Innovation In Cancer Care Research Articles

Disparities in Clinical Trial Participation: A Cross-Sectional Survey of Cancer Patients at a Midwest Academic Medical Center.

Research conducted on homogenous populations can lead to biased and misleading findings, impeding the development of effective interventions and treatments for diverse populations. Low participation among minority groups further leads to disparities in access to innovative cancer care and treatment outcomes associated with trial participation. To better understand cancer patients' attitudes and willingness to participate in clinical trials, solid tumor patients attending their clinic visits were invited to complete a survey. The survey included questions on demographics, previous trial participation, and future trial interest. Responses were analyzed with frequency tables and chi-square tests. Of 300 participants, only 96 (32%) were asked to participate in a clinical trial. Of these, 81 (84%) chose to participate and 15 (16%) did not. There were notable differences by race but not gender or education level. Of the 204 who had never been asked to participate, 70% indicated that they would be willing to participate in future, and there was a strong sex-race interaction. Non-White males were the most hesitant group. Of 204, 99% indicated that they would participate to access new treatments, and 57% would participate to contribute to research overall. This study shows that many solid tumor patients undergoing treatment are not offered clinical trials. Racial differences in attitudes toward trial participation are evident. Nonetheless, many patients are willing to participate in trials to access innovative treatments and to support research. Culturally relevant outreach to build trust with minority groups is needed to increase overall participation in clinical trials.

An application (ePRO) -based patient reported outcomes of quality of life from an innovative cancer care delivery model.

e23176 Background: With the accessibility of smartphones, it has become possible to develop applications for patient-reported outcomes. Quality of life (QoL) is an important measure in oncology research. We developed a phone application that could use any standardized form to be filled in by the patient. Here, we report using the EORTC questionnaire, QLQ-C30, built into the application as a form for data collection from our ongoing district cancer care program, which offers support at government district hospitals in India using an alternate oncology work force. Methods: An application (ePRO) was created, which allows one doctor administrator to follow the patients. Once the application is downloaded, the patient opens the QoL questionnaire (QLQ-C30), built into the application, and completes it using a smartphone. The researcher downloaded the data in Excel format and analyzed it. The application was attempted at a tertiary cancer center and a public hospital district cancer unit. A cross-sectional study was conducted over six months in 2023.The data were analyzed using SPSS version 24. Results: The application was downloaded and activated on the smartphones of 441 patients. Patients completed the form available through the application. Of all the respondents, 229 (51.9%) were male and 212 (48.1%) were female. The mean QoL of the tertiary hospital was 69.29, with a standard deviation (SD) of 18.98.The QoL scores were 50.94 (SD 23.50) in district hospital 1 and 77.01 (SD 17.35) in district hospital 2. The difference between one district and the other was significant (p < 0.001). The symptom scale scores varied between district hospitals and other hospitals. Conclusions: This presentation serves two purposes: to validate a new patient-reported outcome application and to provide data on QoL from peripheral centers compared with tertiary centers. The use of technology is feasible and can help gather patient-reported outcomes easily. There appears to be a difference in the quality of life of patients from different geographical locations. [Table: see text]

COSA's 50th Annual Scientific Meeting, 50 years of innovation in cancer care: Learning from the past to inspire the future, 1-3 November 2023.

COSA's 50th Annual Scientific Meeting, 50 years of innovation in cancer care: Learning from the past to inspire the future, 1-3 November 2023.

Evidence supporting innovative cancer care delivery model for overcoming health disparity.

