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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.
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.
A drug's label should say whether its dose was chosen by comparing several doses or simply by finding the most patients could tolerate. Doctors could then know how much room there is to reduce the dose safely.
Any oncologist could send a difficult case, with the records, to a specialist centre and get a written expert opinion back within three days, free to the patient.
Guidelines usually wait for a drug to be licensed for a use before recommending it. For old drugs no one will license, guidelines should act directly on trial evidence.
Test the large language models doctors and patients are already using against a continually refreshed set of cancer questions, scoring not just correct answers but whether the sources they cite are real and support the claim.
About six in every thousand gallbladders removed for stones contain cancer. A written pathway that sends every specimen to the pathologist, refers every T1b or deeper cancer to a liver surgeon within two weeks and books the second operation within eight would turn a lottery into a system.
For each treatment recommendation in the guidelines, publish a short explanation patients can read in their own language: what it is, why it is recommended, and what the evidence says.
Every cancer trial would have to publish a short, clear summary that patients can understand, within twelve months of results, in one public place.
A free web service where any app or hospital system can ask 'what is the recommended treatment for this exact situation today' and get a cited, versioned answer.
A simple website that shows, every year, how much research money each cancer receives compared with how many people it kills, so the gaps are impossible to ignore.
Nobody keeps track of how differently the same drug is approved and dosed around the world. A public scoreboard would make the differences visible and push regulators to converge.
Keep a running, well-documented list of cancer practices and approvals that were reversed by later evidence, so the pattern of mistakes is visible and teachable.
Keep a public list of the questions doctors and patients most need answered but no trial addresses, and tie research funding to it.
Measure and publish, for every practice-changing result, how long it takes before most eligible patients in each country and hospital actually receive it.
Test head to head whether an AI that reads the record and the evidence recommends treatments as well as a panel of experts, and whether patients do as well.
Trials tell us a drug works but not where it fits among the others. Commit to answering 'which order' from hospital data within a year of each approval.
When you look up a paper, you should immediately see whether anyone has tried to repeat it and whether they succeeded.
Give every tumour board a tool that pulls up the relevant trials and guideline lines for each case with citations, records what was decided, and later shows how the patient did.
Wherever cancer information appears online, a visible marker shows whether it matches what trusted sources say, with a one-click link to the plain-language evidence.
Every patient newly diagnosed with advanced cancer would have their records reviewed by an expert centre within a week, without travelling. The review often changes the plan.
Build a public, machine-readable map connecting every cancer trial to its results, the drugs and biomarkers involved, and the guideline recommendations it supports, with a source for every link.
Almost every newly diagnosed patient searches for what to eat and finds sugar-starvation, alkaline and juice-cure claims. If the oncology team asks about diet first and hands over good information, the myths have less room.
When a study is retracted or corrected, every guideline and software tool that relied on it would be alerted automatically, so wrong evidence stops influencing care.
Thousands of oncologists trained in poorer countries now work abroad. A structured programme could let them join weekly video case conferences for hospitals back home, improving decisions at almost no cost.
When a computer suggests a treatment, it should show the doctor the specific trial result and guideline sentence behind the suggestion, so it can be checked and trusted.
Trial results (hazard ratios, confidence intervals, subgroups, toxicities) would be deposited in a computer-readable form so they can be pooled, checked and used by software immediately.
A drug label says 'for PD-L1 positive patients' but does not say that other tests give different answers. Labels should list the validated tests and how much they disagree.
Trial results are often presented at conferences months or years before the full paper appears, leaving doctors to act on slides. Require that the full structured results are published the same day.
When your biopsy or gene test comes back, you get a version written for you, drafted by software and checked and signed by your clinician, alongside the technical report.
Europe already publishes a detailed report explaining why each drug was approved. If every country did, smaller regulators could reuse the work.
The report that tells a patient their tumour's mutations should also tell them which trials are recruiting for those mutations within reach, with the status checked that week rather than copied from a stale list.
Most oncology guidelines exist only in English, and national adaptations lag by years and often diverge. Machine translation checked by a clinician-verifier per language could publish each recommendation update in 20 languages within 30 days, side by side with the source and with local adaptations flagged explicitly.
Wikipedia's medical pages receive billions of views and its cancer pages are among the most read, yet they are often out of date on treatment. Funding a standing team of oncology editors and translators, as Cochrane and WHO have done with Wikimedia, would keep them current against living guidelines and add structured trial and drug identifiers to Wikidata.
Wikipedia is the most-read medical reference on Earth. Pay expert editors to keep its cancer pages accurate, current and available in the languages most patients speak.
The evidence for old drugs against cancer is scattered across hundreds of papers. Assembling it into the format regulators and funders need is cheap and would speed decisions.
Instead of a review that is out of date on publication, fund teams to keep one continuously updated review per cancer setting, adding each new trial as it appears.
Pay scientists a small bonus, added to their grant, when they post their results and data openly within six months of finishing an experiment, whether the result was positive or not.
