What's the future of cancer care?
Interview with
The sobering statistic is that roughly one in every two of us will have a brush with cancer at some point in our lives, and as the world population continues to grow, and the population ages, the burden of malignant disease is destined to inflate significantly. At the moment, with a few exceptions where there are screening programmes for conditions like breast cancer, we operate chiefly a reactive response to the disease: when we pick it up, we then launch into a - usually very expensive - programme of treatment that can have variable outcomes. This, as Oxford University oncologist Andrew Bassim Hassan argues to Chris Smith, needs to change. We need to become much better at preventing and picking up cancer in the first place, and we need to do it by embracing new technology and data tools. Expensive, yes, but, he suggests, probably not much more so than the money we already spend reactively at the end of someone's life. So why not bite the bullet and front-load the equation, aiming to keep people healthier for longer...
Andrew - We have an increasing global population and an increasing age of that global population. That immediately converts into an increased incidence and prevalence of cancer across the globe. Different cancers, different subtypes of the same cancer in different people with different physical and genetic makeup.
Chris - So if one looks at lists like those that the WHO publish of morbidity and mortality around the world, where on that list does cancer sit as a cause of loss of life globally?
Andrew - It's not the highest. The highest is mainly infectious diseases, but cancer is one of those key elements along with cardiovascular disease that is increasing steadily and is quite a significant disease burden worldwide.
Chris - And what opportunities in this era now present themselves to us, given what you've just said in terms of how we might be able to make inroads against what we foresee to possibly be at the top of that list in the future?
Andrew - We've got to think about cancer from all different perspectives. From a preventative perspective, screening and intensively monitoring people who may be at high risk of developing a cancer in order to try and catch the cancers early on in the disease process offers up the best opportunity for cure and long-term survival. If we rely on a strategy that starts to intervene with cancer very much late in its process where it may have already spread to other sites in the body, we may be pouring a huge amount of effort and resources into a problem that we're already realising is very difficult to solve. And that latter strategy is very expensive.
Chris - If I were the health minister and I came to you and said, right, I want to make cancer a priority and I want to take away a lot of the barriers that confront you at the moment to delivering really exceptional cancer care and affecting cures in as many cases as we can, but control in the rest, what would be on that list then of things that you would be saying to me, 'I need to surmount the following problems, or I need resourcing of the following areas to do that?'
Andrew - The current UK government have probably got it right in that the emphasis does need to move to early diagnosis and prevention. I would want a screening system that incorporates the modern technologies such as genome sequencing, both of the person as well as the DNA that has emerged in the cancer. That information, integrated with the healthcare record scans, imaging, all of that needs to be brought right forward into the pathway. Through that strategy, we will have a better chance of intervening earlier with new technologies that are also emerging, such as cancer vaccines, in order to prevent patients progressing all the way down to the spread of the disease. Now to do that, you've got to move to a new model. How you do that will require a step change of investment in order to get it working. That includes data, how you connect all that information together, and how you make sure that's protected, analysed properly, and the right decisions made from that information.
Chris - A lot of this hinges on a personalised approach to this, doesn't it, especially where the DNA aspects are concerned. But this is very expensive. Screening people in this way, having people who are really good at interpreting the results of those screens, admittedly AI can help us a bit there and help to weed out some cases, but this is very, very expensive. How do you see us dealing with the economics of all of this, because the world population is going up not down and, as you say, it's an ageing population where this is going to become more common, not less.
Andrew - Well, the first thing to cover is that we spend the majority of our healthcare budget, be that for cancer or anything else, in the last six months of life. We try and stem a disease process that's taken years to develop and we are finding it very difficult to overcome that, to reverse that. In fact, some people would say it's impossible to reverse some of those. So I think we need to think differently and move the money around. I think it exists within the system. That's the first thing to say. The second thing to say is that the costs of some of these tests have dramatically fallen. To sequence your whole genome now costs about £300. That's the cost of a mobile phone or a flight to Paris. If we think in those terms, and we start to think about the scale of cancer, maybe up to 50% of us in our lifetime, then you can get the sort of feel that in fact the cost benefit equation looks actually really good. It's because the cost of these tech developments have dramatically fallen. I think the economic argument is very strong. I think this is actually a cost effective solution. This is actually going to save money if we play this correctly.
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