e13521 Background: Disparity in cancer care is the biggest challenge faced by the health systems. The solution could be brought out by new models of service delivery. To mitigate the challenge, an innovative district cancer care model was launched across 6 states of India. A cancer care unit has been established in government district hospitals, which constitute pivot of health systems in all low- and middle-income countries of the world . It assists cancer patients in complete care continuum from diagnosis to end of life care. Here, we report how a district cancer care model (Pendharkar model) proved its validity during the covid pandemic, by providing relentless cancer care, when specialized cancer services were paralyzed in the country. Methods: Patient data were collected from four government district hospitals of Ujjain (Madhya Pradesh) Bhilwara, Jhalawar and Churu (Rajasthan), over three years, including period of Covid pandemic and lockdown. The numbers were analyzed for attendance in outpatient and inpatient services, numbers of chemotherapy sessions administered, from January 2019 to December 2021. Standard statistical calculations were done. Results: A total of 4873 new patients were registered in the cancer units (1614,1678,1581 per year), over the period of three years: 2019, 2020, 2021. Annually, there were 695,643 and 609, new patients registered in the Ujjain district, 190,252 and 204 in Churu, 349. 276.and 276 in Jhalawar, and 380,507 and 442 in Bhilwara. Over a three-year period, there were 37183 outpatient visits in total (11416, 13665, and 12102 in 2019, 2020, and 2021 respectively). The number of inpatient admissions were 18593 (5047,7077,6469 respectively). A total of 17639 sessions of chemotherapy were performed during this period (5133,6361,8745 in 2019, 2020, and 2021 respectively). The data showed no change despite pandemic lockdown. Conclusions: Utilization of outpatient and inpatient services, as well procedures rendered, did not change despite covid and lockdown in caner units of government district hospitals. The data clearly demonstrates the robustness and resilience of this health care model of system strengthening, using alternate oncology workforce, task sharing and capacity building. It worked equally efficiently in different parts of India and maintained its effectiveness even during pandemic, when complete collapse of healthcare was noticed around the world. The oncology societies and international organizations could take more interest in analyzing and improving this delivery model, which has immense capability of reducing health disparities.[Table: see text]

Disparities in molecular tumor board recommendations and treatment implementation.

e18582 Background: The Inova Schar Cancer Institute Molecular Tumor Board (ISCI MTB) is a multi-disciplinary group that meets biweekly to discuss molecular test results for patients with advanced cancer to inform potential targeted therapy and clinical trial options. Previous work analyzing the racial distribution of patients in the ISCI MTB compared to the institutional cancer registry (CR) demonstrated that self-identified Black/African American patients were under-represented in the MTB. We next sought to evaluate the association between race and the implementation of MTB-recommended therapy. Methods: We evaluated ISCI MTB records from 1/1/16 to 12/31/21 and identified patients with at least one treatment recommendation informed by molecular biomarker results, including clinical trials, targeted medications, immunotherapy, and chemotherapy. Patient data were extracted from the EMR using the Epic Slicer/Dicer Tool and integrated with the MTB REDCap database. Manual chart review was used to fill missing data and identify patients for whom at least one MTB recommendation was implemented. Recommendation implementation was defined as treatment with or prescription of a recommended therapy or evaluation for a clinical trial. Results: 244 of 530 patients (46%) had one or more MTB recommendations implemented. There was no clear distinction in age at MTB presentation (64 vs 65) or sex (45% of males and 47% of females vs 55% of males and 53% of females) between patients who had recommendations implemented and those who did not. 45% of White/Caucasian, 41% of Asian, 56% of Black/African American, and 58% of Hispanic/Latino patients had MTB recommendations implemented. No statistically significant differences in implementation of recommendations were observed for age, sex, or race. Conclusions: Fewer than half of patients with advanced cancer receive biomarker-directed or investigational therapies recommended by an institutional MTB. White and Asian patients are less likely than Black/African American and Hispanic/Latino patients to be treated with MTB-recommended therapy, although these differences did not reach statistical significance. Further investigation of confounding variables including payor status and care fragmentation is necessary to clarify potential disparities and barriers to accessing innovative cancer care.