A Swedish trial found that cheap aspirin roughly halved recurrence in colorectal cancer patients with a particular tumour mutation. Nobody is going to market it, so health systems must adopt it deliberately.
Conferences headline the trials that worked, while most negative trials end up as posters or are never submitted. A standing plenary at ASCO, ESMO and AACR for negative and practice-reversing trials, with a discussant drawing lessons for design and biology, would make the failures impossible to miss.
Treatment guidelines tell doctors what to do at each step but rarely which trials are open for that step. Adding a live, monthly-updated list to each decision node would put trials where doctors look.
Three PD-L1 tests run on the same tumours called 46, 75 and 73 percent of them positive and agreed only 69 percent of the time. With atezolizumab withdrawn, pembrolizumab's test (22C3, combined positive score of 10) is the only one that matters, yet laboratories still run whichever kit they have. One assay, one score and a proficiency scheme would end answers that vary by postcode.
Drugs are labelled phase 1, 2 or 3 so everyone knows how proven they are. Biomarkers should carry a comparable grade, from B1 discovery to B5 utility shown in a randomised trial, so that a marker with only discovery-stage evidence is not mistaken for a validated one in guidelines and papers.
Hospitals rarely know what fraction of their patients got the recommended treatment. Software reading the electronic record can show each team, every month, where care deviated from guidelines.
Cancer treatment guidelines would be updated continuously and published in a form computers can read, so hospital systems, apps and decision tools update themselves the day the evidence changes.
For each question patients actually ask, keep a short, current, sourced answer in plain words, updated as evidence changes and available in the languages people speak.
Cancer treatment guidance changes constantly and takes years to reach many clinics. Make guidelines live documents that software can read, updated as evidence arrives and adapted to what each country can afford.
Giving radiotherapy in five larger doses over one week instead of 15 to 25 smaller doses is non-inferior for cancer control and late toxicity in breast and prostate cancer, and triples the number of patients each machine can treat. The barriers are guideline inertia and payment per fraction, not hardware.
Copies of the big antibody drugs are approved and cheaper, but uptake depends on each prescriber; letting the pharmacy substitute the biosimilar unless the oncologist objects would move most patients within a year.
When a trial changes the standard of care, every oncologist would receive a five-minute, case-based lesson within a month, rather than waiting for the next conference.
A phone app that works without internet and guides a general doctor or nurse through diagnosing and treating common cancers with the drugs actually available locally.
Knowledge about how cancers become resistant is scattered across thousands of papers and company files. Pooling it into one structured, public resource would let anyone see the pattern.
Guidelines paid for with public or charitable money would be published under an open licence so any hospital system, app or country can build them in without permission or fees.
Every trial writes its protocol and analysis plan from scratch. A shared library of well-written templates and ready-to-run analysis code would let teams start from the best version rather than a blank page.
The pancreas makes the enzymes that digest food, and a cancer in it, or the operation to remove it, leaves most patients unable to absorb what they eat. Capsules replacing those enzymes are cheap and recommended, yet UK records show only one patient in five was prescribed them. The proposal is to prescribe by default at diagnosis, publish each hospital's rate, and run the trial never done.
One week of breast radiotherapy in five doses works as well as three weeks in fifteen, but clinics paid per dose lose money by switching; paying one price per course removes the penalty.
A drug's label should say plainly how well the people in its trials matched the people who get the disease: 'Black patients were 4 percent of participants and 22 percent of cases.' Doctors and patients can then judge how far to trust the result.
Project ECHO is a weekly video class where district doctors and nurses present real cases to a specialist team, learn by doing, and build a network. It worked for hepatitis C and could work for cancer.
When an aeroplane crashes, an independent report explains why so it does not happen again. When a cancer drug programme is abandoned, nothing is written. Change that.
Report how long patients lived well, not only how long they lived. Methods exist (Q-TWiST) but are rarely used.
In England and Wales a national audit now reports each year what share of people diagnosed with pancreatic cancer receive any treatment aimed at the cancer, how many are discussed by a specialist team and how many see a specialist nurse. The proposal is a national target for the treatment rate, published by hospital, so the trusts furthest behind are visible.
Fund proper trials of the methods used to get new evidence into practice (training, reminders, feedback, incentives), measured by whether patients actually receive the better treatment.
Show each hospital, every month, how often its patients received the recommended treatment, compared with peers, so gaps are seen and closed.
Every cancer consultation is recorded with consent and the patient receives the audio plus a checked written summary of what was said and decided.
Between one in eleven and one in five gallbladder cancers is HER2-positive and two HER2 drugs are now approved, but testing still happens only when someone asks. Making it automatic on every advanced biliary diagnosis, on resection tissue where it exists, would find the patients the trials were built for.
