Oncology needs a recalibrated approach that is more patient-centred and delivers equitable cancer care. An approach that prioritizes:

• patients’ needs with treatments that improve survival and quality-of-life
• patient informed decision making
• making treatments accessible to all patients 

Cancer treatment decisions are increasingly complicated. While some cancer treatments provide large benefits, many new approved treatments do not help patients live longer or better (1,2).

All cancer treatments have side-effects, can cause substantial financial burden, and can result in lost time for patients spent in hospital rather than with friends and family.

Cancer systems now face a troubling paradox. In some circumstances there is substantial overuse of treatments with very small benefits, while at the same time many patients worldwide lack access to effective treatments which can make a meaningful difference in their lives.

Commercial interests, rather than patient interests, often drive cancer care and research. New cancer medicines now cost on average US$200 000 per year per patient, including those that do not help patients live longer or have better lives (4,5).

A substantial proportion of industry revenue is used for marketing campaigns to influence patients, policy makers, and oncologists irrespective of clinical need (6). Industry marketing
campaigns and media reports often hype marginal treatments, which contributes to overuse of cancer treatments with small or negligible benefits (7). These marginal treatments are not benign – they cause toxic side effects and financial burdens, negatively impacting patients quality of life.

How have these problems arisen in modern cancer care?

• Over the past few decades cancer clinical trials have shifted from predominantly publicly funded studies designed to answer questions important to patients, to industry funded trials designed to achieve regulatory approval or commercial advantage (1).
• The goal of improving and lengthening the lives of patients and that of making a profit for are often not aligned.
• Industry’s control of the research agenda has created a system that is predominantly focused on new cancer medicines at the expense of investigating new approaches to surgery, radiotherapy, palliative care, and prevention.
• This model is problematic. Surgery and radiotherapy cure many more patients than cancer medicines yet receive much less funding for research and delivery of care. Moreover, in low-middle income countries most patients are diagnosed with incurable disease yet do not have access to adequate pain relief and palliative care.
• Another problem is the lack of clear communication regarding the magnitude of benefit and risks associated with therapies. When facing terminal cancer it is difficult for both oncologists and patients to balance hope with reality when discussing prognosis and treatments. Patients and clinicians often feel compelled to do something when faced with progressive disease, even if that something has minimal benefit and causes toxicity. Clear and compassionate communication is necessary to ensure that patients make informed treatment choices.

Patients deserve better information and better care. To achieve this, paradigm shifts will be needed in education research design and investment, policy, media and communication, and delivery of care (8). In April, 2023, global oncologists and patient advocates met at Queen’s University (Kingston, ON, Canada). The objectives of this meeting were to establish core tenets to guide development of a patient-centred Common Sense Oncology movement, develop goals and an action plan, and disseminate CSO guiding principles so that oncology trials and treatments are focused on outcomes that matter.