Fred Ashbury, PhD, MACE, Keith Thompson, MD, FASCO, Casey Williams, PharmD, Kirstin Williams, CNP, PHD
One of the most pressing and perplexing issues affecting healthcare today is how to facilitate the efficient and effective transfer of clinically relevant knowledge and technologies from discovery and subsequent demonstration of their value to routine medical practice. The timeframe from scientific discovery and validation to routine clinical application is often lengthy, which often manifests as sporadic penetration into community settings. To respond to the urgent need, faster adoption of new knowledge and technologies by cancer practices will require fresh thinking. Otherwise, experience has assured the loss of countless lives, unnecessary morbidity, and trillions of dollars of wasted resources.
At the individual patient level, there are psychological, cultural, social, and financial costs. For practitioners, a few of the challenges include the professional and personal costs of keeping pace with the constant stream of new information, longer working hours, identification of side effects and management of patients receiving novel therapies, and regulatory changes. There are also societal costs, including increased financial burden on families and other support systems for patients, the skyrocketing costs of novel therapeutics, absence of qualified workers due to the premature death of cancer patients or withdrawal from the workforce to receive complex treatments over long periods of time, and the amplified burden on the already stressed clinical and technological resources.
Barriers to Diffusion of Genomic Science into Routine Cancer Practice
There are several barriers that will need to be addressed if we are to facilitate cancer genomics as part of routine practice. Some of the barriers are at the individual level, while others are at the institution and societal levels.
It is important to acknowledge the key challenges:
Limited knowledge of cancer genomics by many clinicians Genomics and precision oncology is relatively new for practitioners and it is constantly evolving. It is difficult for clinicians to keep up and manage the complexities of new research, tests and novel therapies available to their patient, on top of their existing responsibilities and practice.
Need for innovative technological solutions A.I. solutions can be leverage and help bridge the resource gap to facilitate a providers’ decision to refer patients for molecular testing, to receive and process discrete sequencing results in real-time, to identify options for treatment decision making, and to drive effective monitoring, assessments, treatment and side-effect management.
Consequences for adopting the innovation In thinking about the competition between guidelines and personalized medicine, it is reasonable to question which path should betaken, what are the circumstances of adopting innovation and what the outcome will be.
Length of tenure in practice The longer a person is in practice, the greater potential for the clinician to become entrenched in existing behaviors, proving to be a challenge to replace with new behaviors.
Limited knowledge of cancer genomics by many clinicians As new targeted therapies are approved almost daily, it is extremely difficult to keep up with science. The lack of experience, in how to administer, dose, monitor and assess performance of the treatment and how to manage side effects of precision oncology is a barrier for clinicians.
Competition in the "knowledge" base The production and dissemination of knowledge and clinical practice guidelines in cancer (and other diseases) has escalated substantially over recent years. The increase in knowledge is difficult for individuals to assimilate and this is amplified with innovations such as genomics.
Lack of integration with community health resources Genomics and precision oncology is relatively new for practitioners and it is constantly evolving. It is difficult for clinicians to keep up and manage the complexities of new research, tests and novel therapies available to their patient, on top of their existing responsibilities and practice.
Individual clinician personality So much of adoption depends on an individual’s personality and whether they prefer to be innovators or are risk-averse and adopt and implement at the rate of their peers.