Conversations

How can we work together to achieve a future in which we’re beating cancer by providing care that is effective, affordable, high quality and patient-centered?

Contributors Respond

Ellen V. Sigal, Ph.D.

Ellen V. Sigal, Ph.D.

Chairperson and Founder of Friends of Cancer Research

Read Ellen V. Sigal, Ph.D. 's bio

The key to beating cancer will be found through true collaboration from all sectors. 

For years, Friends of Cancer Research has convened the best and the brightest from all sectors to address some of the most pressing issues in cancer treatment. By creating venues focused on an open and constructive dialogue, we have found real solutions and established some pretty groundbreaking initiatives.

One of these such venues is an annual conference we hold each year in partnership with the Brookings Institution. As an outgrowth of that conference, we are in the final stages of planning of a Lung Cancer Master Protocol. This project, a true public-private partnership which includes the NCI, NIH, industry and academia, has the potential to revolutionize and accelerate the way new biomarker-defined therapies are tested for lung cancer. In this project, the master protocol will govern how multiple drugs, each targeting a different biomarker, will be tested as potential treatments for lung cancer.  Each arm of the study will test a different drug that has been determined to target a unique genetic alteration.  The use of cutting-edge screening technology will help identify which patient is a molecular match to each arm.  This will create a rapidly evolving infrastructure that can simultaneously examine the safety and efficacy of new drugs.   This approach will have the ability to improve enrollment, enhance consistency, increase efficiency, reduce costs, and most importantly - improve patient’s lives.  

As the project moves forward, each of our partners has committed to do business differently.  It is our hope that this can serve as a template for the future of clinical research.

This trail, and collaborations like these, represent how working together can create new opportunity for patients with serious illness, and find solutions for areas where few treatment options may be available or accessible.  We should all commit to being open to new models like this, after all, the patients that we are striving to help don’t have the time to wait. 

For more on this collaboration you can visit us at http://www.focr.org/master-protocol or @CancerResrch on Twitter https://twitter.com/CancerResrch

Edward Abrahams, Ph.D.

Edward Abrahams, Ph.D.

President of the Personalized Medicine Coalition (PMC)

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By more precisely targeting treatments and prevention to the individual patient, personalized medicine is a key part of the solution to get us to cancer care that is more effective, affordable, and patient-centered. 

The scientific discoveries of recent years have provided notable insights into this dreaded disease, telling us, for example, that there are over 200 identifiable forms of cancer. We must ensure that public policies allow the emerging science of personalized medicine to move as rapidly as possible from the laboratory to the patient.

Collaboration is critical to this effort and PMC strives to be a convener and consensus builder in our role as a coalition. To that end we have compiled a set of principles to ensure that cost-containment policies do not undermine personalized medicine and do protect innovation, the physician-patient relationship, and patient values and choice. Our broad membership from across the personalized medicine community has come together behind these principles and I invite other groups to join us.

Key principles include:

  • Support increased emphasis on patient-centeredness, patient engagement, and the patient-physician relationship;
  • Incentivize prediction, preemption, and prevention of cancer and other diseases;
  • Reform assessment tools (in particular comparative effectiveness research and health technology assessment) to better align with emerging science and patient-centered health care. Support approaches that accommodate the multiple dimensions of value instead of centralized standards based on average comparative clinical or cost effectiveness;
  • Expand and make effective use of informatics and “learning health systems”;
  • Sustain funding for basic research at the National Institutes of Health and match with incentives for innovation in the private sector;
  • Protect innovation and value in new payment models.

To better inform policymakers and key stakeholders regarding the ways smart public policies can improve cancer research and care, the Personalized Medicine Coalition and other organizations have come together to form the Turning the Tide Against Cancer initiative. An effort  to sustain innovation by advocating for the changes referenced above, the initiative embodies the spirit of collaboration that is necessary to advance the complex cancer research and care ecosystem.

Recognizing the growing power of personalized medicine to prevent, detect, and treat the disease, we owe it to patients to seize the opportunities that have been created. We must accurately define and measure the value of tests and treatments in order to foster innovation, achieve better outcomes, and lower overall costs to the health system. 

J. Leonard Lichtenfeld, MD, MACP

J. Leonard Lichtenfeld, MD, MACP

Deputy Chief Medical Officer, American Cancer Society

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Patient-centered medical care has become a buzzword in medical practice over the past several years. Although the care we deliver cancer patients has undergone some changes, there hasn’t been much attention actually paid to how we deliver more effective and appropriate care when viewed through the lens of the patient with cancer.

