Translating Modern Care of Blood Cancers Beyond the Academic Walls

As I sit here at the beginning of a new academic year, a time when we renew and recharge, welcome new learners, and set the agenda for the coming year, I am struck by a few reflections.

Life as an oncologist in 2024 is a conundrum. On one hand, we rejoice in the success of modern drug development, new molecular testing and diagnostics, and our newfound ability to detect the smallest hints of disease that went undetected just a decade ago. The breakthroughs have been nothing short of spectacular, and patients are clearly benefiting.

Balance this excitement with the patients we see in clinic who have exhausted all these options. We look them in the eye and talk about comfort and the best ways to spend their remaining time. It is impossible to live in both moments; yet they inform each other, drive each other, and drive me in my quest to leave no patient behind.

This is the Yin and Yang of clinical oncology. We see and experience firsthand the joy of remission or cure, with the struggle of discussions that often bring an abrupt end to cherished relationships with patients. New trainees with no long-term way to assess success are hungry for knowledge that can help them surpass the gains of our current generation. However, they haven’t yet seen that not every patient benefits from all these new advances due to social, financial, and access-related reasons. At a time when the optimal way to deliver the highest level of care is politically, socially, and financially in flux, we are no closer to tangible solutions that help provide complex care for patients in rural or urban deserts of cancer care.

As we put together this issue of Blood Cancers Today, our readers and authors are confronted with the same set of challenges. Don’t get me wrong; I would not for a moment go back two decades when therapeutic nihilism prevailed in cancer care; a time when we knew more than we could actually do. But the sting that not all patients can see these benefits remains and should drive our approach to democratize cancer care.

In high school, I was a big fan of Carl Sagan, who proclaimed, “We live in an extraordinary age. These are times of stunning changes…” He was just a few years early for cancer care. That time is now, and it is exciting to see that these developments have significant impacts on our practices and the patients we serve. At the same time, we must strive to improve access and ensure that high quality, state-of-the-art care is available for more than a select few who can travel to tertiary referral centers. If we can create ways to bring these “real world” solutions to the places where most cancer patients are treated, we will have successfully raised the tide of cancer care for all.

Sagar Lonial, MD, FACP, is Chair and Professor in the Department of Hematology and Medical Oncology, the Anne and Bernard Gray Family Chair in Cancer, and Chief Medical Officer of Winship Cancer Institute at Emory University School of Medicine in Atlanta, Georgia.