Payer-funded trials that omit surgery or radiotherapy in low-risk patients
Many low-risk patients get operations and radiotherapy they may not need. Health systems would fund the trials that find out who can safely skip them, and keep the savings.
Payers and public funders sponsor randomised trials of omission or de-escalation of local therapy: omitting sentinel node biopsy in older women with favourable breast cancer (as SOUND and INSEMA tested), omitting radiotherapy after breast-conserving surgery in genomically low-risk disease, active surveillance instead of surgery in low-risk thyroid and prostate cancer, and shorter or lower-dose regimens. These trials save money, reduce harm and address overdiagnosis, but have no commercial sponsor. Genomic and imaging biomarkers now allow risk-adapted selection that makes omission trials ethically and statistically feasible.
- Surgery and radiotherapy cure most, get least · Surgery and radiotherapy cure more people than drugs do, but attract a fraction of the research investment.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
- Overdiagnosis and false alarms · Finding more cancer is not the same as saving lives. Screening also finds cancers that would never have hurt anyone, and treats them.
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not linked directly; found by shared links- IdeaPay per course of radiotherapy, not per session, so short courses are not penalised
Shares Payers fund trials of cheaper, shorter or lower-dose versions of expensive treatments, Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam), Prostate cancer.
- IdeaModern autopsy studies to measure how much silent cancer people carry
Shares Overdiagnosis and false alarms, Thyroid cancer, Prostate cancer.
- IdeaMake one-week radiotherapy the default in overloaded systems
Shares Surgery and radiotherapy cure most, get least, IMRT / IGRT (modern external beam), Prostate cancer, HR-positive / HER2-negative breast cancer.
- IdeaAn international body to rename indolent lesions so 'cancer' means something
Shares Overdiagnosis and false alarms, Thyroid cancer, Prostate cancer.
- IdeaCertified decision aids required for every preference-sensitive cancer decision
Shares Overdiagnosis and false alarms, Prostate cancer, HR-positive / HER2-negative breast cancer.
- IdeaMolecular indolence classifiers bundled with every screening programme
Shares Overdiagnosis and false alarms, Thyroid cancer, Prostate cancer, HR-positive / HER2-negative breast cancer.
- IdeaProstate active surveillance without scheduled biopsies: MRI and blood tests decide
Shares Overdiagnosis and false alarms, Toxicity and quality of life are undervalued, Prostate cancer.
- IdeaMake skipping radiotherapy the default for very low-risk breast cancer
Shares Overdiagnosis and false alarms, Toxicity and quality of life are undervalued, HR-positive / HER2-negative breast cancer.