Research and innovation in global cancer control
Authors: David A Jaffray, George Alleyne
Journal: The Lancet Global Health (2018)

Technology is enabling a period of change that is characterised by substantially reduced cost of measurements, data transport, storage, computational capacity, information aggregation, and knowledge synthesis. The underlying digital fabric tying these technologies together allows them to not only interoperate but to operate autonomously with a high degree of personalisation. The digital nature of our world means that technology is not just a tool to do our work, it is altering the way we go about formulating it. It could be said that it is no longer about adopting digital technology, it is about changing the way we work in response to a digitally enabled world. The effect of technology on social interaction is also profound, with broad geopolitical effects on humanity on a daily basis. These sociotechnological shifts need to be leveraged to accelerate progress towards controlling cancer, a disease that is projected to affect 24·9 million people each year by 2035.1Atun R Jaffray DA Barton MB et al.Expanding global access to radiotherapy.Lancet Oncol. 2015; 16: 1153-1186Summary Full Text Full Text PDF PubMed Scopus (513) Google Scholar In periods of dramatic change, it is worthwhile to step back and rethink our approach. The scale of the global cancer control problem demands that we consider new paradigms to accelerate our rate of learning, discovery, and innovation. We discuss three important technology-enabled trends that will affect how we formulate and execute cancer research and innovation strategies in the coming decades. The first trend is information-sharing and connectivity. In the past 10 years, the world has experienced a dramatic reduction in information asymmetry. The development of the internet and mobile smart-phone technology allows near instantaneous sharing of information worldwide. This trend has placed immense pressure on both content providers and information hoarders to perform in a socially responsible fashion with respect to information-sharing. Health-care systems are responding by providing patients with full access to their own health records. The same trend is affecting the medical research community, with the growing expectation of open science whereby scientific datasets are treated as global assets in the fight against disease. The principles for data sharing are being codified and will drive a period of renewed discovery and collaboration.2Wilkinson MD Dumontier M Aalbersberg IJ et al.The FAIR Guiding Principles for scientific data management and stewardship.Sci Data. 2016; 3: 160018Crossref PubMed Scopus (5294) Google Scholar The nature of data governance will also bring individual patients into the collaboration through digital consent mechanisms that are enabled by public ledger technologies such as the blockchain.3Ekblaw A, Azaria A, Halamka JD, et al. A case study for blockchain in healthcare: "MedRec" prototype for electronic health records and medical research data. 2nd International Conference on Open & Big Data; Vienna, Austria; Aug 22–24, 2016.Google Scholar Remarkably, the increased availability of data is now being matched by machine-learning technologies that far exceed the human capacity to aggregate data.4LeCun Y Bengio Y Hinton G Deep learning.Nature. 2015; 521: 436-444Crossref PubMed Scopus (41634) Google Scholar These technologies also promise to democratise access to interpretation and even diagnosis through cloud-based services. Person-controlled datasets will become a powerful component of activating patient engagement and driving evidence-based health care in the real world. Humanity has never experienced this level of connectivity, yet it is well understood that connectivity is a driver of innovation,5Johnson S Where good ideas come from: the natural history of innovation. Riverhead Books, New York, NY2010Google Scholar and collective scientific review drives discovery.6Dunbar K Blanchette I The in vivo/in vitro approach to cognition: the case of analogy.Trends Cogn Sci. 2001; 5: 334-339Summary Full Text Full Text PDF PubMed Scopus (170) Google Scholar These conditions need to be reinforced to accelerate progress against cancer. The second trend is person-centred health and wellness and the shift towards value-based health care. In 1978, Kleinman and colleagues7Kleinman A Eisenberg L Good B Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research.Ann Intern Med. 1978; 88: 251-258Crossref PubMed Scopus (1966) Google Scholar emphasised the need for more social engagement in medicine and provided a compelling perspective on the misrepresentation of effort and value for health care delivered through institutional and societal frameworks. Nearly 40 years later, little progress has been made in finding the balance in developed nations, and failing efforts to export modern medicine to developing countries further highlight the issues with existing approaches. In parallel, mobile and social networking technologies are enabling social interaction between traditional care givers, medical professionals, and individuals in need. Economic support for these systems-thinking paradigms8Frenk J Reinventing primary health care: the need for systems integration.Lancet. 2009; 374: 170-173Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar are being reinforced with the development of standardised measures of outcomes that drive values-based health-care investment.9Porter ME A strategy for health care reform—toward a value-based system.N Engl J Med. 2009; 361: 109-112Crossref PubMed Scopus (672) Google Scholar In the context of cancer, these provide a powerful platform for research and innovation that drive towards real value and are enabled by technological means of measuring patient-reported benefit and monitoring financial and labour costs.10Johansen NJ Saunders CM Value-based care in the worldwide battle against cancer.Cureus. 2017; 9: e1039PubMed Google Scholar The third trend is validating, motivating, and optimising investment in cancer through accurate modelling of cost and benefit. The development of investment frameworks that model the demand, cost, and benefit of intervention (both social and economic) have effectively directed investment towards the fight against HIV/AIDS in Africa11Atun R Knaul FM Akachi Y et al.Innovative financing for health: what is truly innovative?.Lancet. 2012; 380: 2044-2049Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar and, more recently, have been applied to cancer therapies.1Atun R Jaffray DA Barton MB et al.Expanding global access to radiotherapy.Lancet Oncol. 2015; 16: 1153-1186Summary Full Text Full Text PDF PubMed Scopus (513) Google Scholar These frameworks rely on detailed calculations derived from global data sources to provide clarity to decision makers regarding investment in health care. These early efforts portray larger-scale modelling efforts akin to climate change studies in which simulations of need and investment are used to optimise further investment and to drive the creation of new, targeted technologies and processes. This trend will be enabled by the 1 trillion internet-of-things and mobile sensors that will be operating in the world by 2020.12Topol EJ Steinhubl SR Torkamani A Digital medical tools and sensors.JAMA. 2015; 313: 353-354Crossref PubMed Scopus (107) Google Scholar Large-scale efforts to measure global activity, including metrics for health13ClinicalTrials.gov. Apple Heart Study: assessment of wristwatch-based photoplethysmography to identify cardiac arrhythmias. https://clinicaltrials.gov/ct2/show/NCT03335800 (accessed Feb 5, 2018).Google Scholar and education,14Rumiehttps://www.rumie.org/Google Scholar are already being explored at scale. In view of the broad adoption of smart phones, measurement of the social determinants of health is a predictable progression. These platforms provide immense opportunity for research and innovation by allowing the potential effect of completely new technologies and practices to be simulated in silico before pursuing high-cost, low-yield investment in science and technology development. In summary, the scale of the global cancer control problem necessitates that we adapt to the rapid pace of technological change in pursing effective research that brings impactful solutions to the benefit of patients with cancer worldwide. We need to leverage the important opportunities being created and transform our approach to cancer research and innovation. We declare no competing interests.