Effectiveness, applicability and accessibility measure the value of novel technologies and therapies in oncology
Innovation in oncology is not a luxury, rather a necessity. Yet, it is not the mere presence of technology or novel therapies that defines true innovation, but the value they bring to patients and, by extent, to the society as a whole. If innovation does not tangibly improve lives or address inequities, it may be perceived just like a playful toy. To many, innovation evokes images of futuristic laboratories, gene-editing tools and breakthroughs in cell-based therapy , with its transformative potential being sometimes overrated. However, from a health system’s perspective, innovation must be operationally feasible, highly effective - as proved with person-centric descriptors - and, most importantly, universally accessible.
I believe innovation is a double-edged sword, offering hope while carrying the risk of widening the inequity chasm. In public health, in fact, innovation is seen through a population-wide lens, prioritising cancer continuum strategies to reduce disparities (Lancet. 2024 Feb 3;403(10425):409).
Innovation can be disruptive, as some breakthroughs that make headlines have shown so far in oncology. Immunotherapy, for instance, has revolutionised our approach to cancer treatment, but it has also come with new questions about scalability and accessibility, and an impact in terms of budget, healthcare systems, and equity. However, disruptive revolutions, made through a creative destruction and a re-shape of the ways we treat cancer, happen once in a while. More often, an incremental innovation is observed - small steps, improved processes, facilitated delivery. But even in this case, innovation hardly means sustainability, as it may bring to an increased resource utilisation.
A great potential comes with a great risk. When implemented with no systemic approach, no pursuit of equity as a goal and no access-oriented, health-for-all spirit, innovation is unlikely to result in tangible outcomes that have value for all people with cancer. Value of innovative approaches must be proved in the real-life context of patients. For instance, if innovative therapies remain accessible only in resource-rich settings, they just symbolise inequity. Many innovations also demand advanced infrastructure and specialised expertise, such as genomic profiling, which are scarce in low- and middle-income countries, thus severely restricting their practical applicability (Annu Rev Pathol. 2022 Jan 24;17:387–402).
Innovation without value is progress without purpose. I call for a value-based approach to innovation in oncology. This means prioritising advancements that maximise patient benefit, health equity and social good over those that merely showcase technological prowess. The value of a therapy is not solely its ability to extend life, but it must also be assessed in terms of quality of life, financial toxicity and accessibility. Without these dimensions, innovation is a golden promise for the few, not the many.
Tools like the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) are essential to evaluate therapies based on patient-centric benefits and ensure that health systems invest in interventions that provide the greatest value.
Oncology should be seen as a balanced integration of equitable cancer care and technological abilities and expertise: losing this balance may dissipate the true potential of some advances in the field. I believe that the true measure of innovation is not in its novelty rather in its ability to close the inequity gap.
