The cost of cancer care in the U.S. was $125 billion in 2010 and is projected to increase to $175 billion by 2020. Total spending on cancer care is driven by the cost to treat an individual patient and the number of patients treated. For example, sipuleucel-T, a novel immuno- therapy for metastatic prostate cancer, was found to improve survival by several months in a population of patients with few proven options. However, its cost was more than $100,000 per patient for a three-dose course of treatment. While, regulatory reform and preclinical innovations have the potential reduce the high cost of developing cancer therapies, there is an urgent need for innovative strategies that will allow the cancer patient to pay less and expect more within the cancer care continuum. A combination of innovative health care delivery models and technologies are needed to overhaul the unwieldy costs of cancer care in the 21stcentury. Two key drivers that increase the use of cancer therapeutics is under utilization and/or limited access to cancer prevention and overutilization of treatment owing to a lack of insight into who will benefit least and most likely from treatment. Novel technologies that ideally enable “see and treat” strategies that consolidate multiple touch points into as few as possible have the potential to prevent cancer and avert the need for toxic cancer therapies. One example where the potential impact of see and treat strategies can be demonstrated is in cancer prevention. Cervical cancer prevention is based on well-established interventions including human papillomavirus (HPV) vaccination and screening followed by treatment of pre-invasive disease. In the U.S., cervical cancer incidence and mortality have decreased by 70% over the last 60 years due to screening with the Pap smear [10]and, more recently, the HPV test; however, women living in medically underserved regions experience a disproportionately high burden of cervical cancer. In the U.S. alone for example, half of cervical cancers occur in women in medically underserved communities.There has been significant effort both in the U.S. and globally to increase access to screening but screen-positive women need a confirmatory test at a referral setting followed by biopsy, which, if positive, requires yet another visit for treatment. The three-visit model is required because test results at each visit are not immediate and the technologies required for confirmatory testing and treatment are not effective in communities where access to health care is fragile. Novel technologies that that consolidate multiple touch points into as few as possible in the first mile of the cancer care continuum have the potential to prevent this readily preventable cancer.Another example where the see and treat interventions could transform care is in the over utilization of expensive, toxic cancer therapies. With the widespread adoption of mammograms for cancer detection, modern research has principally pivoted towards a focus on how to reduce overtreatment of patients, particularly those with early stage breast cancer. Unfortunately, there remains a distinct lack of tools to reduce overtreatment, while ensuring the best possible outcome for patients. One example is the current approach to mitigate the risk of local recurrence through breast conserving therapy (BCT). Achieving clear margins during surgery followed by weekly radiation therapy all strive to maximize removal of residual tumor cells and to prevent local recurrence. However, secondary cancers from radiation therapy and the potential for cancer dissemination as a result of re-excision surgeries requires new approaches that reduce overtreatment particularly in patients with early stage disease. Similarly, not all women benefit from toxic treatments like chemotherapy and identifying those least likely and most likely to benefit is important. Solutions that are significantly less expensive and have a shorter turn around time will make the availability of tests to reduce overtreatment from chemotherapy available to a broader number of patients. In my talk, I will discuss how disruptive approaches to both technology innovation and health care delivery models could broaden access to preventive services and reduce over utilization of toxic treatments. Point of care technologies will be key to making this shift. This idea is not entirely new. Historically, before advanced medical technologies were invented much of medical care was provided at the community level or in the patient’s home. While the shift in centralized care has transformed health in the United States, it is no longer sustainable and the shift to preventing disease and effective management of chronic disease is essential. My talk will focus on technologies that do not require laboratory environments to support more patient-centered approaches to healthcare delivery. Examples will include portable self-contained devices that detect and treat disease, and can enable the selection of optimal therapies through patient and/or monitor the effectiveness of a specific treatment. Innovations in genetic testing, imaging, theranostics and artificial intelligence that are already growing will be the key to closing the gap.

Acknowledgements

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References

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