Press release: IHE researchers co-author international expert report on precision oncology in The Lancet Oncology

Precision oncology is creating new opportunities for cancer diagnosis and treatment, but its development also brings major clinical, economic and organisational challenges. A new international expert report, Accelerating equitable cancer genomics and precision oncology in health care and research: A Lancet Oncology Commission, published in The Lancet Oncology, presents comprehensive recommendations for implementing precision oncology in a more evidence-based, equitable and sustainable way. IHE’s Thomas Hofmarcher and Oskar Frisell contributed health-economic expertise on costs, resource use and the implementation of precision medicine.

One of the key differences between traditional cancer care and precision oncology is the amount of information available to guide patient diagnosis, treatment and follow-up. The benefits of precision oncology vary across cancer types, biomarkers and treatments. For some patients, molecular diagnostics may be crucial in determining the choice of treatment, the decision not to treat, or the need for more intensive follow-up. For others, the benefits remain more uncertain.

“Global disparities are also substantial. Many patients, particularly in low- and middle-income countries, lack access to biomarker testing and biomarker-guided treatments. Limited diagnostic capacity, expertise, funding and access to medicines risk further widening disparities globally, regionally and nationally,” says Thomas Hofmarcher, Research Director at IHE.

The entire patient journey needs to be considered as an integrated pathway

The report therefore highlights the need to consider precision oncology within the context of the healthcare system as a whole. This is a challenge directly relevant to the Swedish healthcare system, where individual interventions are often assessed separately, both clinically and from a resource perspective. To enable well-informed decisions about resource use and prioritisation, while maximising benefits for patients, the entire patient journey – from sampling and diagnostics to clinical interpretation, potential targeted treatment and completion of treatment – needs to be considered as an integrated pathway.

Oskar Frisell comments:

“One challenge is that precision oncology does not currently always lead directly to changes in treatment regimens or care pathways. In many cases, existing methods work at least as well. We are still at an early stage of development and, in several areas, lack both the evidence and the treatments required to justify widespread implementation.

“However, this type of advanced cancer care can be viewed as an investment in the future. By collecting data from genomic diagnostics and outcomes from advanced targeted therapies, we can improve the prospects for future cancer patients. This is where much of the value lies at present: in the learning healthcare system. But developing cancer care in this way requires resources that enable both access to treatments and responsible data collection. In the short term, there may therefore be a case for greater central government responsibility for funding.”

Oskar adds:

“This is not a call for the government and taxpayers to accept higher prices for medicines and diagnostics. Rather, we need to ensure that appropriate infrastructure is in place so that we can capitalise on the value being created.”

Swedish infrastructure for precision medicine

One example of such infrastructure is PROMISE, a Swedish national initiative that aims to integrate large-scale multi-omics research data with healthcare data to advance precision medicine. By leveraging Sweden’s integrated healthcare system, the initiative aims to enable earlier diagnosis and more personalised treatment.

The Swedish National Board of Health and Welfare has also received several government assignments aimed at supporting the equitable implementation of precision health in Swedish healthcare. These include support for the FOCU.SE study, a new national coordination structure, and Sweden’s centres for precision medicine and genomic medicine. The aim is to build expertise, infrastructure and collaboration between regions so that precision diagnostics and treatments become accessible throughout the country.

More information and link to the report