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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe incidence of cancer is expected to rise substantially by 2030, because of the increasing world population, aging, and the introduction of cancer risk factors from developed countries to risks that already exist in low- and medium-resource countries. Patients in low-resource countries typically present with advanced cancer. Obstacles to prevention, early detection, and therapy include scarce human resources, financial barriers, lack of radiotherapy facilities, limited access to anti-cancer drugs and palliative care, and insufficient coordinated action.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Egenomics clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eaffordability of care\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EIncreasing Cancer Burden and Globalization\u003C\/h2\u003E\u003Cp id=\u0022p-2\u0022\u003EThe incidence of cancer is expected to rise substantially by 2030, because of the increasing world population, aging, and the introduction of cancer risk factors from developed countries to risks that already exist in low- and medium-resource countries. An expected 1% per annum increase in cancer incidence will result in approximately 26 million new cases in 2030, with most of the increased in developing countries [Thun MJ et al. \u003Cem\u003ECarcinogeneis\u003C\/em\u003E 2010]. Patients in low-resource countries typically present with advanced cancer. Obstacles to prevention, early detection, and therapy include scarce human resources, financial barriers, lack of radiotherapy facilities, limited access to anti-cancer drugs and palliative care, and insufficient coordinated action.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Peter Boyle, PhD, DSc, International Prevention Research Institute, Lyon, France, the current model is broken. An international policy based on collaboration is needed, with a global consortium that involves governmental and nongovernmental organizations, the pharmaceutical industry, and other partners.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESuccessful models for tackling this critical problem include: the Academic Model Providing Access to Healthcare, which aims to deliver essential primary care services, control HIV, and mitigate the social and economic consequences of HIV\/AIDS; the School of Nursing and Midwifery, University of Dundee, Scotland, UK, which provides distance health education in low-and middle-income countries; Hospice Africa Uganda, which provides palliative care and education in palliative care; and the Susan G. Komen Global Alliance in low-income countries.\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\u003Ch2 class=\u0022\u0022\u003ECost and Effectiveness of New Cancer Treatments\u003C\/h2\u003E\u003Cp id=\u0022p-5\u0022\u003EIan Tannock, MD, PhD, University of Toronto, Toronto, Ontario, Canada, discussed the high cost of cancer treatments relative to their effectiveness. Many new drugs provide small gains at a high price.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EDr. Tannock and colleagues found that only 37% of 25 new targeted agents approved by the US Food and Drug Administration (FDA) cost \u0026lt;$100,000\/life-year gained. The cost of new targeted agents needs to be reduced by a median 78% to be cost-effective, even in Western countries. The investigators recommended that registration of new anticancer drugs should require value-based pricing that renders them cost-effective. In addition, healthcare rationing is essential to ensure fair distribution of limited resources, regardless of a country\u0027s wealth.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EDrug pricing is based more on maximizing profits than clinical benefit and is the major cause of the limited availability of off-patent drugs, such as methotrexate and doxorubicin. The profit motive for drug development makes it difficult to evaluate new roles for old drugs, which is important in developing countries. Drug pricing is based on effectiveness measures in clinical trials and is driven by the United States. Drug approvals based on cost-effectiveness would lead to more equitable distribution. Oncologists should be aware of the relative costs of drugs and choose cheaper alternatives when options are equal.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EA strategy to maximize therapeutic benefits for all patients is to lobby the European Medicines Agency and the FDA to link approvals for new therapies in wealthy countries to agreements by drug manufacturers to provide the therapies at a much lower price to countries that cannot afford them.\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EBarriers and Challenges to Cancer Research\u003C\/h2\u003E\u003Cp id=\u0022p-9\u0022\u003EAccess to cancer drugs and new diagnostic procedures is critical to cancer control around the globe. Studies show that patients enrolled in clinical trials have improved care and outcomes. Participation in clinical research enables quick and smooth introduction of new, effective treatments in standard practice. According to Tanja Cufer, MD, PhD, University Clinic Golnik, Ljubljana, Slovenia, only about 3% of cancer patients worldwide are participating in clinical trials.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ELast year, the ASCO International Affairs Committee conducted a web-based survey of 300 oncologists from 24 countries on challenges to clinical cancer research. Eighty oncologists responded, 41 from high income countries (HIC) and 39 from low- and middle-income countries (LMIC; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Most respondents had participated in up to 10 trials in the previous 5 years. A significantly higher percentage of oncologists from HIC versus LMIC participated in \u0026gt;10 clinical trials during this time. More respondents from LMIC reported it took \u0026gt;120 days from regulatory initiation to enrollment of the first patient.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16939\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16939\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16939\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EMajor Obstacles to Cancer Research.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-15\u0022\u003ELack of funding was the most important obstacle and patient accrual the least important for academia-driven clinical trials in HIC and LMIC. The second most important obstacle in HIC was lack of time or competing priorities and in LMIC, it was regulatory issues.\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EFuture Global Cancer Research\u003C\/h2\u003E\u003Cp id=\u0022p-16\u0022\u003EAccording to Richard L. Schilsky, MD, University of Chicago, Chicago, Illinois, USA, cancer is a systems issue that encompasses biological, healthcare delivery, clinical trial information, and patient support systems. Researchers are recognizing that every tumor has a unique profile, with multiple molecular subtypes within each histologic type. A schema of personalized medicine developed by MacConnaill and Garraway [\u003Cem\u003EJ Clin Oncol\u003C\/em\u003E 2010] based on DNA profiling and targeted therapies is being challenged by emerging data on intra-patient tumor heterogeneity [Gerlinger M et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012] and evolution of histologies and genotypes.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EThe vision of personalized care faces many challenges, including the need for molecular pathway analysis, validated biomarker assays, an information infrastructure able to support decision-making and patient monitoring, multiple effective therapies, and increasing regulatory complexity. The success rate of bringing drugs to market is 5% to 8%, resulting in great inefficiencies and costs.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003ETo address these challenges, new learning structures are needed, including global research consortia, community-based networks, and learning healthcare systems. There is a need to move toward trials that have the greatest potential to provide benefits for patients, with selection of participants based on molecular characteristics. Pragmatic clinical trials in community clinical practice are also important. Patient-centered, rapid-learning cancer care systems, such as ASCO Cancer-LINQ, that incorporate data collection and comparative effectiveness research with implementation, assessment, and refinement of new evidence are needed.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/7\/NP.6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzngtq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzngtq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}