# Knowledge reaches practice too slowly

Source: https://onco.cc/bottlenecks/b-knowledge-diffusion/  
OnCo record `b-knowledge-diffusion` (Bottleneck). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Knowledge diffusion is slow: it takes years for a proven result to change what most patients receive, and no one can keep up with the literature.

## Summary

The often-quoted estimate that it takes 17 years for research evidence to reach clinical practice is an average across medicine, and oncology, with more than a million and a half new biomedical citations indexed in MEDLINE each year and guidelines that change several times a year in the commonest cancers, is at the demanding end. Oncologists in community practice cannot read the primary literature, guideline documents run to hundreds of pages, and knowledge is fragmented across specialties, so uptake of new standards (for example, biomarker testing, de-escalation, geriatric assessment) lags years behind evidence and varies widely between hospitals. Patients, meanwhile, cannot find trustworthy, current, plain-language information about their own disease and options. Living guidelines, curated knowledge bases embedded in clinical systems, decision support at the point of care, and open plain-language resources are the mechanisms for closing the gap.

## Fields

- Kind: Bottleneck
- Last checked: 2026-09-08
- Stage: data-knowledge
- Severity: major
- Metrics: Estimated average time for research evidence to reach clinical practice: 17 years (Morris, Wooding & Grant, Journal of the Royal Society of Medicine 2011); Citations added to MEDLINE per year (recent years): More than 1.5 million (NLM MEDLINE citation counts by year of publication); Patients with metastatic non-squamous NSCLC in a US community network tested for all five guideline-recommended biomarkers before first-line therapy (2018-2020): Under half (Robert et al., Lung Cancer 2022)
- Causes: The volume of publication exceeds any clinician's capacity to read and appraise it.; Guidelines are long documents rather than decision tools embedded in the systems clinicians use.; Community oncologists treat every cancer and cannot track sub-specialty evidence in each.; Continuing education, reimbursement and institutional protocols lag guideline changes.; Patient-facing information is either too technical, out of date, or commercially or ideologically biased.

## Sources

- Morris, Wooding & Grant, The answer is 17 years, what is the question (JRSM 2011): https://doi.org/10.1258/jrsm.2011.110180
- NCI PDQ Cancer Information Summaries: https://www.cancer.gov/publications/pdq
- OncoKB: https://www.oncokb.org/
- MEDLINE citation counts by year: https://www.nlm.nih.gov/bsd/medline_cit_counts_yr_pub.html

