Our approach to cancer care is dated and ineffective. Sadly, the results speak for themselves.

Working with cancer patients, oncologists, world-renowned cancer researchers and technology innovators our non-profit research facility created a Precision Medicine Protocol to serve as a framework and guide to help healthcare leaders transition away from failed hit-or-miss, standard-of-care treatment dogma to a more conservative, science-based, look-before-you-leap precision medicine approach to care. Cancer patients need your help to make this a reality.

The Problem

It takes more than 15 years, on average, for a new medical technology or healthcare innovation to enter widespread clinical use. At the same time, medical knowledge doubles every few months, making it nearly impossible for health systems, insurers, and clinicians to keep pace with new information, adopt innovations, and change existing practices. Sadly, as a result, most cancer patients receive less than optimal care.

The situation is compounded by the fact that no two cancers are alike. As world-renowned oncologists and cancer researchers identified more than a decade ago, cancers are like snowflakes: they share similarities, but no two are exactly alike. Despite this variation, our healthcare system continues to rely on outdated organ-based, one-size-fits-all clinical guidelines. These guidelines do not adequately account for the variation among each person's unique cancer. Consequently, they greatly limit the number of treatments considered to organ-specific drugs, delay the time to effective care, increase toxicity and often waste finite resources on high-cost low-clinical-value treatment.

A further challenge for oncologists is that there are 300+ FDA-approved cancer drugs, many that are used in combination. They generate 4.5+ million one-, two-, and three-drug treatment options — far more than any individual can evaluate and assess. To identify the best treatment, oncologists must determine the unique genomic drivers of each patient’s cancer, then match those drivers with the drugs most effective at targeting the specific gene mutations fueling the cancer’s growth. This has been no small task — until recently.

The Solution

For patients, physicians and payers alike, the solution is a move beyond the cancer industrial complex‘s outdated sameness-based standard-of-care (SoC) approach which often results in unremarkable outcomes. We must move to precision medicine, a comprehensive patient-centric approach that recognizes the critical impact of each cancer’s molecular profile. Precision medicine uses genomic information about a cancer’s unique molecular makeup to inform and guide science-based treatment decisions, e.g., make a diagnosis, create a custom patient-specific treatment plan, monitor disease progression and therapy effectiveness.

Evidence that individualized cancer therapy can outperform SoC treatment abounds. Numerous clinical trials and real-world studies of matched, multi-drug regimens show that higher “matching scores” between tumor alterations and chosen drugs correlate with improved response rates, progression free survival, lower severe toxicity and sometimes overall survival vs. the SoC approach. When treatments are selected based on tumor biology, you can often use fewer or lower intensity agents with better benefit–risk balance. And today, we have AI-enabled precision medicine tools that help oncologists select treatments that are likely to be more effective, less toxic and a greater value. Indeed, compared to SoC treatment, precision medicine is a far more conservative look-before-you-leap approach to care — that we must embrace ASAP. To do otherwise would continue to deny patients access to vital genomic testing and the option to try potentially viable FDA-approved cancer drugs and to support more wasteful spending on high-cost, low-clinical-value drugs.

The Challenge

Precision medicine is fundamentally different than SoC cancer treatment. As such, the transition to it will be profound. To date, payer adoption has been slow and difficult ... and cancer patients are paying the price.

Our experience is that cancer patients and their oncologists rarely alter their routines unless change is required ... and that care is often driven by a patient's healthcare coverage. Coverage decisions that deny, delay or disrupt access to care affect the treatment cancer patients receive and the outcomes they experience. Because payers and employer plan sponsors make coverage decisions, the burden is, in great part, on them to be the catalyst for change to genomics-driven precision medicine for cancer patients. That responsibility cannot rest with providers or health systems, which do not control coverage determinations.

By supporting precision medicine, payers promote more effective, individualized cancer care while addressing the quality, cost and value considerations attendant to coverage decisions. To drive this change, health insurers and employer plan sponsors must embrace precision medicine. However, despite its clear advantages, payers and employer plan sponsors have been slow to adopt precision medicine. This hesitation reflects limited awareness, persistent misconceptions, and insufficient or unclear guidance on implementation. Consequently, most payers continue to rely on the stale, pre-genomic era SoC approach to cancer treatment, missing opportunities to improve patient outcomes and contain healthcare costs.

The challenge with advancing the move to precision medicine rests with educating and motivating payers.

How We Are Making A Difference

To address the challenges that impede the effective, efficient, and empathetic delivery of high-quality personalized cancer care, the Research Consortium created a data-driven Precision Medicine Protocol for patients, physicians and payers. Patented on the patient active concept created by cancer advocacy pioneer Dr. Harold Benjamin, the protocol catalyzes patients from passive bystanders into informed, engaged, and empowered shared decisionmakers ... and leverages all of the precision medicine approaches, tools, and technologies available to oncologists today. Illustrated below, the protocol provides a practical framework and guidance for payers to support more effective individualized cancer care.

