How common sense oncology can help redefine precision medicine and improve patient experiences

When people think of cancer research, they often picture scientists in white coats developing new drugs in a lab. That work is vital. But equally important—and often overlooked—is figuring out how to bring these treatments to patients in ways that truly improve their lives. 

That’s where cancer policy researchers like me come in: we seek to find policy solutions that help give patients access to better drugs that not only cure their cancers but do so in ways that maintain their quality of life and don’t bankrupt healthcare systems with limited resources—not an easy task, as you can imagine, but one I’m passionate to see through. 

This passion has been forged through years working as a medical oncologist around the world. I’ve studied, practiced and conducted research in Nepal, Japan, the United States and now Canada. In lower-income countries especially, I’ve watched patients die because they lacked access to existing, inexpensive treatments like standard chemotherapy. In higher-income countries, I’ve watched patients endure toxic, high-cost therapies that did not extend their lives but robbed them of quality time with their loved ones. 

Neither of these approaches are helpful for patients, which is why I’m convinced that cancer care, and cancer research, must change. We need an approach that focuses on access to drugs and other therapies, but that also delivers outcomes that actually matter to patients, such as survival, quality of life and dignity. 

That’s why I helped launch the Common Sense Oncology movement, which pushes for a reset in how we generate evidence and make decisions in cancer care. We believe cancer research must focus not only on developing new treatments, but also on understanding how they impact the health of our patients and our healthcare systems. It seeks to ask new questions, such as: Who exactly will benefit from this drug and by how much? Can we reduce its toxicity? Can shorter treatment duration be just as effective? Do patients feel better and live better? Does it make sense for healthcare systems to fund this treatment? 

These questions have a profound impact on how we understand precision oncology. Of course, we still need to give the right treatment to the right patient at the right time, but precision oncology must also mean delivering treatments at the right dose and for the right duration so we can reduce toxicity and optimize quality of life and costs of care. This is the main goal of common sense oncology, and my purpose as an oncologist and a researcher. 

Initiatives like the Marathon of Hope Cancer Centres Network’s Patient Voices in Research are helping make this possible. By placing cancer survivors (including those receiving treatments) and their caregivers at the heart of research funding decisions, the Network is ensuring that studies tackle real-world concerns, from access to therapies across jurisdictions to patient-reported outcomes and supportive care interventions. This is what patient-centred research should look like: collaborative, pragmatic and driven by lived experience. 

I remain optimistic. If we can shift cancer research and care to build on realistic hope rather than hype, we can deliver treatments that are not just innovative, but truly impactful. By embracing common sense oncology, we have the chance to redefine precision medicine in ways that honour what matters most—helping patients everywhere live not only longer, but better. 

*Bishal Gyawali, MD, PhD, FASCO, is a physician-scientist, medical oncologist, and Associate Professor in the Department of Oncology and the Department of Division of Cancer Care and Epidemiology, in Queen's University at Queen’s University. Known internationally for his work in global oncology, evidence-based medicine, and health policy, Dr. Gyawali combines clinical practice with a bold research agenda aimed at making cancer care more equitable, affordable, and effective. Dr. Gyawali is also the lead researcher on a project funded through the Network’s Patient Voices in Research initiative.

If you’re interested in reading more about the Common Sense Oncology initiative, see the following publications: 

• Common Sense Oncology: outcomes that matter. Booth et al., Lancet Oncology 2023 
• Cancer treatments should benefit patients:  a common-sense revolution in oncology. Gyawali & Booth, Nature Medicine 2022
• Common Sense Oncology: Equity, Value, and Outcomes That Matter. Wilson et al., ASCO Educational Book 2024
• Common Sense Oncology principles for the design, analysis, and reporting of phase 3 randomised clinical trials. Gyawali et al., Lancet Oncology 2025 

Note from the Marathon of Hope Cancer Centres Network: through the generation of the Gold Cohort dataset, the Network is supporting an immunotherapy treatment duration trial as well as a pragmatic trial studying informed decision-making for ovarian cancer patients.