The Biggest Challenge in Oncology Today is…

I just returned from the 2023 American Society of Clinical Oncology (ASCO) annual meeting, which I attended with 36,000 of my closest oncology friends. The meeting offered exciting science and meaningful clinical insights. What we understand about the biology and treatment of cancer is progressing at breakneck speed. It’s an exciting time to be in oncology.

But, of course, challenges still exist. New insights create new problems. Thinking about this made me curious about what ASCO attendees think are the biggest challenges they face in oncology today. So, I conducted a spontaneous, small market research project. I captured responses to a single question – “What do you believe is the biggest challenge in oncology today?”

I spoke to 82 attendees, a mix of clinicians, researchers, and other oncology-related professionals. I did my best to get a representative sample – 52 were from the US and 30 were ex-US attendees. Historically, US attendees were roughly 61% of the total, so this mix was consistent. The gender split was equal – 41 males and 41 females. I did not probe on age, but I tried to engage folks who seemed to represent the overall age demographic at the meeting. I also did not ask about professional setting (i.e. academic/ university versus community). Only two people turned me down; most folks appreciated being asked and were happy to share their thoughts.

Initial reactions were generally rather wide-eyed. I admit the scope of the question is broad, but I wanted respondents to think about the question at a high level and not answer through the narrow prism of their own specific needs. Most respondents were thoughtful and took time to craft a well-reasoned answer. Several clear themes emerged; I did my best to consolidate responses and describe high level themes that reflected the respondents’ views.

So, what did we learn? Here is a summary of the biggest challenges mentioned.

Globally – Personalized Medicine/Precision Oncology
More than 1 in 5 respondents mentioned this as the biggest challenge. As one respondent put it, “it’s getting the right medicine to the right patient at the right time.” With all the success and advancement in treatment modalities, if the new treatments don’t get to the patients that need them, they offer little meaningful value. A potential solution implies leveraging evolving technologies aggressively. Precision oncology uses new diagnostic approaches, biomarkers, and genetic testing to define the specific nature of both the disease AND the patient more clearly. This challenge acknowledges patient uniqueness and recognizes that beyond indications and guidelines, patients are (or should be) treated one individual at a time.

US – Information Overload
US attendees identified two challenges as biggest (the number of mentions for each differed only by 1). One was Personalized Medicine/Precision Oncology consistent with responses as a whole. In addition, US respondents mentioned information overload as the major challenge. One respondent used the term “cognitive burden,” a phrase I feel elegantly captures the issue. Advancement in oncology is evolving at a torrid pace. The number of new agents, additional indications, and new combinations represent a huge amount of information that needs to be absorbed and then applied. New mutations are being identified daily. The growing list of mutations is further highlighting the disease complexity that is being uncovered. How do oncologists keep track of all the information? How are they educated on an ongoing basis as this complexity grows? How do patients begin to understand the level of complexity? US attendees believe that keeping up with the constantly evolving information flow and then understanding how to apply it to patient treatment is the major challenge. Interestingly, this response is US-centric possibly because US clinicians have the greatest potential access to the new treatments.

Ex-US – Patient Access
Attendees from outside the US mentioned patient access as their biggest challenge. While ex-US attendees did include many from developed countries (the UK, EU, Australia, Japan), I also spoke with many from developing countries (eastern Europe, Africa, central Asia). In the developing world, attendees wish patients could access even the simplest therapies; the latest generation of therapies is virtually unavailable even in academic centers. Patients with financial resources usually travel to developed countries to access the latest therapeutic options. However, even in the developed ex-US world, there is limited access to socio-economically disadvantaged communities. (The same could be said for the US as well). Access to the “latest and greatest” therapies is often viewed as a luxury limited to the developed world.

Gender – Responses seemed different
Interestingly, male and female attendees differed in what they felt was the biggest challenge. For males, information overload was the biggest challenge. For females, it was personalized medicine/precision oncology. Does this mean that males tend to be more data centric while females tend to be more patient centric? We know that gender does impact how individuals approach illness and wellness. While this is certainly not a conclusion we can draw from this study, it is an intriguing perspective into how each gender might approach how they think about the challenges they face.

There were several other broad categories that were mentioned by respondents – fiscal pressures, clinical trial issues, specific clinical improvements, and less time to move results from clinical trials to clinical practice. All of these add a richness to the nuance of the question: What is the biggest challenge in oncology today? Obviously, there is no single right or wrong answer.

As the oncology space continues to evolve, new challenges continue to emerge. At least for now (ASCO 2023) it seems that finding ways to personalize oncology treatment using more precise tools and incorporating the rapidly expanding knowledge base in a meaningful and productive way are the biggest challenges.
This is the first in a series of articles about The Biggest Challenges in Oncology from ASCO 2023.