The genomics revolution will impact the prediction, diagnosis, treatment, and survival of cancer patients. We are going to have to find new ways to deliver cancer care if we are to realize that potential. Being able to obtain a genomic signature is one thing. Interpreting it, making it relevant to practice, and getting the right care to the right patient at the right time is another.

I am beginning to hear rumblings that in parallel to the explosion of genomic based research and treatment we also need to reengineer the entire spectrum of cancer care. We must not only assure access and quality, but also pay attention to quality of life, spirituality, understanding financial impact of cancer, and survivorship among other topics. We will have to do more than find targets and create medicines that interfere with those targets and improve our success rates. We must be more holistic if we are to bring true success to the patients we care for.

As one leader in the field said to me recently, “There is no personalized medicine without better cancer care.” That means all of us —for-profit and nonprofit alike— must make a commitment to improving cancer care. We have to tear down the walls and rebuild the model. We must listen to our patients and incorporate true patient-centeredness, not just mouth the words. We must offer support and counseling to those in need at their greatest moments of need. We must understand the short and long term impacts of the care and treatments we offer. We must think along several paths simultaneously, coordinate our efforts, and create a cohesive model that does not exist today.

This is no simple task, and who takes the leadership to help guide this process remains uncertain. Without leadership, commitment and focus from all of us engaged in our concern for cancer patients, their families and loved ones we will bump along the road over too long a time.

The science is coming at us at an amazingly rapid rate. We cannot let the glamour of that science bedazzle our vision so much that we ignore the more fundamental issue of how we truly offer patient-centered care. Bringing our collective knowledge, wisdom and experience to the creation of a truly patient centered model of cancer care could be as meaningful to our patients as the next therapeutic advance.

It is time we made personalized medicine truly personal.

William S. Dalton, Ph.D., MD

William S. Dalton, Ph.D., MD

CEO, M2Gen

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Cancer touches everyone.  It affects individuals of every age, every gender, and every race.  Nearly 1 out of every 2 Americans born today will be diagnosed with cancer in their lifetime.  It is also the most costly disease to the nation, contributing $77.4 billion in direct medical costs and $124 billion in lost productivity. 

Clearly, cancer is an important area for personalizing medicine by finding better, more precise approaches to preventing and treating cancers, and improving patient outcomes.  Research in the discovery, development and delivery of personalized cancer care through a “Continuous Learning Health System” is an essential part of the solution.

One approach to personalized cancer care began at Moffitt Cancer Center in Tampa, FL more than 10 years ago. The “Total Cancer CareTM” approach places the patient at the center, with the goal of identifying all the needs of a patient and developing a means to meet those needs. The Total Cancer CareTM observational study establishes a partnership with consenting patients that grants the ability to follow them throughout their lifetime by collecting and storing their clinical information, studying their tumor or normal tissue using molecular techniques, and asking for the ability to re-contact them when future novel therapies may be of benefit. The focus is on caring for the patient, not just treating the disease by: 1) creating a system to identify the needs of individual patients; 2) identifying markers that would predict needs and risks so that interventions could become preemptive; 3) identifying molecular signatures for patients who are not likely to respond to standard of care; 4) utilizing clinical characteristics and molecular profiling techniques to match the right patient to the right treatment, at the right time and place; and 5) raising the standard of care for all patients by integrating new technologies in an evidence-based approach to maximize benefits and reduce costs.

Pursuit of these solutions to achieve the cancer care of the future requires the development of a large regional cancer biorepository, in parallel with the development of a data warehouse and information system containing patient clinical and molecular data. It also requires very large patient populations to study and engage.  Although Total Cancer CareTM at Moffitt has grown to over 100K participating patients at 18 clinical sites across the U.S. it must continue to expand the number of patients being followed, in particular as treatments become more targeted. To achieve the goal, the resulting data warehouse must provide views to the same data to serve 4 primary stakeholders: researchers, clinicians, administrators and patients themselves.

The solution to effective, affordable, high quality and patient centered cancer care can only be developed through an evidence-based health system that will identify the best options for patients based on their personal traits and characteristics. And that requires the engagement by many stakeholders to contribute, study and give back the results of a rapid learning system for cancer.