Joseph Alvarnas, MD

The fault, dear Brutus, is not in our stars, but in ourselves... Julius Caesar (I, ii, 140-141)

There is an epidemic failure within the game to understand what is really happening. ––Peter Brand (Jonah Hill), Moneyball, 2011.

In an article published in Electronics Magazine on April 9, 1965, Intel cofounder Gordon Earle Moore noted that the number of transistors in an integrated circuit doubled every year. He extrapolated that this rate of growth in computing power would continue to double every 2 years throughout the late 1960s and in to the 1970s and 1980s. The prediction, which became known as Moore’s Law, proved prescient. Intel and other industry leaders took this as both a prediction for the pace of innovation and a push for the industry to create “computing [that] would dramatically increase in power, and decrease in relative cost, at an exponential pace.” From 1965 to today, the technologies, depth of innovation, and corresponding impact from discoveries made in the pursuit of achieving and sustaining Moore’s vision have affected our lives in profound and unexpected days. Conversations rarely take place today without someone glancing at a smartphone to close a business deal, to let family know they will be late, or to post pictures of the conversation on a social media site.

Joseph Alvarnas, MD, discusses the history of cancer care and what the future might look like in the space.

“Every great magic trick consists of three parts or acts. The first part is called ‘The Pledge.’ The magician shows you something ordinary. ...The second act is called ‘The Turn.’ The magician takes the ordinary something and makes it do something extraordinary. Now you’re looking for the secret, but you won’t find it, because of course you’re not really looking...Every magic trick has a third act, the hardest part, the part we call ‘The Prestige.’” — Christopher Priest, The Prestige

A letter from our Editor-in-Chief, Joseph Alvarnas, MD.

Film is truth 24 times a second, and every cut is a lie – Jean-Luc Godard

Dr Alvarnas is editor-in-chief and director of Value-Based Analytics at City of Hope, Duarte, California.

Dr Alvarnas is editor in chief and director of Value-Based Analytics at City of Hope, Duarte, California.

There is no shortage of academic, industry, and government sources that identify value as equaling cost/outcomes; there is far less uniformity of opinion when it comes to defining what that means for a particular patient affected by cancer.

As we shift to the precision-medicine model of cancer care, it is essential to develop a scalable system that can deliver these care solutions in a patient-centered, economically sustainable way.

High-quality cancer care can only occur when the “transitions in care” are delivered in a prospectively planning, systematic, patient-centered way.

As the task of describing value delivery in cancer care seems to grow in complexity the closer that we examine it, this is essential in order to both rationally control the growth of healthcare costs and ensure that we do not undermine patient care.

A note from the editor-in-chief.

These are uncertain times in healthcare and the anxiety levels of stakeholders remain high as everyone waits to see how the appointments and policy changes within the new administration will impact healthcare in the United States in the near future.

As we enter a time of extraordinary advances in cancer care, some of the optimism over these advances has been tem­pered by the growing realization of the challenges of delivering these cancer care solutions.

This issue of Evidence-Based Oncology is dedicated to understanding the implications, scope, and opportunities within the realm of cost sharing in oncology.

Despite the breadth of metrics, there seems to be a significant disconnect between the relatively prosaic, process-based measures that largely dominate our quality portfolio and the high-level, aspiration-driven demands of delivering increasingly complex care to patients with cancer.

As cancer care stakeholders move through processes of creating, deploying, and reporting quality metrics, it is important to remember that these measures alone are not sufficient to bring better care to patients.

Despite the fundamental advances in cancer care technology and care delivery that have made these improvements possible, our delivery system remains quite inefficient and frequently falls short of being truly patient-centered. Is a system-based solution the answer?

While the number and diversity of immunologically-based anticancer agents have increased dramatically, a number of challenging questions persist: sequencing with existing regimens, selection of best responders, cost, and patient access.

While cost is an important component of value, it tells only a small part of the cancer care story. By focusing on issues of payment and cost alone, we miss our opportunity to engage cancer care stakeholders in the process of creating a more effective system of care.

A missed opportunity in cancer care, according to Joseph Alvarnas, MD, is the use of age-adapted treatment strategies for adolescent and young-adult patients (AYA).

In his editorial piece, Joseph Alvarnas, MD, narrates the importance of precision medicine in oncology care.

Evidence-Based Oncology's editor in chief introduces the special issue on cardio-oncology.