In the past 50 years, cancer in many cases has morphed from a certain death sentence into a chronic illness. However, cancer is unlike other chronic conditions. There are hundreds of different cancers, classified by where they start in the body and how their cells behave. To turn cancer from an acute, life-ending illness into a chronic one, we now understand that cancer must be treated with a targeted, personalized approach. Cancer research and advancements in treatment will continue to evolve and play a critical role in reducing cancer mortality rates.
Looking ahead in 2025 and beyond, cancer care will become even more targeted—and in turn, more complex—as innovations aim at prioritizing each patient’s unique circumstances. Community oncologists will need more resources to manage these rapid developments in care, along with further investment in solutions that help patients navigate their cancer journey.
The era of personalized cancer treatment
In my 20 years of treating patients as an oncologist, I have watched cancer care evolve in three dramatic waves. As an oncology trainee, my treatment choices were primarily restricted to “cytotoxic drugs”—chemotherapy that harmed good cells along with bad, causing severe toxicity along the way.
The first revolution in care that I witnessed involved biologic therapy. Antibodies were used to target molecules on cancer cells, leading to more effective, less toxic treatment. Since patients tolerated this treatment better, they could be on therapy for years, thereby prolonging their lives without the added side effects.
With the biologic therapy revolution in full swing, I have witnessed a second revolution in care focused on immune therapy. As we have learned how to harness the body’s immune system to fight cancer, we have seen tremendous improvement in outcomes across almost every cancer type. One of the most groundbreaking forms of immune therapy—CAR-T therapy—involves taking a patient’s own immune cells, reprogramming them in a lab to more effectively recognize and attack cancer, and then re-infusing them into the patient. Even though hundreds of patients now undergo CAR-T therapy every day, we have much to learn. Hundreds of clinical trials in the U.S. alone are investigating the use of CAR-T cells for a wide range of cancers.
The third revolution in care came with the concept of precision oncology, where we search for each cancer’s unique driving force—its set of mutations that can be targeted for the best outcomes. Over the last decade, we have learned a tremendous amount about the basic biology of cancer. Today much of the focus is on identifying the specific biological targets, such as the mutated gene or the biology of the proteins on the cancer cell. Researchers then develop a treatment plan that matches the cancer’s molecular profile. Unlike traditional chemotherapy, which indiscriminately kills healthy cells and cancer cells, precision oncology helps determine the right treatment for the right person at the right time for their specific cancer.
This shift from harsh, broad-based cytotoxic therapy to precision oncology has highlighted how the genetics of both the patient and the cancer itself can be used to treat cancer. This approach has resulted in sharp drops in cancer mortality and improvements in patients’ quality of life and health outcomes.
The challenge with delivering the right treatment to the right patient
What do these innovations in care mean for the day-to-day practice of oncology? Cancer care is getting more complicated. These enormous strides in genomics and precision medicine are improving survival rates, but the inherent complexity in care has widened the divide in health outcomes depending on where treatment is received.
Research suggests that cancer outcomes are significantly better at the National Cancer Institute-Designated Comprehensive Cancer Centers, yet only 20 percent of cases are treated at those institutions. One contributing factor to this disparity is geography: One in six Americans lives in a rural area. Approximately 66 percent of rural counties have no oncologist, requiring many patients to take time off work, spend limited resources, and travel—sometimes hundreds of miles—to receive care.
Clinical advances in cancer are evolving rapidly, making it challenging for community oncologists to keep up. With research progressing so quickly, the challenge is getting these new therapies to the right patient at the right time. Much of the research comes from large academic institutions that have cancer subspecialists with expertise in a specific type of cancer. Yet, community oncologists provide about 80 percent of cancer care in the U.S., treating a wide variety of malignancies. There is a significant opportunity to connect patients with subspecialty expertise to review cases, confirm diagnoses, and ultimately inform optimal treatment paths, including the latest clinical trials.
To bridge this gap, we are seeing an increased adoption of digital health solutions, including services like remote case reviews that enable greater collaboration between community oncologists and cancer subspecialists from academic research centers. These services help provide more equitable access to specialized expertise because cost and the inability to travel to these centers present barriers to the best cancer care.
Making care more patient-centered
With so much focus on new targeted treatments, it is important not to treat oncology care as a technological arms race but instead recognize that cancer is a profoundly human journey. Patients need assistance managing the enormous financial burden that comes with a cancer diagnosis, resources to promote their mental well-being, and support into survivorship to help them re-enter the workplace or their daily lives. These aspects are equally as important as the type of treatment in impacting the patient’s survival and recovery.
As we head into 2025 and beyond, I remain optimistic about the future of cancer care. Collaborations and partnerships will play a key role in ensuring patients receive the care they need. The remarkable breakthroughs we are seeing in innovative treatments and precision medicine, as well as the greater focus on meeting the needs of patients at all stages of their cancer journey, are promising. The continued development of solutions that help patients access the most appropriate treatment, regardless of where they reside, and more importantly, offer a personalized approach throughout the entire cancer journey, will be instrumental in improving cancer care and achieving optimal outcomes.
Yousuf Zafar is a hematology-oncology physician.
