Advancing the Wave of Democratization of Cancer Care

In the Dawning of Democratized Cancer Care, I explained how scientific advances in molecular profiling are beginning to democratize cancer care, empowering cancer patients everywhere with the knowledge that each cancer is individual and introducing a new era of personalized cancer therapy.

I described how innovative national clinical trials offer patients with advanced cancer access to molecularly guided therapies in their own home towns without long, tiring journeys to urban cancer centers. With studies like TAPUR (Targeted Agent and Profiling Utilization Registry) by the American Society of Clinical Oncology and the National Cancer Institute’s MATCH (Molecular Analysis for Therapy Choice), any oncologist with a patient whose molecular tests indicate the use of a certain drug may obtain it from the trials.

TAPUR and NCI-MATCH are a great start, but we need more experimental trials like these to develop novel first-line cancer therapies and better second-line treatments. We also need every oncologist to have access to broad-scale molecular profiling AND the full spectrum of therapies indicated by molecular profiling, not just those in clinical trials.

Executive, legal, and legislative efforts are contributing to the democratization of cancer care. At the end of 2014, President Obama signed the Recalcitrant Cancer Research Act. The law focuses on research efforts on cancers with very low survival rates and developing early detection methods and better treatment options to help improve outcomes for those diagnosed with the most deadly forms of cancer. At the beginning of 2015, the president announced his $215 million Precision Medicine Initiative to achieve medical breakthroughs. The 21st Century Cures Act now is working its way through Congress to get new medical treatments to market faster.

Accountable care and risk-based reimbursement models that focus on quality and value will further push the envelope of democratizing cancer care, and insurance companies can add to the movement by bringing reimbursement to each component of personalized cancer therapy: patient intake and outcomes data collection; the molecular assays themselves; and data analysis and integration.

The pharmaceutical industry may advance the wave of democratization of cancer care by contributing all of its approved drugs into trials like TAPUR and MATCH for distribution to anyone with cancer so we can investigate if medication for one kind of cancer works with other kinds of cancer.

Medical schools can help complete democratization of cancer care by graduating physicians who are trained on genomics and proteomics, are fully educated on the molecular basis of cancer, and who think about cancer based on its molecular defect matched with the right therapy and not in terms of the site of origin. Progressive medical schools can help change the language and perceptions of cancer and how it is treated in our society.

Democratizing the complex field of cancer care is not easy. We’ve increased access to information on cancer care—that is, we’ve democratized the ability to generate molecular profiling and real-time access to the information—but the ability to act on that information still lags. We are providing patients with key information that their own cancer is unique and needs to be treated as such, but there is a great deal of work to be done in putting that knowledge to work.