Pharmacoeconomics of novel pharmacotherapies in triple-negative breast cancer

ABSTRACT Introduction Triple-negative breast cancer (TNBC) represents the most aggressive breast cancer subtype carrying unfavorable clinical outcomes. Although traditionally chemotherapy has represented the only systemic treatment option available, novel drugs have changed the treatment landscape, granting approval by regulatory agencies worldwide, while determining new economic struggles on health systems for their high prices. Areas covered In this review, we provided a comprehensive analysis of pharmacoeconomic studies of drugs recently approved in the early and advanced settings of TNBC. Expert opinion Novel systemic treatment options redefined the therapeutic algorithms for TNBC by establishing new paradigms, based on substantial clinical benefits. Pembrolizumab and olaparib in the curative setting portend high value, as shown with the use of value frameworks, resulting in cost-effective interventions. In the metastatic setting, new drugs have demonstrated mixed improvements in patient-centric end-points, resulting often in interventions unlikely to have good value for money. We believe that cost-effectiveness alone is not a metric to inform the opportunity to invest on new interventions, while the intrinsic value of medicines should be the driver of the decisions. We endorse a patient-centric priority setting that can ensure health system sustainability, to timely deliver innovative cancer care to all in need and positively impact on population health.

Advancing digital health innovation in oncology to improve the lives of cancer patients.

e13609 Background: Oncology is renowned for leading innovation in research and in care. However, digital innovation in cancer care and research appears to be limited relative to other therapeutic areas. Methods: A multi-stakeholder roundtable, co-hosted by the Digital Medicine Society (DiMe) and Moffitt Cancer Center, convened experts from 35 leading organizations in life science R&D, regulators, payers, innovators, and with core representation from cancer patients and patient experts. Discussions addressed the current state of digital innovation in cancer care, root causes of digital health innovation challenges in oncology, and identifying action-oriented approaches to collaborative solutions needed to advance the safe, effective, ethical, and equitable use of digital innovations in oncology. Results: There was consensus among roundtable attendees that digital innovation lags behind in oncology relative to other therapeutic areas. Challenges identified as ‘low hanging fruit’ for digital innovation include reducing patient administrative burden, supporting care navigation, optimizing decision making in care and research, optimizing clinical pathways, and improving how we monitor both performance status and safety. Reducing financial toxicity and disparities in disease burden must be imperatives of digital innovation in oncology. Access to care and health outcomes for all patients must also be improved. Impediments to digital innovation in oncology include a proliferation of digital point solutions as opposed to system level innovations; transactional digital solutions that do not promote ongoing engagement and reengagement for the lifetime of the patient journey; lack of trust among patients and clinicians; the absence of data sharing incentives and infrastructure; and business and payer disincentives to digital transformation. Conclusions: Digital innovation frameworks can support more effective and equitable approaches to care that are accessible, scalable, and inclusive, thereby reducing the burden of cancer. To achieve this, clinical, technical, and operational best practices necessary to develop, design, and deploy high-quality digital interventions into cancer care must be established. There is no reason for the successful adoption of digital interventions in oncology to lag behind other therapeutic areas. Intentional action with urgency is required by the multi-stakeholder community through a collaborative effort to realize the full promise of digital innovation for patients and the systems that support those who care for them.

Molecular Tumor Board: A bottom-up approach as method for change.

e13537 Background: Precision oncology represents, together with immunotherapy, the leading innovation in cancer care. As a result, a growing number of patients will be treated in accordance with their disease’s specific genomic profile rather than the sole histology. At the same time, it is becoming more and more difficult to promptly adopt organizational solutions to deliver the right treatment to the right patient. In order to manage the complexity of genomic profiling and its clinical impact, Molecular Tumor Boards (MTBs) have been established. However, there is still broad heterogeneity among recommendations about the role and aims of MTBs worldwide. Globally, a top-down approach prevails, showing significant differences in the indication of hierarchical structure, composition, and autonomy of established MTBs. In the Hub & Spoke cluster of the academic Hospital of Udine, we adopted a contrarian, bottom-up approach to address the challenge of MTB implementation in the context of a healthcare organizational project. Methods: To face the challenges of precision oncology, an MTB was established in the Friuli Centrale Local Health Authority, North East Italy, as part of a project called “Precision Oncology Pathways”. Its implementation was derived trough a bottom-up approach, focusing on the real impact of this new activity on the hospital context. The aim of this strategy was to make issues emerging from daily practice and from direct information sharing among professionals involved in the integrated care pathways (ICPs) of cancer patients. This project involved two different departments (oncology, medical laboratory) and 8 different units. A project manager was introduced to facilitate interaction among stakeholders, and semi-structured interviews were conducted to define critical hurdles for MTB implementation. Results: A proposal for a bottom-up approach to implement precision oncology clinical pathways will be presented. Organizational findings and a decision-making workflow will be illustrated. Three main aspects turned out to be critical for MTB implementation: the communication gap among stakeholders, the clinical impact of technological innovation, and the role of MTB within ICPs. Besides, interdisciplinary study groups were set up to discuss criteria for patient's referral, the informed consent submission process, quality aspects of analytical methods, essential elements of the genomic report, criteria for the interpretation of genomic tests, and verify regulatory issues and adherence to guidelines. Conclusions: A redefinition of the whole ICP is needed for effective MTB implementation in real practice, according to local peculiarities. In our vision, MTBs represent the corner stone of a new treatment paradigm, and their activity should be patient centered, integrated within ICPs, and focused on the hurdles of tumor genomic profiling (clinical, ethical, pharmaco-economic and technological).