## Connected records

- collections: [CIViC](https://onco.cc/collections/civic/), [ESMO Clinical Practice Guidelines & MCBS](https://onco.cc/collections/esmo-guidelines/), [International Guideline Harmonization Group for late effects of childhood cancer](https://onco.cc/collections/ighg/), [NCCN Guidelines](https://onco.cc/collections/nccn/), [NCI PDQ Cancer Information Summaries](https://onco.cc/collections/cancer-gov-pdq/), [OncoKB](https://onco.cc/collections/oncokb/), [PubMed & Europe PMC](https://onco.cc/collections/pubmed-europepmc/)
- ideas: [A 'dose evidence' panel in every label: how many doses were tested, and how](https://onco.cc/ideas/idea-tr1-dose-evidence-statement-in-label/), [A digital second-opinion network answering community oncologists within 72 hours](https://onco.cc/ideas/idea-data-72-hour-second-opinion-network/), [A guideline fast track for repurposed drugs with phase 3 evidence but no manufacturer](https://onco.cc/ideas/idea-reg-guideline-fast-track-repurposed/), [A monthly-updated benchmark for AI answers to oncology questions with citation accuracy](https://onco.cc/ideas/idea-data-living-llm-oncology-benchmark/), [A national incidental gallbladder cancer pathway: histology for every gallbladder, referral within two weeks, re-resection by eight](https://onco.cc/ideas/idea-gbc-national-incidental-cancer-pathway/), [A plain-language explainer for every guideline recommendation, in every major language](https://onco.cc/ideas/idea-data-patient-explainers-per-recommendation/), [A plain-language summary of every cancer trial result within a year](https://onco.cc/ideas/idea-data-plain-language-summary-mandate/), [A public API serving the current standard of care for any cancer, stage and biomarker](https://onco.cc/ideas/idea-data-standard-of-care-api/), [A public dashboard of research money per death for every cancer](https://onco.cc/ideas/idea-fund-dollars-per-death-dashboard/), [A public index of how the same cancer drug's label differs between countries](https://onco.cc/ideas/idea-reg-label-divergence-index/), [A public registry of cancer treatments that were later shown not to work](https://onco.cc/ideas/idea-tr2-reversal-registry/), [A public registry of unanswered clinical questions linked to funding calls](https://onco.cc/ideas/idea-data-unanswered-questions-registry/), [A public tracker of how long each country takes to adopt new evidence](https://onco.cc/ideas/idea-data-evidence-to-adoption-tracker/), [A randomised trial of AI-generated treatment recommendations versus tumour boards](https://onco.cc/ideas/idea-data-ai-vs-tumour-board-rct/), [A real-world sequencing analysis within a year of every new approval](https://onco.cc/ideas/idea-data-sequencing-analysis-per-approval/), [A replication status badge on every cancer paper, visible in PubMed](https://onco.cc/ideas/idea-tr2-replication-status-badge/), [A tumour board assistant that cites its evidence and tracks outcomes](https://onco.cc/ideas/idea-data-tumour-board-evidence-assistant/), [A verified information layer that labels and links cancer content across platforms](https://onco.cc/ideas/idea-moon-verified-information-layer/), [An asynchronous expert second opinion for every new advanced-cancer diagnosis](https://onco.cc/ideas/idea-acc-universal-asynchronous-second-opinion/), [An open knowledge graph linking trials, results, biomarkers, drugs and recommendations](https://onco.cc/ideas/idea-data-open-evidence-knowledge-graph/), [Ask about diet at diagnosis, and prebunk the myths before the internet does](https://onco.cc/ideas/idea-nl-ask-about-diet-prebunking/), [Automatic flagging of retracted or corrected evidence in guidelines and decision support](https://onco.cc/ideas/idea-data-retraction-propagation/), [Credentialed diaspora oncologists staffing remote tumour boards for home-country hospitals](https://onco.cc/ideas/idea-acc-diaspora-tele-tumour-boards/), [Decision support that cites the exact trial and guideline line it relies on](https://onco.cc/ideas/idea-data-provenance-first-decision-support/), [Deposit trial results as structured data, not just PDFs](https://onco.cc/ideas/idea-data-structured-trial-results-deposit/), [Drug labels must state which biomarker assays were validated and how they compare](https://onco.cc/ideas/idea-tr2-label-assay-concordance/), [End the abstract-to-paper gap: require full results with any conference presentation](https://onco.cc/ideas/idea-data-full-data-with-abstract/), [Every pathology and genomic report ships with a signed 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cancer indication](https://onco.cc/ideas/idea-data-funded-living-systematic-reviews/), [Funder bonuses for releasing results and data within six months, negatives included](https://onco.cc/ideas/idea-fund-open-results-bonus/), [Get