As noted, it takes some 15 years, on average, for a new medical or healthcare innovation to gain widespread clinical acceptance. In cancer care however, there is broad agreement that we do not have that long to transition to precision medicine ... especially among cancer patients. Recognizing this urgency, several years ago the non-profit Research Consortium embarked upon an initiative to advance the adoption of precision medicine among patients, physicians and payers. Working closely with dozens of cancer patients, academic and community oncologists, world-renowned cancer researchers and med-tech innovators we developed a deep understanding of precision medicine and of how our healthcare system fails most cancer patients.

What we saw and learned was truly disheartening. Most of the physicians we encountered -- and far too many oncologists -- had inadequate functional knowledge of genomics, cancer biology, molecular medicine and related fields. Few oncologists, especially those that practice in community settings, had meaningful real-world experience using genomic information to guide treatment decision making, monitor disease progression or gauge treatment effectiveness. We observed limited awareness among payer medical directors regarding the workings of precision medicine versus standard-of-care approaches to cancer treatment; and most held misconceptions about the FDA new drug approval process, combination drug therapy, and precision medicine and the true cost of not adopting it. We saw many patients receive poor care, and experience gaps in care, as a result of repeated avoidable errors in medical care delivery and care team communications. We observed that employer plan sponsors and their benefits consultants perpetuate poor benefits design and nonsensical administration policies that contribute to inefficient, more costly care and poor outcomes for cancer patients. Clearly, much remains to be done to remedy this situation.

Cancer is consistently the leading cause of high-cost claims in U.S. health insurance and cancer claims continue to increase in frequency, severity and cost. Cancer represents the largest share of large-claim spending and accounts for a disproportionate portion of employer healthcare costs. Yet despite this, controlling costs has proven to be elusive and much of the $150 billion spent on high-cost, low-clinical-value cancer drugs could be avoided with evidence-based controls. This creates a strong motivation for payers and employers to improve care delivery while containing costs. Payers and employer plan sponsors can improve survival and contain costs by prioritizing genomic diagnostics, aligning coverage with biologic rationale, and shifting reimbursement toward value-based models. By funding targeted testing, supporting molecular decision-making infrastructure, and discouraging empiric therapies with poor expected benefit, payers can reduce avoidable utilization, prevent futile care, and enable more durable, personalized treatment strategies.

We Need Your Support

For five decades the principals of the Research Consortium have been at the forefront of change in employer-based healthcare. Indeed, Research Consortium founder Richard Nicholas began working with cancer patients in the 1980s, when we helped develop and fund what is today the world's largest cancer support network -- providing $50+ million in free support services each year to some 700,000 cancer patients from 200 worldwide locations. This experience working with cancer patients, oncologists and payers provides a solid foundation for advancing personalized cancer care, effectively and efficiently. And, as an independent, nonprofit enterprise with no profit motive or vested interest, we serve as a trusted and honest broker. At the 2023 annual meeting of the Society of Professional Benefit Administrators — whose members manage the health plans of tens of millions of Americans — we presented "Equipping Patients, Physicians and Payers to Outsmart Cancer with Game-Changing Technology for Precision Medicine" and aired this video ... which got a standing ovation.

Payers must be the catalysts for change in cancer treatment. In this next phase of our initiative, we will focus on introducing payers and employer / union plan sponsors to our Precision Medicine Protocol and supporting them as they implement it. This work will include the following components:

• Education: Providing an educational overview of precision medicine and how it differs from the SoC.

• Clarifying Misconceptions: Addressing misconceptions about precision medicine, its effectiveness and cost.

• Reviewing Coverage: Revisiting cancer-related coverage policies, procedures, and benefit designs.

• Introducing Technology: Presenting precision medicine technologies to improve care and contain costs.

• Evidencing Clinical Utility: Demonstrating how genomic testing and precision medicine will improve care.

• Reducing Waste: Demonstrating how to reduce wasteful spending on high-cost, low-clinical-value drugs.

Your support will enable the Research Consortium to continue its important work with health insurers, plan administrators and employer / union health plan sponsors to advance personalized cancer care on an expedited timetable. Please support our work by giving generously. Cancer patients everywhere will be glad that you did.

About The Research Consortium

Established at the behest of healthcare industry veterans, the TPA NETWORK Research Consortium is a non-profit, industry-wide healthcare research initiative that helps providers evaluate and assess new medical technologies, plan participants obtain leading-edge healthcare, scientists advance medical research, and payers reduce their risk … by conducting payer-focused translational research, in real-world settings.

Advancing Personalized Cancer Care

Helping to Drive the Transition to Precision Medicine ... for Cancer Patients

Team Members