What will cancer care look like in the future?

Karol Sikora
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This year over a third of a million Britons will be told they have cancer. While that might sound like an alarming statistic, one and a half million people are currently living with the disease, successfully managing their symptoms. And due to the remarkable advances in treatments, by 2030 this number will soar to over three million.

There’s been an explosion in our molecular understanding of how our own cells become subverted to grow and divide abnormally to become malignant. Based on this knowledge, we’re now poised to see some incredible advances in prevention, detection and treatment. Cancer will become a chronic illness, joining conditions such as diabetes and heart disease. While these conditions affect how people live, they don’t inexorably lead to death. Long-term survival will be normal even for patients with cancers that have spread from their primary site. The political importance of cancer is huge, as voters perceive it as the most pertinent issue in health today.

Dramatic progress is likely in surgery, radiotherapy, chemotherapy and immunotherapy leading to increased cure – but at a price. The cost of many cancer drugs now exceeds £100,000 per year. The completion of the human genome project, and the dramatic lowering of the cost of whole genome sequencing of an individual, has brought the prospect of sophisticated genetic risk assessment requiring careful integration into screening programmes. And excellent palliative care to relieve pain and suffering at the end of life must be a basic right. Yet its availability is often still patchy even in well-funded healthcare systems. The next twenty years will undoubtedly be a time of unprecedented innovation, but personalisation is the key.

The political importance of cancer is huge, as voters perceive it as the most pertinent issue in health today

It will also be a time of great social change driven by access to information. People are no longer passive recipients of care but active, empowered partners. Healthcare is fast becoming a consumer good – available on demand to those who have the resources. Even now, 75% of the world’s cancer drugs are sold in the United States, home to less than 5% of our population. But all healthcare systems are struggling to keep up with the burden of aging populations, novel technology and a much better informed and demanding public.

Age is the biggest driver of a cancer incidence. At the same time new technology in many areas of medicine is bringing improvements to the quality and length of life. Major innovations in many areas are likely to have the greatest impact on cancer. Biosensors to detect early disease, genetic prediction of cancer risk, robotics and nanotechnology together with patient-empowered diagnostics and high-cost molecular-targeted therapies will all need to be anticipated in the future configuration of cancer care.

Living long and dying fast will become the mantra of 21st century medicine

Global providers will emerge to deliver optimal care tailored to local geographical and economic environments. Huge datasets will be continuously analysed by powerful computers to see previously hidden patterns, creating a new world of knowledge through artificial intelligence. The future landscape of cancer service delivery will be very different – fast-paced, competitive, consumer-focused, internet-aware and driven by much more real-patient involvement.

The ability of technology to improve cancer care is assured. But this will come at a price – the direct costs of providing it and the costs of looking after the increasingly elderly population it will produce. We will eventually simply run out of things to die from. New ethical and moral dilemmas will arise as we seek the holy grail of compressed morbidity. Living long and dying fast will become the mantra of 21st century medicine. Our cancer future will emerge from the interaction of four factors: the success of new technology, society’s willingness to pay, future healthcare delivery systems and the financial mechanisms that underpin them.