Digital technology is poised to change healthcare. The field of oncology has been hailed by many as ripe for disruption. In this webinar, our HealthXL Digital Health in Oncology Advisory Board came together as a panel to discuss the future of cancer care. The panel, comprising Ethan Basch (Chief of Oncology, University of North Carolina), Andrew Norden (Chief Medical Officer, OncoHealth) and Lynda Chin (Founder and CEO, Apricity) explored key challenges that lie ahead for this specialty and developments they anticipate to take place over the next 10-15 years as we collectively navigate a path towards a unified, digitally enabled healthcare system. 

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Promising technologies poised to revolutionise oncology in the next 10-15 years

Remote patient monitoring (RPM) technologies present an abundance of opportunities to transform oncology, including in the areas of care coordination, decentralised clinical trials, and home-based chemotherapy. As healthcare leans towards a more personalised approach, the future trajectory of care delivery is fundamentally linked to technologies that enable medical professionals to 'meet patients where they are'. Over the next 10-15 years, other innovative technologies such as genomic sequencing and blood-based diagnostics are also set to redefine the landscape of oncology. 

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AI/ML technologies: Potential powerhouses that need to mature for cancer care delivery

Although Artificial Intelligence (AI) and Machine Learning (ML) promise a wealth of opportunities for oncology, the panellists felt that these technologies, at present, are more relevant to R&D activity than direct care delivery. The use of AI/ML systems to make clinical decision support recommendations, although promising, is still not ready for ‘primetime’. However, one promising avenue is generative AI, which holds great potential to improve communication in cancer care. By tackling common challenges such as timing, cultural sensitivity, and education levels, generative AI could significantly improve the patient-practitioner communication.

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Implementation, not innovation, is the main hurdle for ePRO technology in oncology

Electronic Patient-Reported Outcomes (ePRO) have shown proven benefits in oncology care, yet their implementation remains a significant obstacle. A key barrier is ensuring a skilled, sensitive workforce is at hand to address patient concerns when implementing ePRO systems.  There needs to be the right person at the other end of the phone when an ePRO system is implemented, with the right skillset, such as cultural sensitivity, medical expertise and so forth. A mismatch between technology vendors and clinical operations can further hinder successful deployment, as vendors tend not to control the ground-level clinical operations, which can hinder implementation. Furthermore, a lack of flexibility in tailoring these technologies to fit into existing clinical workflows exacerbates the challenge. 

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Scalability requires cross-sector collaboration between stakeholders

Infrastructure is another barrier that needs to be addressed. Solutions need to be scalable, which is difficult to achieve currently. This lack of scalability poses a significant barrier to the wide implementation of technological solutions in oncology. To address this, industry stakeholders need to collaborate and strategise on how to fund proven technologies at scale. Currently, there is a disconnect between incentives for digital technologies, such as ePROs, and those for traditional therapies. For example, while ePROs are much cheaper to implement than starting patients on treatments like immunotherapy, reimbursement incentives exist for immunotherapies which don’t exist for ePROs. As a result, ePROs and similar digital health tools lack the financial incentives that could drive widespread adoption. 

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Emerging innovative business models bring hope for the future of cancer care

New business models are emerging that bring optimism for the future of technology integration in oncology. For example, the American Society of Clinical Oncology (ASCO) have invested in an initiative, APC4, that brings together oncology practices, overseen by ASCO. This initiative is designed to encourage the implementation of a wide range of technologies, including remote monitoring, patient navigation, and decentralised clinical trial technology into practices. Alongside this, the Centers for Medicare & Medicaid Services (CMS) in the US have introduced a new voluntary payment model, the ‘enhancing oncology model’, which is set to launch this summer (2023). This model includes mandatory care enhancements, including the implementation of ePROs. 

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Visions for cancer care in 2040 

The expert panel’s vision for cancer care in 2040 included the creation of a ‘learning health system’. This system would seamlessly integrate everyday care with research and development activities, with the help of technology. Many tools to enable this already exist today, but by 2040, the hope is that they are widely available, potentially through increased governmental support. The panel also envisages a future where the patient experience is greatly improved, through a combination of technological and human advancements, and cancer patients would have immediate access to their care teams and necessary resources, with the ability to have their questions answered promptly. 

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