Breaking Down Barriers to Precision Oncology Care

Breaking Down Barriers to Precision Oncology Care

Health Literacy and Clinical Trial Participation in French Cancer Patients: A National Survey.

Simple SummaryInadequate health literacy (HL) can impair many aspects of communication, including the invitation to participate in clinical research. This study aimed to assess the relationship between HL and trial participation in French cancer patients. Our results showed that 37.6% were classified as having limited HL. One in ten (10.3%) respondents reported having been previously invited to participate in a clinical trial. Of these, 75.5% had enrolled. Limited HL was associated with fewer trial invitations but not with enrollment once invited. Addressing HL is necessary to create a more inclusive health system and to reduce inequalities not only in access to innovative cancer care, but to health inequalities in general.Few studies have explored the relationship between health literacy (HL) and trial participation. In this context, we aimed to study this relationship in French cancer patients. We used data from the French national VIe après le CANcer (VICAN) survey. Two questionnaire items focused on previous invitations to participate in clinical trials and subsequent enrollment. The Single Item Literacy Screener was used to measure functional HL. In total, 1954 cancer patients responded to both VICAN surveys (two and five years after diagnosis). Mean age was 54.1 ± 12.7 years at diagnosis, and 37.6% were classified as having limited HL. One in ten (10.3%) respondents reported having been previously invited to participate in a clinical trial. Of these, 75.5% had enrolled. Limited HL was associated with fewer trial invitations but not with enrollment once invited. Multivariate analysis confirmed the negative effect of limited HL on clinical trial invitation (adjOR = 0.55 (0.39 to 0.77), p < 0.001) after adjustment for multiple characteristics. Patients with limited HL received fewer invitations to participate in trials but were likely to enroll when asked. Addressing HL is necessary to create a more inclusive health system and to reduce inequalities not only in access to innovative cancer care, but to health inequalities in general.

Abstract 719: The emergence of the COVID-19 pandemic and its impact on a novel cancer care delivery model at Federally Qualified Health Centers

