We asked 80 oncology leaders: What is a belief we hold in oncology that’s wrong (the “big lie”), and what would the data show if we tested it?
Here are the top 10 answers:
The Lie: We are close to finding the cure for cancer.
The data would show: The future isn’t going to have one drug that “cures cancer once and for all.” Remember cancer isn’t one disease, it’s 200+ distinct diseases. Some cancers have strong long-term outcomes, especially when caught early (e.g. testicular cancer cure rates are >95%). As long as human cells divide, mutations will occur, and cancer will arise. The future is more about helping people live long, full lives with cancer, managed like a chronic disease.
The Lie: Innovative cancer drugs drive the majority of survival gains.
The data would show: Improvements in early detection, public health initiatives, surgery, and supportive care have historically contributed more to mortality reduction in many cancers than novel drugs have. For metastatic solid tumors, median survival has improved by only weeks to months despite decades of research and hundreds of billions in spending. We already know many interventions that would dramatically reduce cancer burden: tobacco elimination, obesity reduction, environmental carcinogen regulation, but preventions like these don’t have a strong business model. So, these high-impact interventions remain chronically neglected.
The Lie: Enrolling in hospice means giving up too soon.
The data would show: Patients enrolled in hospice earlier often live longer, with fewer ER visits, and at lower cost. When fully informed, most patients prioritize quality of life over marginal survival benefits. Many clinicians and families delay hospice until the very end, when it should be a default part of care from the start. The reality is some cancer patients just want to make it to the wedding or the graduation. But, that is not always respected or observed.
The Lie: Once you survive cancer, you are cured and are in remission.
The data would show: Cancer survivors face elevated risks of secondary cancers, cardiac disease, cognitive impairment, and psychological distress for decades. Our “cure and discharge” model abandons patients precisely when they need ongoing surveillance and support. We should also be measuring quality-adjusted life years, which is how long a patient lives and how well they live, rather than tracking a yes / no survival metric.
The Lie: Oncologists treat patients for the financial profits.
The data would show: Taking care of their patients is their mission. If you have met an oncologist, they don’t do this just for money. You can’t go into cancer care unless it is a passion and mission. Every oncologist leverages all of the information they have to make the best treatment decision they can for a patient. The issue is that (due to structural, system-level issues) oncologists and health systems don’t have the capacity and resources to perfectly treat every patient they are taking on with high enough attention.
The Lie: Outcomes for cancer in the U.S. are fairly uniform.
The data would show: Massive geographic disparities exist today, as a patient with good health insurance still has better outcomes (on average) in NYC than a patient on Medicaid in rural South Dakota. Outcomes drastically change based on care access, as logistical barriers (transportation, navigation, financial toxicity) are often the real blockers to receiving timely cancer care. AI holds the promise to level that playing field and give patients the opportunity to receive the correct intervention far quicker and with more precision than they may otherwise be getting.
The Lie: More expensive cancer treatment is better.
The data would show: Community oncology centers with good navigation and adherence programs often match or beat large academic centers on real-world survival and cost-effectiveness. Just because you pay 4x for treatment does not mean you are getting a 4x better outcome.
The Lie: Patients and providers need complete information every step of the way.
The data would show: Many patients find survival percentages confusing and anxiety-producing. They want clarity, not numbers. They want to know what they can do, not probability distributions. And, providers have a belief they need to have all of the information ready before they see the patient, so they make them wait until the imaging, pathology, etc. is done. Outcomes would improve if providers started seeing the patient as early as possible.
The Lie: Cancer care is too complex for primary care physicians (“PCPs”) to manage.
The data would show: PCPs could safely manage much of cancer survivorship care, routine surveillance, and even some straightforward treatment protocols. Oncologist-only care creates bottlenecks, delays, and fragmentation while ignoring that PCPs often know patients better and effectively manage their other chronic conditions.
The Lie: Precision medicine works wonders for every patient.
The data would show: Only 10-15% of patients today received a matched targeted therapy, and an even smaller fraction (~5%) have seen improved outcomes from that personalized drug. For the majority, expensive genomic testing provides no clinical benefit while delaying standard treatment and increasing costs. We are good at predicting populations, but still have some work to do on predicting individual treatment response. Meaning, we are very good at knowing what will happen if we flip a coin 100 times, but not as good at knowing what will happen if we flip it one time.
Comedy!
Remember Go-Gurt? Their whole marketing premise was that kids are too busy to eat yogurt in a bowl. As if a ten-year-old was like, “Mother, I simply can not sit for dairy. Put this yogurt in a tube. I need to meet Billy for our Play-Doh play date.”
We weren’t busy. We were just waiting for someone taller than us to drive us somewhere.
And those commercials… Go-Gurt showed us kids skateboarding and eating yogurt at the same time. Eating yogurt while standing still is risky. Yogurt is the least extreme food there is. It’s just milk that’s given up.
Now as adults, we pretend we’re busy in different ways. Like putting “Sent from my iPhone” in our e-mail signature. Why do people still have that? Like we need to know what device produced this masterpiece: “Sounds good thx”
People keep “Sent from my iPhone” on their email like they’re Navy SEALS mid-mission. Sorry for the short response, I’m on the go. Relax, you’re at Starbucks waiting for your Frappuccino.
We started life too busy for spoons, now we’re too busy for punctuation. We’re all still those kids, just older, more stressed and now lactose-intolerant.
Asks
Have a great holiday season!
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