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Equality in treatment choices - Achievable fact or fad?

posted on 2/28/2018 Facebook Facebook

“When medical science grows, but leaves behind the three A''s!”


Affordability, Availability, Accessibility are the pillars whichaffect standard of care in healthcare. If we have to introduce this very“subject-to-change” outcome indicator in simple terms, it does not meanperfection in practice, but refers to all the conscientious efforts/cautionexercised by the healthcare provider under the available means. Medicalmalpractice and negligence continue to be the biggest global indicatordiscussed in relation with standard of care, but these are controllable!Imagine the perennial issues which in many ways permanently dent the standardof care. In simple terms; Why is the treatment outcome for a breast canceraffected women in US different from that in the Asian continent? When medicalscience grows with a global effort and in a multi-centric fashion, what blocksthe lab-to-bedside transition, which will ultimately culminate to affectingstandard of care in more than one sense?


Let''s look at cancer in detail in this regard now. A dreaded globaldisease, cancer continues to keep the researchers and the medical communityconfounded due to its ever-growing hallmarks affected by innumerable biologicaland environmental factors; both having an common switch though i.e. genes!Radiotherapy, surgery and chemotherapy are the three treatment and managementmodalities for cancer, and also the guideline recommended norm for whichmedical professionals are trained. However, the ever growing scientificresearch community today claims controlling the switch is the safest navigationmode in cancer management. Thus clinical genomics started gaining recognitionand today stands as the key decision maker in determining therapeutic andmanagement strategies as well as assessing risk and recurrence.


Identification of the genetic signature in the tumor of a patient,and subsequent treatment aka personalized treatment/tailored treatment choicehas now been included in National as well as International guidelines whichalso details the key genes as well as hotspot regions which need to be testedas per tumor type. Presence of approved diagnostic tests, guidelines forrecommendation regarding therapeutics, management strategies, etc. Now can becharted efficiently when a geneticist, a counselor and a physician work intandem. But inspite of having the best and ever-evolving technology ofNext-Generation Sequencing (NGS) today, is its reach and benefit uniform? Twocancer patients bearing the same genetic signature, for e.g. BRCA-positivebreast cancer, frequently have different outcome. What is the advantage linkfor the survivor against the one who lost the battle?


Genomic analysis in the clinical front involves analysis of DNA orRNA as well as proteins which when done using sequencing technology can havethe whole genome, exome or even specific targeted regions analyzed depending onneed. This generates huge volume of data in GB''s and thus IT and computationtechnology aid in the big data analysis, using which clinical geneticists drawconclusion and sketch recommendations. When it comes to genetics, racial andregional difference plays a big role is a known fact and thus use ofpre-published data in a straight-forward manner may not prove entirelysufficient and explorative methodologies need to be applied to generate acomprehensive picture. Also, the prevalence of most mutations does not directlyextrapolate towards the pathogenecity of the same. The identification of rare secondarymutations which render the ongoing treatment ineffective can be cited in thisregard. The data generated in such a setting then becomes priceless and imaginethe power outcome when millions of such data points become an aggregateknowledge base for the research and the clinical community to draw inferencefrom!


Developing a well-collated and ever-expanding database apart from foruse by the clinicians, can also be effectively put to use by the drugdevelopers, and clinical trial designers to understand the prevalence expanseas well as to study the outcome is an unbiased manner. This would also end upbecoming a powerful starting point for drug companies to develop formulationswhich would work with greater efficacy for a particular racial group loweringchances of side effects at stages of trial or fear of drug withdrawal. Such aconcerted development will also ensure drug approvals occur in an expeditedmanner and the faith of clinicians on drawing genomics based disease managementstrategies will increase manifold. This will also improve patient involvementin the treatment course. Working on collaborations, and multi-centriccontributions combined with IT and big data analysis tools will emerge to bethe most powerful exponentially growing arena to improve cancer care.


Transcending different geographies and biological mysteries usingstored genomic data for better patient outcome will play a big role in reducingthe gap between the have and the have not''s in healthcare. The genomic data canalso be used to identify and price formulations as per prevalence and demandfor therapeutics; e.g: High prevalence of lung cancer with EGFR alterationswould increase demand for EGFR-TKIs in that particular group. This will ensureuniform standard of care practice is put into action. Death by cancer is a painand stress in more than one form, and the current gap in therapeutic outcomesacross geography actually adds up to anxiety. Imagine a patient or a supportingfamily member or partner hears that the treatment would have been better in XYZplace and the ensuing level of guilt and anguish in which the affected willlament for life knowing about the umpteen possibilities and “if only''s”!Accessibility to world''s medical information in general will help tap the mostrelevant therapeutic connect to dramatically improve prognosis outcome.


This molecular levels global knowledge sharing initiative will expandthe catalogue of cancer molecular markers and help fight its hallmarks better.At the table, it will help connect millions of medical professionals andpatients in one platform and also increase transparency between all the arms ofhealthcare like pharmaceutics, diagnostics and clinical trial coordinators anddrug regulators. Extending the benefit further, reviews have also identified,genomics-guided therapeutic choices to be cost-saving for upto 27% for theinvolved. 


Believing we are marching towards such a favorable endpoint soon!

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