biomarker-directed aspirin after colorectal surgery into labels and guidelines](https://onco.cc/ideas/idea-reg-aspirin-pik3ca-implementation/), [Give negative trials plenary slots at the big cancer conferences](https://onco.cc/ideas/idea-tr2-negative-plenaries/), [Guidelines list the open trials at every decision point, updated monthly](https://onco.cc/ideas/idea-tr1-open-trials-inside-guidelines/), [Harmonise PD-L1 testing for triple-negative breast cancer around one scored assay, with external quality assurance](https://onco.cc/ideas/idea-tnbc-pd-l1-assay-harmonisation/), [Label every biomarker claim with an evidence phase, like drugs](https://onco.cc/ideas/idea-tr2-biomarker-evidence-grading/), [Live guideline-concordance dashboards for every tumour board, generated from the record](https://onco.cc/ideas/idea-acc-guideline-concordance-dashboards/), [Living guidelines published as versioned, computable rules](https://onco.cc/ideas/idea-data-computable-living-guidelines/), [Living plain-language evidence summaries for every common cancer question in 20 languages](https://onco.cc/ideas/idea-moon-living-plain-evidence-summaries/), [Living, machine-readable guidelines pushed to the point of care in every country](https://onco.cc/ideas/idea-moon-living-machine-readable-guidelines/), [Make one-week radiotherapy the default in overloaded systems](https://onco.cc/ideas/idea-acc-hypofractionation-default-lmic/), [Make the biosimilar the default at the pharmacy for trastuzumab, bevacizumab and rituximab](https://onco.cc/ideas/idea-cost-biosimilar-default-substitution/), [Micro-learning pushed to community oncologists within 30 days of a practice change](https://onco.cc/ideas/idea-data-thirty-day-practice-change-learning/), [Offline decision support for generalists treating common cancers in low-resource settings](https://onco.cc/ideas/idea-data-offline-cds-lmic-generalists/), [One open atlas of how tumours escape every drug](https://onco.cc/ideas/idea-bio1-open-resistance-atlas/), [Open licences for publicly funded cancer guidelines](https://onco.cc/ideas/idea-data-open-licensed-guidelines/), [Open-source protocol and statistical analysis plan templates with runnable code](https://onco.cc/ideas/idea-tr1-open-protocol-and-sap-library/), [Pancreatic enzyme replacement by default: prescribe at diagnosis, audit the rate, and run the trial that settles survival](https://onco.cc/ideas/idea-pdac-enzyme-replacement-prescribing-by-default/), [Pay for a course of radiotherapy, not for each fraction](https://onco.cc/ideas/idea-cost-hypofractionation-payment/), [Print the participation-to-prevalence ratio in every drug label and assessment report](https://onco.cc/ideas/idea-tr1-representativeness-in-the-label/), [Project ECHO tele-mentoring for district clinicians managing cancer](https://onco.cc/ideas/idea-acc-echo-tele-mentoring-oncology/), [Public post-mortem reports when a cancer drug programme is stopped](https://onco.cc/ideas/idea-tr2-termination-reports/), [Quality-adjusted survival reported in every trial publication and label](https://onco.cc/ideas/idea-moon-quality-adjusted-survival-standard/), [Raise the share of UK patients who receive any active treatment, and publish it by trust](https://onco.cc/ideas/idea-pdac-uk-active-treatment-rate-audit-and-target/), [Randomised trials of how to spread proven cancer treatments, not just what works](https://onco.cc/ideas/idea-data-implementation-trials-programme/), [Real-time guideline-concordance feedback for every cancer centre](https://onco.cc/ideas/idea-data-guideline-concordance-dashboards/), [Recorded, AI-summarised consultations given to patients by default](https://onco.cc/ideas/idea-moon-recorded-consultations/), [Reflex HER2 testing of every advanced gallbladder and extrahepatic biliary cancer](https://onco.cc/ideas/idea-gbc-reflex-her2-testing-advanced-biliary/), [Reflex re-scoring of HER2 0 versus 1+ with digital assistance so every eligible triple-negative patient reaches trastuzumab deruxtecan](https://onco.cc/ideas/idea-tnbc-her2-ultralow-testing-uptake/), [Require every oncology candidate to publish how much reaches the brain](https://onco.cc/ideas/idea-bio2-brain-exposure-disclosure/), [Scoop protection and co-publication norms to reduce academic secrecy](https://onco.cc/ideas/idea-fund-scoop-protection-policy/), [Subscribable alerts when the standard of care changes for a patient's situation](https://onco.cc/ideas/idea-data-standard-of-care-change-alerts/), [Test every man for DNA repair faults on the day his prostate cancer is found to have spread, not three treatments later](https://onco.cc/ideas/idea-prostate-hrr-testing-at-metastatic-diagnosis/), [Tie coverage and copays to the ESMO benefit scale](https://onco.cc/ideas/idea-cost-value-scale-in-coverage/), [Toxicity-management