Nature Oncology had a very intriguing write up (a viewpoint) from varied cancer researchers about the next decade in cancer research.
I have written extensively about keeping the research ideas grounded. These are the broad themes where cancer research is likely headed (the list is suggestive, not exhaustive):
- Palliative care.
- Management of oligometastases
- Fractionation schedules.
- Ageing and multi-disciplinary management.
- MR-Linac; functional and adaptive radiation therapy.
Radiation Oncologists were always aware of the tumour microenvironment; a clinical target volume is the culmination of the accumulated wealth of experience based on recurrence patterns.
The next decade is going to see the maturity of the long-term outcomes of modulated radiation therapy across several sub sites. We have made rapid strides in the clinical delivery of particle therapies (with its caveats), and the efforts are being made to make them accessible (with evidence, of course).
Biomedical science is essential to understand the molecular complexities of tumours and “target” them better. However, the result is a slow translation of the lab research in the clinical domain that determines outcomes. I remain circumspect about newer and expensive therapies that promise only a “progression-free-survival”. As clinicians, we grapple with the human dimension of cancer diagnosis and relapses if and when they happen.
I haven’t discounted the role of machine learning (and currently, my efforts to standardise symptoms quantitatively). The newer generation of physicians also needs to be receptive towards rapid changes in electronic medical records (and digital scribes) to prevent early burnout. Likewise, newer forms of minimally invasive surgery and reconstruction have taken centre stage with improved survival.
As I have repeatedly been saying, scientific experiments (especially, genetic sequencing) needs to be accessible, reproducible and worthwhile to drive innovation.
I firmly believe that the next breakthrough would be in our thoughts- to humbly accept the frailty of human existence. End of life care with empathy and access to opioids (and standard approaches) would be more welcome than cancer metabolomics. I do not deny the “march of science” but concretise our encapsulated understanding in the form of universally accepted evidence.