About a third of triple-negative tumours are HER2-low and so eligible for trastuzumab deruxtecan, but the difference between a HER2 score of 0 and 1+ is the one pathologists agree on least, and most triple-negative tumours were scored before the label mattered. Re-scoring archived slides with digital help when a patient relapses would find the eligible third.
Whether a drug gets into the brain is measured early in development but rarely published. Making that number public would show which existing drugs could treat brain disease.
Scientists hide results for fear of being beaten to publication. If journals and funders guaranteed that a preprinted finding cannot be scooped, and encouraged rival groups to publish side by side, sharing would become safe.
Doctors and patients could subscribe to a specific cancer, stage and biomarker and be told, with sources, the moment the recommended treatment changes for that situation.
About one man in eight with prostate cancer that has spread carries an inherited DNA repair fault, and about one in five has one in the tumour. The drugs for those faults have moved to the beginning of treatment, but the test is still usually done near the end, when it is too late to use the result.
Oncology has two respected scales that grade how much a drug helps in each indication; payers could set low copays for high-grade uses and require a conversation for low-grade ones instead of blanket prior authorisation.
Give the nurses and pharmacists who take patients' calls a tool that walks them through recognising and managing side effects of modern cancer drugs, including when to escalate.
The fastest rise in bowel cancer is in people two decades younger than any screening programme, who reach diagnosis through symptoms, often after several visits. Screening cannot help them; the referral pathway can.
The pre-built treatment menus in hospital computers often stay unchanged for years. Require them to be updated within a month of any guideline change, using the machine-readable guideline feed.
Cancer is now understood to change its identity and behaviour without new mutations, to be shaped by bacteria inside and around it, and to be helped along by ageing cells. This explains why some tumours escape targeted drugs by changing cell type and why gut bacteria affect immunotherapy response.
Checkpoint inhibitors are now given to hundreds of thousands of patients a year, many in community clinics and emergency departments, so a common, explicit playbook for their autoimmune side effects saves lives. The guideline standardised when to stop, when to give steroids and when to escalate, and made multidisciplinary toxicity teams routine. It does not remove the judgement needed for rare events or for patients whose cancer is responding.
Enzyme replacement is cheap, guideline-recommended (NICE NG85) and under-prescribed; the National Pancreatic Cancer Audit now reports the prescribing rate as a performance indicator, which the UK and NHS page tracks.
The answer to a question three individual trials could not answer on their own, and the reason docetaxel with androgen deprivation became standard for metastatic hormone-sensitive disease. It also stopped a widely used bone drug being credited with a survival effect it does not have.
The clearest case in cancer screening of a national body acting on the harms rather than the headline. Whether it was right is still argued: testing and localised-stage diagnosis fell, and the long-term effect on metastatic presentation and mortality is the subject of the studies that followed.
One bottleneck page and 18 idea pages on OnCo cite this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing pages listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.
The hallmarks are the mental map most oncologists and researchers use to think about what cancer is and where drugs act. A newcomer can understand nearly every therapy as an attack on one hallmark: kinase inhibitors on proliferative signalling, checkpoint blockade on immune evasion, anti-VEGF drugs on angiogenesis.
The standard of care in limited-stage small-cell lung cancer from 1999 until ADRIATIC added immunotherapy in 2024, and a rare example of a curative gain in a disease that has had almost none.
Shares An asynchronous expert second opinion for every new advanced-cancer diagnosis, A digital second-opinion network answering community oncologists within 72 hours, Real-time guideline-concordance feedback for every cancer centre, Live guideline-concordance dashboards for every tumour board, generated from the record.
Shares A verified information layer that labels and links cancer content across platforms, Fund expert editors for the cancer pages of Wikipedia and Wikidata, Fund oncologists to maintain cancer articles on Wikipedia in many languages, A monthly-updated benchmark for AI answers to oncology questions with citation accuracy.
Shares Recorded, AI-summarised consultations given to patients by default, A public registry of unanswered clinical questions linked to funding calls, Subscribable alerts when the standard of care changes for a patient's situation, Kris Hallenga.
Shares A 'dose evidence' panel in every label: how many doses were tested, and how, A public index of how the same cancer drug's label differs between countries, Print the participation-to-prevalence ratio in every drug label and assessment report, A public registry of cancer treatments that were later shown not to work.
Shares Credentialed diaspora oncologists staffing remote tumour boards for home-country hospitals, Project ECHO tele-mentoring for district clinicians managing cancer, Micro-learning pushed to community oncologists within 30 days of a practice change, Offline decision support for generalists treating common cancers in low-resource settings.
Shares End the abstract-to-paper gap: require full results with any conference presentation, Give negative trials plenary slots at the big cancer conferences, A public registry of cancer treatments that were later shown not to work, Funder bonuses for releasing results and data within six months, negatives included.
Shares A plain-language summary of every cancer trial result within a year, Guidelines list the open trials at every decision point, updated monthly, Require every oncology candidate to publish how much reaches the brain, An open knowledge graph linking trials, results, biomarkers, drugs and recommendations.