decision support for nurses and pharmacists](https://onco.cc/ideas/idea-data-toxicity-cds-for-nurses/), [UK gap: shorten the route to diagnosis for patients below the screening age, where the rise in incidence is](https://onco.cc/ideas/idea-crc-uk-young-patient-referral-and-diagnostic-interval/), [Update hospital order sets within 30 days of a guideline change](https://onco.cc/ideas/idea-data-order-set-defaults-30-days/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- technologies: [After treatment in Australia: a stated model of survivorship care](https://onco.cc/technologies/rejuv-access-survivorship-care-australia/), [AI trial matching & clinical decision support](https://onco.cc/technologies/ai-trial-matching/), [Alternative medicine used instead of standard treatment](https://onco.cc/technologies/alternative-medicine-instead-of-treatment/), [Comprehensive genomic profiling](https://onco.cc/technologies/cgp/), [Exercise is the best-evidenced thing on this front, and most survivors are not doing it](https://onco.cc/technologies/rejuv-access-exercise-programmes/), [Geriatric assessment](https://onco.cc/technologies/geriatric-assessment/), [Probiotics, antibiotics and stewardship around immunotherapy](https://onco.cc/technologies/probiotics-antibiotic-stewardship-io/), [The Children's Oncology Group Long-Term Follow-Up Guidelines](https://onco.cc/technologies/rejuv-paed-cog-ltfu-guidelines/), [The handover from children's to adult services, where follow-up falls away](https://onco.cc/technologies/rejuv-paed-transition-to-adult-care/), [What has actually been implemented since those trials, and what has not](https://onco.cc/technologies/rejuv-measure-epro-implementation/), [Who gets told about fertility before treatment, and who does not](https://onco.cc/technologies/rejuv-access-fertility-preservation/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [Deutsche Krebsgesellschaft](https://onco.cc/institutions/deutsche-krebsgesellschaft/), [EMBL's European Bioinformatics Institute](https://onco.cc/institutions/embl-ebi/), [European Association for Cancer Research](https://onco.cc/institutions/eacr/), [European Society for Medical Oncology (ESMO)](https://onco.cc/institutions/esmo/), [Lasker Foundation](https://onco.cc/institutions/lasker-foundation/), [Memorial Sloan Kettering Cancer Center](https://onco.cc/institutions/mskcc/), [National Cancer Institute (NIH)](https://onco.cc/institutions/nci/), [National Comprehensive Cancer Network (NCCN)](https://onco.cc/institutions/nccn-org/), [Organisation of European Cancer Institutes](https://onco.cc/institutions/oeci/), [Union for International Cancer Control](https://onco.cc/institutions/uicc/)
- terms: [Companion diagnostic](https://onco.cc/terms/companion-diagnostic-term/), [HER2-low and HER2-ultralow](https://onco.cc/terms/her2-low/), [Standard of care](https://onco.cc/terms/standard-of-care/), [What is not a second cancer: recurrence, metastasis and field cancerisation](https://onco.cc/terms/rejuv-second-what-is-not-a-second-cancer/)
- key papers: [ASCO 2021 guideline: how to recognise and manage the immune-related side effects of checkpoint inhibitors](https://onco.cc/key-papers/paper-asco-irae-guideline-jco-2021/), [Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study](https://onco.cc/key-papers/paper-roberts-pert-survival-pancreatic-cancer-pancreatology-2019/), [Hallmarks of Cancer 2022: adding phenotypic plasticity, epigenetic reprogramming, microbiomes and senescent cells](https://onco.cc/key-papers/paper-hallmarks-new-dimensions-cancer-discov-2022/), [STOpCaP: docetaxel or bisphosphonates added to standard of care in hormone-sensitive prostate cancer, a systematic review and meta-analysis](https://onco.cc/key-papers/paper-vale-stopcap-docetaxel-bisphosphonates-lancet-oncol-2016/), [The answer is 17 years, what is the question: understanding time lags in translational research](https://onco.cc/key-papers/paper-morris-j-r-soc-med/), [The Hallmarks of Cancer: six capabilities every tumour must acquire](https://onco.cc/key-papers/paper-hallmarks-of-cancer-cell-2000/), [Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide](https://onco.cc/key-papers/paper-turrisi-twice-daily-thoracic-radiotherapy-limited-sclc-nejm-1999/), [USPSTF 2012: screening for prostate cancer, recommendation statement (grade D)](https://onco.cc/key-papers/paper-moyer-uspstf-prostate-screening-ann-intern-med-2012/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- people: [Albert Lasker](https://onco.cc/people/albert-lasker/), [Ashya King](https://onco.cc/people/ashya-king/), [Katie Couric](https://onco.cc/people/katie-couric/), [Kris Hallenga](https://onco.cc/people/kris-hallenga/)
- trials: [ALASCCA](https://onco.cc/trials/alascca/)

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