The growing complexity of cancer care has created an unprecedented challenge for community oncologists, who lack adequate decision support systems despite treating the vast majority of cancer patients in the United States. This systemic gap threatens to impact patient care quality and highlights the urgent need for innovative solutions.
Dr. Maurie Markman, president of medicine & science at City of Hope Atlanta, Chicago, and Phoenix, points to a fundamental disconnect between academic oncology and community practice. "Approximately 85% to 90% of patients with cancer in the United States are taken care of in the community," he explains. "Where is the organized decision support for the community oncologists who are always and only trying to do their best for their patients in this increasingly complex arena?"
The Limitations of Current Support Systems
The existing framework of treatment pathways provides limited utility, particularly beyond first- and second-line treatments. Community oncologists face multiple challenges:
- Managing multiple cancer types simultaneously
- Limited consultation time (15-20 minutes per patient)
- Rapidly evolving treatment landscapes
- Complex insurance requirements
- Managing chronic cancer cases
"If you're taking care of [patients with] multiple diseases, and the patients come to you and say, 'What about this? What about that? What is optimal therapy?' If you're going from one patient to the next, maybe [you can afford] a 15-minute visit," Dr. Markman notes, highlighting the time constraints that compound the decision-making challenge.
Clinical Trial Limitations and Real-World Practice
Current clinical trials, while crucial for drug approval, often fail to reflect real-world patient populations. Key issues include:
- Underrepresentation of elderly patients and those with comorbidities
- Focus on regulatory approval rather than clinical practice guidance
- Limited guidance for sequential therapy decisions
- Insufficient data on cancer as a chronic illness
Potential Solutions and Future Directions
Dr. Markman advocates for a comprehensive approach to address these challenges:
- Development of AI-assisted decision support tools
- Enhanced real-world data sharing systems
- Creation of robust treatment pathways that account for disease chronicity
- Greater involvement from national organizations like the NIH and NCI
"Maybe artificial intelligence can be a partner here. Maybe real-world data that we get from databases, if we shared, can answer these questions for the doctor who is not an expert in the field," suggests Dr. Markman.
Financial and Practical Barriers
A significant obstacle to implementing comprehensive decision support tools is the lack of financial incentives. Questions remain about who will fund, maintain, and update these systems. The challenge extends to ensuring daily updates as new research emerges and treatments evolve.
The situation demands immediate attention from the oncology community and healthcare stakeholders. Without adequate decision support, community oncologists will continue to face mounting challenges in delivering optimal care in an increasingly complex treatment landscape.