Abstract Background: The emergence of COVID-19 has particularly disrupted the lives of vulnerable patients needing comprehensive care, including cancer survivors. Moreover, patients receiving immunosuppressive treatment for cancer are at heightened infection risk and when infected, cancer survivors are at higher risk of serious infection. Further complicating matters, surgeries with curative intent have been significantly limited and systemic therapies for patients with cancer have been delayed to minimize patient and staff exposure to SARS-CoV-2. Preexisting gaps in cancer screening, treatment, and follow up as well as in the monitoring of primary care needs for patients at Federally Qualified Health Centers (FQHCs) have become more apparent due to the COVID-19 pandemic. The 4R model (Right information and Right Care for the Right Patient at the Right Time) is a novel approach our team developed to facilitate cancer planning, as a vehicle for patient enablement and team-based care delivery across the oncology and primary care continuum. The innovative cancer care delivery model has been successfully implemented and used in a pre-COVID setting. The COVID-19 pandemic provides an urgent need to study the ways in which preexisting cancer care delivery models have been disrupted and to adapt processes in order to provide quality care. Methods: Semi-structured interviews are being conducted with clinical care team members (N=10), patients (N=25), family/caregivers (N=10), and community organizations (N=5) in order to identify areas in which care for patients with cancer in a primary care setting have changed and how clinics are adapting to their patients' needs in the setting of the COVID-19 pandemic. A Rapid analysis process, which is a qualitative analysis method recommended for circumstances in which a quick analysis is required to adopt changes to an ongoing process, will be utilized. Results: Preliminary results from stakeholder feedback and clinical care team interviews have revealed changes in the FQHC's approach to cancer care coordination during the COVID-19 pandemic. In the spring/early summer of 2020, clinical team members were overburdened with clinical operation changes and the need to swiftly re-allocate resources towards COVID-19 testing. Non-emergent appointments transitioned to telehealth and care coordinators, the keystone of the 4R model, were working remotely and were met with significant obstacles in referring cancer survivors to specialty care and community resources. Conducting additional interviews will help elucidate the receptivity of the recently implemented 4R cancer care delivery model and inform how telehealth can be harnessed during this time to meet the complex needs and coordinating care for patients with cancer. Citation Format: Nicolas Francone, Will Dunne, Jonathan Alhalel, Sankirtana Danner, Nihmotallahi Adebayo, T Madorsky, Cassandra Osei, Juan Rivera, J Trossman, Christine Weldon, Elizabeth Adetoro, Melissa Simon. The emergence of the COVID-19 pandemic and its impact on a novel cancer care delivery model at Federally Qualified Health Centers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 719.

An innovative cancer care partnership for patients in the community.

Natalie Bingham, Lead Oncology Nurse, LloydsPharmacy Clinical Homecare (nbingham@lpclinicalhomecare.co.uk) and Sarah Etherington, Oncology Matron, Royal Surrey County Hospital, Guildford; members of the team that was runner-up in the Innovation Award category of the BJN Awards 2021.

Accelerating Advances in Cancer Care Research: A Lookback at the 21st Century Cures Act in 2020.

The 21st Century Cures Act (Cures Act), signed into law in 2016, was designed to advance new therapies by modernizing clinical trials, funding research initiatives, and accelerating the development and use of health information technology. To analyze the current issues in cancer care related to the implementation and impact of the Cures Act, NCCN convened a multistakeholder working group. Participants discussed the legislation's impact on the oncology community since enactment and identified the remaining gaps and challenges as experienced by stakeholders. In June 2020, the policy recommendations of the working group were presented at the virtual NCCN Policy Summit: Accelerating Advances in Cancer Care Research: A Lookback at the 21st Century Cures Act in 2020. The summit consisted of informative discussions and a multistakeholder panel to explore the recommendations and the future of the Cures Act. This article explores identified policy recommendations from the NCCN Working Group and the NCCN Policy Summit, and analyzes opportunities to advance innovative cancer care and patient access to data.

Flying the plane while you build it.

In this issue of Evidence-Based Oncology™ we see a foreshadowing of what the future of cancer care innovation could look like and how we may learn to move forward, safely, at an ever-accelerating pace.

Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study

BackgroundThe status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)–funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed.ObjectiveThis study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020–funded projects.MethodsTwo international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed.ResultsTechnical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work.ConclusionsTechnology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations.

Employers: innovators and partners in the delivery of more effective and equitable cancer care.

Employers have the focus, innovative mindset, analytical tools, and drive to partner effectively with innovative cancer care entities to bring better care to their respective members.

Enhancing efficiency and outcome in cancer care integrating patient's and survivorship perspectives

