Knowledge reaches practice too slowly

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.

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.

Use AI translation plus expert checking so that when a cancer guideline changes, doctors in every major language see the change within a month rather than years.

Wikipedia is where most people first read about their cancer. Pay clinicians and librarians to keep the cancer pages accurate, current and readable in many languages.

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. A dedicated plenary for important trials that failed would make the lessons 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.

Drugs are described as phase 1, 2 or 3 so everyone knows how proven they are. Biomarkers should carry the same kind of label so a 'promising' marker is not mistaken for a validated one.

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 15-25 smaller doses is proven safe for breast and prostate cancer and could treat three times as many patients on the same machines.

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.

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.

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.

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.

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 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.