What Really Matters for Cancer Care - Health Systems Strengthening or Technological Innovation?

Modern medicine has long been characterised by a relentless focus on innovation and the expansion of biomedical and scientific boundaries, with cancer at the vanguard. The more recent advent of precision medicine has pushed boundaries even further, with genomic advances allowing us to decipher the innate biology of a cancer and expand the repertoire of targets amenable to systemic therapies. However, this ‘pharmaceuticalisation of cancer care’ risks being highly reductionist in our pursuit of improving outcomes, pivoting research and public sentiment away from the evidence-based reality that early diagnosis as well as high-quality surgery and radiotherapy underpin better cancer outcomes for populations. The new generation of precision cancer medicines, especially immuno-oncology, are expected to contribute to 70% of the total cost of active care by 2025, whereas at the same time nearly 50% of the global population has little or no access to diagnostics or palliative care, and up to 80% have no access to timely, safe and affordable surgery and radiotherapy, let alone basic generic chemotherapy.