Abstract Although the Austrian health care system generally presents the highest standards and excellence structures of cancer care, patient outcomes continue to lag behind in the global comparison with respect to include the patient's perspective in cancer care. Therefore, potential inefficiencies must be considered in future health system development to achieve more efficient processes and higher outcomes for patients suffering from cancer. The contribution presents the development of the All.Can initiative in Austria, in line with a cancer care framework and derived health targets for patients suffering from cancer including a special focus on the patient's and survivorship perspectives and enhancing the influence of patient organisations in current Austrian cancer care. The proceeding is based on a systemic and applied approach to embed All.Can Austria in the national health landscape and ensure a strategic orientation with a concept paper including literature review and stakeholder research. One important point was to include health professionals in the process and experts from different political sectors with a strong relationship to health according to the concept of health in all policies, referring to the real needs of e.g. patients and cancer survivors. The next step consisted of the development of a policy framework for all sectors to empower patient organisations to gain more efficient structures that incorporates multi-stakeholder involvement. The developed cancer care framework and targets of All.Can Austria aiming at new priorities in Austrian cancer care, creating high-level political commitment to patient outcomes and providing a basis for the empowerment of patient organisations, in consequence changing the system step by step and piloting innovations in cancer care. A special tool will support the allocation of resources for projects in prevention and health promotion linked to the developed health policy framework. Key messages Establishing the All.Can initiative in Austria to empower patient organisations by building innovative structures in Austrian cancer care. Enhancing efficiencies and patient outcomes in cancer care according to health in all policies.

218 How Scientific Evidence is Used to Adopt Complex Innovations in Cancer Care: A Multiple-Case Study from Nova Scotia, Canada

218 How Scientific Evidence is Used to Adopt Complex Innovations in Cancer Care: A Multiple-Case Study from Nova Scotia, Canada

Satisfaction survey from an innovative cancer care delivery model (Pendharkar model), creating access at scale: An outcome research.

e18002 Background: With the aim of empowering alternate oncology workforce, to resolve the issue of access, a unique cancer care delivery model (Pendharkar model) was launched in 4 states of India, spread across 125 districts with population coverage of around 210 million. The model has established nodal cancer units in every government run district hospital and created a point of contact for cancer- a physician-medical officer. Hundreds of patients have been seen by these hospital in last four years. The aim of this analysis was to survey the patient population attending and their satisfaction level. Methods: An elaborate survey was conducted amongst patients coming to district hospital. It sought information on satisfaction, choices. The written responses were sought, and data analysed. Results: Overall.186 patients were surveyed. Nearly 62 % of the patients had visited hospital multiple times before. Referral pattern showed that about 7 % of the patients were referred by other patients who were treated here, 62 % of the patients were referred by other medical professional, including nearby cancer hospitals and specialists. More than half of the patients (54.1) had taken cancer treatment outside district hospital, at some point of time. On question of comparison of service 65 % felt services to be better in government run setup, the time to start of therapy was much faster (74%).The time given by the doctor to the patient was satisfactory, highly appreciated by 97% of the respondents. Ease of accessibility of the staff was positively accepted by 100 %. All were happy with the level of communication by the doctors and nursing staff. Chemotherapy experience was better in district hospital set up for 58 % of the patients. More than 95% rated nursing services of high quality and all were happy with the behaviour of nurses. 80% were interested in continuing chemotherapy in same government hospital. Majority said that they are happy with their decision of taking chemotherapy in district hospital and would definitely refer other patients here. Conclusions: The survey strongly favours the model of empowerment of alternate oncology workforce in government run district hospital, and achieves high level of satisfaction amongst cancer patients.

When oncologic treatment options outpace the existing evidence: Contributing factors and a path forward

Oncology is one of the most multidisciplinary areas of medicine, with most patients encountering multiple treatment modalities during the course of their disease. Rapidly occurring innovations in cancer care are continuously expanding the number of treatment options available. However, substantial variation in the amount and quality of evidence supporting new drugs, devices, and surgical approaches exists, compromising evidence-based treatment decisions. To address this important issue, the professional societies representing cancer care providers appointed a multidisciplinary working group: American College of Surgeons Commission on Cancer, American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO), Society of Interventional Radiology (SIR), and the Society of Surgical Oncology. In addition, the working group included a patient and National Cancer Institute (NCI) representative. This manuscript identifies five factors contributing to differences in evidence development for cancer treatment modalities: (1) research funding, (2) methodological challenges to conducting randomized controlled trials in many therapeutic options, (3) regulatory agency oversight, (4) payment policies, and (5) hierarchy and sociological factors in medicine. It makes a series of consensus recommendations that address the need for more cross-disciplinary research and wider adoption of observational research, pragmatic trials, and reimbursement strategies.