The Future of Cancer Care:
Moving from Promise to Reality

Snapshot...
from the future
On June 11, 2048, a few months after her 45th birthday, Victoria Anderson ismeeting with her Multidisciplinary Cancer Care Team (MCCT) at the local
cancer center. Following her annual physical, circulating tumor cells indicativeof early stage breast cancer were found in Vicky’s blood. A follow-up liquidbiopsy confirms the diagnosis. Vicky’s primary care doctor, who is linked with
the MCCT, has referred her to the cancer center and is present at the meetingas the primary care member of Vicky’s team.
The MCCT leader, a cancer specialist, explains to Vicky that she has Stage I
breast cancer. While this news is serious and should not be taken lightly, thegood news, as the doctor explains, is that in 2048, the prognosis for early stage
breast cancer is very positive. With current treatment options, standardized
protocols and integrated care management, disease-free survival for earlystage breast cancer patients averages 96% at five years, 92% at 10 years
and 91% after 20 years. In other words, with proper care provided by an
integrated, multidisciplinary team, the chances are very good that Vicky will
not only survive but will be cancer-free over the long term.
During her visit with the MCCT, thanks to the benefit of artificial intelligence (AI)and access to enormous volumes of data on treatment outcomes in early stage
breast cancer, Vicky is provided with a personalized treatment plan. Her plan
includes an algorithm showing all of the possible treatment options her careteam will consider. Among these options are radiation therapy, combination
immunotherapy, robotic surgery, microwave ablation, and emerging treatments
such as nanoparticle therapy. Vicky’s treatment plan will be adjusted in realtime based on companion diagnostics and treatment response assessments
through imaging during treatment. The MCCT will also connect Vicky with thecancer center’s cancer survivorship and healthy lifestyles teams so she can learn
about lifestyle factors that may affect breast cancer survivors and make anynecessary lifestyle adjustments. Last but not least, Vicky schedules followup visits with her care team and is provided with the appropriate contact
information for team members in case of any questions or concerns.
With all of her available treatment options clearly understood, a personalized
treatment plan provided with follow-up visits scheduled, and a clear understandingof what she can expect from her care team, Vicky leaves her visit feeling like anactive member of the MCCT for her cancer treatment. She feels involved in
all aspects of her care, and very confident that she will be able to overcome
her cancer and move forward to live a happy and healthy life. In other words,
while Vicky is concerned, she is confident
that with the help of her team, she will
Achieving this vision of a world without fear of
get through this and enjoy the rest ofcancer within the next 30 years may sound likeher life. She is not afraid.
science fiction to some. Cancer remains one ofthe deadliest and most difficult to treat diseases
in the world. However, with many of the advances
being made today, it is entirely possible for thisvision to become reality by 2048.

Where are we in 2018?
Rising global incidence andfragmented cancer care
Cancer is currently one of the biggest global
health challenges we face. It is the second
leading cause of death worldwide. Globally,
one out of every six deaths are due to cancer.
An estimated 9 million people died from cancer
worldwide in 2015.1 Against this backdrop ofdaunting figures and global challenges, there aretoday more reasons to be hopeful for the futureof cancer care than ever before. Over the next
30 years, some experts predict that it is entirely
possible that cancer can become a manageable,
chronic disease, similar to diabetes, so that acancer diagnosis will no longer hold the fear thatit does today. Advances in global networking,cloud computing and digital communications areenabling greater connectivity between centersof excellence in cancer care and populations inneed throughout the world. New discoveries andmethodologies in diagnostics, genomics, precision
medicine, immunotherapy, artificial intelligence,robotic surgery, radiotherapy and data analytics
are being introduced every year. Over the next
30 years, these new technologies and treatment
approaches will be used synergistically to createa world where surviving cancer is much morecommonplace. By harnessing these and otheremerging treatments and technologies, we could
see a future in cancer care where a number oftumor types can be effectively managed andeven eradicated.2,3

By harnessing... emerging
treatments and technologies,
we could see a future incancer care where a numberof tumor types can beeffectively managed andeven eradicated.

Achieving a better future
for cancer patients:
the challenges that lie ahead
From fragmented care tointegrated care
One big challenge to achieving the vision of aworld without fear of cancer over the next 30 years
will be moving beyond the current fragmented
cancer care landscape toward a more integrated
approach to cancer care. Helping to remove“silos” between cancer specialists, primary care
physicians, affiliated healthcare providers andpatients is a major challenge that we currently
face. Providing integrated, multidisciplinary cancer
care teams, where cancer patients become active
participants in sharing information and making
treatment decisions, is necessary to move cancer
care forward.4 Ensuring connectivity between
academic institutions, cancer treatment centers,
community oncology practices and primary careproviders is key. Empowering physicians to spend
more of their time treating patients and less time
wrestling with technology is an important mutual
goal for physicians and for technology solutions
providers. And giving patients tools that allow
them to become more active and engaged
members of the cancer care team is critical to
improving outcomes.

