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Invited Commentary |

Visions of Hope in Cancer: Focus on Infrastructure:  Comment on “Characteristics of Oncology Clinical Trials” and “Toward Accountable Cancer Care”

Peter B. Bach, MD, MAPP
JAMA Intern Med. 2013;173(11):979-980. doi:10.1001/jamainternmed.2013.6596.
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It is natural to be frustrated by the slow pace of progress in cancer. Mortality rates in the United States have been declining, but by only 1% or 2% per year.1 The advent of personalized treatment based on tumor genetics has led to the subtyping of cancers based on their genetic features, but we have learned through these discoveries that many new targeted agents linked to these mutations improve outcomes for only a few patients—a pattern most apparent in lung cancer.2 Even in cancers for which effective approaches to prevention or treatment are well known, our knowledge yields smaller health gains than it could in part because our health system fails to deliver consistently optimal, or even acceptable, care.3,4 Meanwhile, the cost of cancer care continues to rise along with health care costs in general, widening government debt, and hampering private sector growth.5

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