many patients at risk of developing cancer, enabling providers to blunt its development through early treatment or prevention strategies.
However, the ability to narrowly define cancer by patient-specific characteristics will mean that treatments will have to be tested in various combinations among small, molecularly defined patient populations, potentially making the development of new therapies and implementation of clinical trials prohibitively expensive.
To solve this problem, ASCO speculates that research sponsors and the U.S. Food and Drug Administration will need to initiate trial designs and endpoints that can lead to rapid drug approval. In addition, CancerLinQ and other rapid-learning systems will aid researchers in corroborating the findings of smaller, faster clinical trials, and drug companies will collaborate on drug development.
Value-Driven Care
The exploding rise in health-care spending in the United States—$2.6 trillion in 2010 and projected to reach $4.5 trillion in 20202—is leading to changes in the way health care, including cancer care, will be delivered and in determining what constitutes value.
According to the report, two major challenges in oncology loom: Oncology care professionals will need to adapt to demands for greater quality, efficiency, and transparency in care provided. And the oncology community will need to address the spiraling cost of new cancer therapies, especially as novel therapies are tested and administered in combinations of two or more drugs. With many new agents costing $100,000 for a course of treatment, combination therapies could be priced out of reach for many patients, threatening both access to care and the sustainability of cancer drug development.
To meet these challenges, new payment models that promote quality and value will be needed. To ensure that value will be the driver of oncology care practice, ASCO’s Quality Oncology Practice Initiative (QOPI) and rapid-learning systems, such as CancerLinQ, will enable providers to know how their care compares with established guidelines and the care received by patients in other practices. Moreover, oncology providers will be compensated according to their ability to demonstrate value and quality as determined by approaches developed by their peers, by patients, and by payers.
In addition, medical school, residency, and CME programs will include emphasis on quality measurement, data analysis, staff management, and other skills physicians will need to succeed under new practice models. Quality ratings for oncologists and oncology practices will be publicly available, allowing patients to judge potential providers for themselves. Through guidelines and insights gained through CancerLinQ, cancer care quality and cost-effectiveness will become more consistent across regions and institutions.
Starting the Dialogue
The picture of oncology in 2030 as presented in ASCO’s vision statement was carefully researched, but Dr. Link emphasizes that this is only a projection. It offers a starting point for ongoing dialogue among ASCO members.
“We want to see if there are areas that we haven’t thought of and addressed. We need to hear from our members about what they are seeing, doing, and reading. We want to know whether they think the information we presented is realistic. We especially want to hear from younger members who are going to be around in 2030 about what they think is necessary, both to meet the challenges of our future and to make things better,” said Dr. Link.
Getting Your Input
How realistic is the vision presented in ASCO’s Shaping the Future of Oncology: Envisioning Cancer Care in 2030? Is this the future that you want to see? What more or what else should oncologists strive to achieve for their patients? What role should ASCO play in the changing paradigm in oncology care?
These are some of the issues ASCO would like to address with its members. To read and download a copy of the complete vision document, go to www.asco.org/about-asco/asco-vision. To post comments on the information presented in the document, log onto asco.org/vision.
“We need the expertise of our members. We want to see how we can improve the suggestions in the vision document. Then ASCO can begin to work on addressing the issues we will confont,” said Dr. Link. ■
Disclosure: Dr. Link reported no potential conflicts of interest.
References
1. American Society of Clinical Oncology: Shaping the Future of Oncology: Envisioning Cancer Care in 2030. Available at http://www.asco.org/about-asco/asco-vision. Accessed August 6, 2013.
2. Centers for Medicare & Medicaid Services, Office of the Actuary: National Health Expenditure Data, 2012 release. Available at www.cms.gov. Accessed August 6, 2013.