Increasing demands on medical
professionals
Rapid, exponential progress in available technology,
data analytics and cancer treatment approaches
over the next 30 years will demand significant
changes in the skill sets that physicians are going toneed to enter their profession. New competencies
will be needed. This will require changes in medical
education, training and certifications for physiciansand other healthcare professionals specializing incancer care.

Earlier detection, diagnosis andlocalized treatment approaches
Diagnosing cancer earlier will significantly improvethe chances of successful treatment outcomes.
With earlier diagnosis, more cancers will betargeted and treated locally (at the tumor site)rather than systemically. In these cases, patientsdiagnosed with early stage disease may not needsystemic treatments such as chemotherapy.
Less reliance on systemic chemotherapy cansignificantly reduce treatment side effects.
The potential impact earlier diagnosis will
have on treatment outcomes and survival
will be transformative. Artificial intelligenceand machine learning have both been shown
to improve the early detection of cancer bymore accurately identifying at-risk patients,
improving diagnostic test sensitivity andspecificity, accelerating our ability to screen
and risk-stratify patient populations, improving
treatment planning and predicting treatment
outcomes.5,6 Blood tests used as “liquid biopsies”
to identify circulating tumor cells will also enableearlier detection, diagnosis and treatment ofcancer, and these technologies are currently
in development. In addition to advances inavailable drugs and biologics to treat cancer,
other treatment modalities including intensity
modulated x-ray and proton therapy (IMRT and
IMPT), stereotactic radiosurgery (SRS), androbotic surgery will become increasingly more
precise. Coupled with the ability to diagnose
cancer earlier and while the disease is still
localized, these technologies will be used more
frequently with curative intent for specific typesof cancer. All of these advancements holdthe potential of delivering better treatment
outcomes and improve both convenience andquality of life for millions of cancer patients.

Harnessing the power of genomics
An accelerated understanding of the complex
molecular basis of cancer is leading towardpanomics, which combines genomics, proteomics,
metabolomics and more. Panomics offers an
expanded framework for learning about thecomplex networks of molecular pathways andcharacteristics of the tumor microenvironment. A
more sophisticated understanding of the factors

The potential impact
earlier diagnosis will haveon treatment outcomesand survival will betransformative.

that drive cancer is significantly increasing thenumber of available targets and allowing for far
greater precision in attacking those targets.2

Transforming data into decision
support tools
Over the past decade we have also witnessed an
explosion in Big Data, particularly in our ability
to collect and analyze vast amounts of data
points. There is great focus within governments,
industry and academia on improving our ability
to synthesize all of this data and leverage it into
actionable intelligence. Our success in doing
this will determine the degree to which we cantransform cancer care over the next 30 years.
The four “Vs” of Big Data:(volume, velocity, variety
and veracity) illustrate the ways in which big data
is expanding to meet the needs of cancer care, andthe challenges inherent in effectively managing
and ensuring the quality and accuracy of thisdata so that it delivers meaningful outcomes tocancer patients. Volume refers to the incredible
amounts of data now being generated. Velocity
is the rapid speed at which data is accumulating.
Variety is the proliferation of different data sets
and the wide range of formats, practice settings,
specialties and disease states for which thesedata sets are being created. Standardizing thesemany different data sets so that together they
provide meaningful, actionable informationthat drives treatment is key. And with so muchdata being generated at an increasingly rapid
rate and for so many different treatment
settings and disease states, the veracity of thisdata—whether it is accurate and error-free—isextremely important as healthcare practitioners
and patients come to rely on it more and more.8

Having large volumes of data is one thing.
Turning that data into useful decision support
tools for physicians and patients is a major
challenge where a significant amount of work
remains to be done. This will require greater
standardization of data sets and electronic
health records (EHRs) between governments,
large institutions and private practices. It will
require better integration between databases
including ASCO’s CancerLinQ® the Surveillance,
Epidemiology and End Results (SEER) databasein the United States, the World HealthOrganization’s Global Cancer Observatory (GCO)
and the EU’s European Cancer Information
System (ECIS) internationally. And it will require
the improved utilization of treatment guidelines.
Last but not least, it will require significant
improvements in the ability to track, analyze
and use patient reported outcomes to change
research and treatment protocols in real time. Allof this will need to be done in ways that adhere
to national and international data privacy laws
and regulations and respect the confidentiality of
individual cancer patients throughout the world.

Tapping the potential of
immunotherapy
Since 2010, when the first randomized clinical
trial of ipilimumab was published, it has become
clear that targeted immunotherapy—treatmentsthat trigger the body’s immune system to fightcancer— has the potential to control or even
eradicate certain types of cancer. While there aredifferent approaches, and some are in early phasesof development, immunotherapy in general holds
enormous promise for several disease processes.
In the past five years, the increased availabilityof approved and investigational targeted
immunotherapy drugs has led to more interestin the potential of combining immunotherapy
treatments with other treatment modalities (e.g.
radiotherapy) for certain types of cancer. The
results of these combination studies have beenencouraging so far, but many researchers believethat we are just starting to scratch the surface.9

There are still major challenges to be overcome
in order for immunotherapy to deliver on its earlypromise. These include patient selection for aparticular treatment based on tumor biomarkers,
effectively managing toxicities, identifying ideal
combinations of immunotherapy and othertherapies for specific tumor types, and managing
treatment costs.

