Last year in Boston, at the John F. Kennedy Presidential Library and Museum, President Joe Biden gave a speech about his own administration’s moonshot – the re-ignited Cancer Moonshot, first initiated in 2016, but given new life by the Biden administration in 2022.
Biden, who lost a son to cancer, has said that this effort is one of the reasons he ran for presidency.
“It’s a disease we often diagnose too late and have too few ways to prevent it in the first place; where there are stark inequities based on race, disability, ZIP Code, sexual orientation, gender identity, and other factors,” he went on. “We don’t do enough to help patients and families navigate the cancer care system. We don’t learn enough from their experience as patients. We don’t share enough data and knowledge to bring the urgency we need to finding new answers. But for each – for each of the ways we know cancer today, we know we can change the trajectory.”
The rhetoric starkly sets this moonshot apart from the “War on Cancer” Richard Nixon declared in 1971. It’s not merely about funding scientific research into new cures and treatments, though that’s certainly a part of it. It’s also about being honest with ourselves as a society about the barriers that keep people – especially marginalised people – from accessing existing cures and treatments.
CancerX’s inaugural project has already begun, focusing on improving care equity and reducing financial toxicity.
Along with the HHS, the Office of the National Coordinator for Health IT, and the Office of the Assistant Secretary for Health (OASH), this effort is being led on the private side by the powerful team-up of the Digital Medicine Society (DiME) and the Moffitt Cancer Center.
And just last month at ASCO, CancerX announced 91 founding members from across the healthcare ecosystem that would help make the CancerX Accelerator a reality, including names like AstraZeneca, Takeda, and Genentech, as well as a who’s who of healthcare providers, payers, and digital health and healthtech companies.
“We have ensured that when we welcome founding members, we are not leaving one or the other member behind,” Dr Smit Patel, DiME’s associate programme director, told pharmaphorum at an ASCO sit-down. “We have patient community groups; we have health systems and organisations who can do some of the implementation and demonstration work. Across the board, whoever we need at the table to drive forward progress is at the table.”
Specifically, DiME and Moffitt have envisioned a “flywheel” approach involving evidence generation, the accelerator, and demonstration projects, that together will move the field forward and solve problems.
“Where are their gaps?” Jennifer Goldsack, DiME’s CEO, asked. “Where are their questions about what good looks like? Let’s answer those questions. Let’s address those issues, then let’s really foster and encourage and bring to maturity those innovative companies to be in a position to implement those best practices. And then let’s create an environment where we can actually implement those new best practices. And we strongly believe that this is going to do everything we need it to, to drive the promise of innovation.”
While Moffitt brings a wealth of experience with cancer care, DiME brings not just a strong background in digital health, but also a record as a convener that can bring many stakeholders together and orient them around an evidence-driven, systematic approach to problem-solving.
“We have to intentionally think about a whole new approach to caring for people with cancer,” Goldsack says. “Taking a data-driven approach that harnesses all of the different tools we have in the digital toolbox pairs it with expert clinicians and clinical expertise, and brings it all together. And that’s why CancerX is so important, because we are taking this big tent approach, we’re doing evidence generation, we’re building and supporting the next generation of innovators, and we’re putting it into practice to make sure it works in this complex care environment.”
The first accelerator cohort is set to be announced in the latter half of 2023. In the meantime, DiME and Moffitt have been hard at work recruiting those 91 partner companies and are now working with them to do the evidence-generation work and to identify specific problems and gaps in care, as well as to build a governance model and appoint a steering committee to make the partnership self-led and self-sustaining. They’ll select companies for the accelerator with an eye towards solving the particular problems they’ve identified, and then cascade into demonstration projects with the most promising of those companies.
And while financial toxicity may exist across the board in healthcare, it’s especially prevalent in cancer.
“When someone is not able to afford the medical treatment, it goes back to life savings. So whatever life savings they have, they use it for cancer care,” Patel adds. “[Then] they have to rely on the supporting network. So, your parents, your grandparents, your kids – it’s a whole family income that gets eroded just for the medical costs. I think it’s critical that we identify right, best practices when it comes to, not just access to care, but […] access to affordable care.”
And cost of care is not the only problem. For instance, unequal access to clinical trials leads not only to poorer-quality trial data, but also to care inequity, as trials often represent the best treatment options in cancer care.
“How can we overcome the maldistribution of the greatest sort of cancer expertise and the patients who need care?” Goldsack asks. “Traditionally, how can you access a clinical trial? You need to be near a centre of excellence or an academic medical centre. We know there’s an opportunity for many more people to go onto a protocol, but that’s not available to them today in their local cancer facility. How can we use things like clinical decision support, for example, and other sorts of AI-based tools to try and support getting as many people onto protocol as possible? How can we think about optimising the chances that every single person with a cancer diagnosis gets onto the therapy that is most likely to save their life?”
And even in routine care, care shortages and delays can take an enormous toll on patients.
“Hearing that you have cancer is devastating by itself. The worst is when they hear that you have to wait one month to even see a doctor for the first time,” Patel says. “And I think that is important. How can we bridge and curb that gap? How can we triage and have good care navigation systems in place that will help individuals who are diagnosed with cancer not to have to wait one or two months to access care, no matter their status?”
These are just some of the sorts of problems that the first effort will address.
pharmaphorum asked Mohan about the awkwardness of working with the full spectrum of stakeholders to reduce cost of care, even though some of those stakeholders are responsible for costs being as high as they are.
“Part of this is having those uncomfortable conversations, but part of this is also thinking about where digital can make a difference?” he said. “How do we help cut down some of those out-of-pocket costs? Avoiding people having to spend to travel, people having to uproot their families to go to a different state to access NCI-designated level care without having to actually do that, and being able to access that regardless of their ZIP code or income level. So, I think there are ways where we can achieve some common ground and there are ways where we’ll have to have some uncomfortable conversations as well.”
Patel says that just because this initiative is focused on the enormous potential of digital to help doesn’t mean that “for every nail we see […] a digital hammer is the answer.”
“There will be times where digital will help for a solution, and there will be times where it’s clear demarcation where digital is not the answer,” he said. “So, I think that having the recognition and identification that those two exist on the same plane, and we’ll be addressing that all together, would be important.”
But of course, CancerX is just one of many parts of the Cancer Moonshot, which also includes efforts around cancer prevention, increased screening, patient services, clinical trial data sharing initiatives, a coalition focused on addressing rural obstacles to care, and much more. And this current effort is just the first project for CancerX.
“This is really, in many ways, a call to action,” Mohan said. “We need everyone to participate. We need the doctors, the developers, the designers, certainly the entrepreneurs, and the scientific community. We need the industry innovators, the investors again, to provide exposure and access to capital coming together with the government support and encouragement, which, thankfully, we have through this Cancer Moonshot platform, so that we can tap into more creativity to push the boundaries and to turn a lot of these aspirations into action.”
Jonah Comstock is a veteran health tech and digital health reporter. In addition to covering the industry for nearly a decade through articles and podcasts, he is also an oft-seen face at digital health events and on digital health Twitter.