Tackling clinical research andtreatment costs
In 2016, The Tufts Center for the Study of Drug
Development estimated the total cost to bring a
new drug to market to be $2.8 billion and rising.10
With cancer incidence and mortality continuing
to rise in developing countries, cost effectivenessmust become the guiding principle in cancer
treatment and clinical research. This is an area
where data analytics, AI and machine learning canhave an enormous impact by reducing the timerequired to complete clinical trials and improving
the quality and utility of the data generated
from those trials. In addition to promising new
drugs and biologics to treat specific tumor types,
new cancer treatment technologies in imaging,radiotherapy, robotic surgery and stereotactic
surgery are adding to the range of treatment
options available to cancer specialists. Overthe next 30 years, to successfully address thechallenges of managing cost effectiveness andimproved access to promising new treatments,
partnerships between industry, governments,
academic institutions and patient advocacy
groups will be critical.

Varian’s role in helping tocreate the future of cancer care
Varian is a global leader in developing and delivering multidisciplinary, integrated
cancer care solutions. Our focus is on creating a world without fear of cancer.
At Varian, our strategy is to put the patient and provider at the center of
our thinking and create an ecosystem with three evolving pillars: intelligent
treatment delivery through effective decision support tools, knowledge-based
medicine (bringing knowledge to the point of care) and analytics—obtaining
actionable insights from aggregated data. Varian pursues its patient centeredstrategy by equipping the world with new tools to fight cancer and solutions
that solve the problems of fragmented care defining the cancer care landscapeof today.
Varian’s advances in intensity modulated x-ray and proton radiation therapy,
stereotactic radiosurgery, and robotic surgery are helping to redefine ‘stateof the art’ in cancer care today. Our practice integration software systems
and solutions enable leading cancer treatment centers, academic research
institutions and community oncology practices throughout the world to provide
integrated, multidisciplinary care with the patient as an active member of theircare team. Varian’s work in building an ecosystem of cost-effective products
and services designed to help solve thebiggest problems facing the global
cancer community gives us hope
At Varian, we believe our unique focus on productsthat our solutions can impact every
and services that span the cancer care continuum
cancer patient in need, regardless ofplaces us in an ideal position to be an integrated
where they are in the world.
solutions provider driving the progress of cancer
care for the next 30 years and beyond.

References
1. World Health Organization. Cancer fact sheet; February 2018. http://www.who.int/mediacentre/factsheets/fs297/en/. Last accessed on 5/3/18.
2. 	American Society of Clinical Oncology. Shaping the Future of Oncology: Cancer Care in 2030. ASCO 2012.
Available at https://www.asco.org/sites/default/files/shapingfuture-lowres.pdf. Last accessed 5/7/18.
3. Ribas A. Tumor immunotherapy directed at PD-1. N Engl J Med 2012; 366:2517-2519.
4. Association of Community Cancer Centers. Empowering Patients, Engaging Providers: The Future of Patient-centered Care in Oncology. Fall 2016.
5. Devi RDH. Devi MI. Outlier detection algorithm combined with Decision tree classifier for early diagnosis of breast cancer. J. Adv Eng Tech. April-June 2016;7(2):93-98.
6. Enshaei A. Robson CN. Edmondson RJ. Artificial intelligence systems as prognostic and predictive tools in ovarian cancer. Ann Surg Oncol. 2015 Nov;22(12):3970-5.
7. Chrischilles EA. Friedman S. Ritzwoller DP. Selby JV. Patients, data, and progress in cancer care. Lancet Oncol. November 2017 (18);e624-e625.
8. 	Raghupathi W. Raghupathi V. Big data analytics in healthcare: promise and potential. Health Information Science and Systems 2014, 2:3.
Available at: https://link.springer.com/article/10.1186/2047-2501-2-3. Last accessed 5/7/18.
9. Larkin J. Chiarion-Sileni V. Gonzalez R. et al. Combined nivolumab and ipilimumab or monotherapy in untreated melanoma. N Engl J Med. 2015;373:23-34.
10. DiMasi JA, Grabowski HG, Hansen RA. Innovation in the pharmaceutical industry: new estimates of R&D costs. Journal of Health Economics 2016;47:20-33.

Important Safety Information
Radiation treatments may cause side effects that can vary depending on the part of the body being treated. The most frequent ones are typically temporary and may include, but are
not limited to, irritation to the respiratory, digestive, urinary or reproductive systems, fatigue, nausea, skin irritation, and hair loss. In some patients, they can be severe. Treatment
sessions may vary in complexity and time. Radiation treatment is not appropriate for all cancers.
Medical Advice Disclaimer
Varian as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual treatment results may vary.

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