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Hematology-oncology physician Yousuf Zafar discusses his article, “The personalization of cancer care in 2025.” He traces the evolution of cancer treatment over the past two decades, moving through waves of cytotoxic chemotherapy, biologic therapies, immunotherapies including groundbreaking CAR-T therapy, and now precision oncology, which targets treatments to the specific molecular profile of a patient’s cancer. While these advancements have significantly improved survival and quality of life, Yousuf highlights the resulting increase in care complexity and the widening gap in outcomes between specialized centers (where only 20 percent of U.S. patients are treated) and community practices (where 80 percent of care occurs), particularly impacting rural areas where 66 percent of counties lack an oncologist. The conversation explores how digital health solutions, such as remote case reviews connecting community oncologists with subspecialists, can help bridge this divide and improve access. Importantly, Yousuf stresses that personalized care extends beyond treatment to encompass vital patient support for financial burdens, mental well-being, and survivorship. Actionable takeaways emphasize the need for collaboration, resources for community oncologists, investment in digital health tools, and a continued focus on patient-centered support throughout the cancer journey.

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Transcript

Kevin Pho: Hi, welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Yousuf Zafar. He’s a hematology-oncology physician. Today’s KevinMD article is “The personalization of cancer care in 2025.” Yousuf, welcome to the show.

Yousuf Zafar: Thank you so much for having me.

Kevin Pho: All right, so let’s start by briefly sharing your story and then jumping into the reasons why you shared this article with KevinMD.

Yousuf Zafar: As you said, I’m a medical oncologist with a focus in gastrointestinal oncology. I did my training at Duke University and was on faculty there for about 17 years as a clinician, as a health services researcher, and as an administrative leader.

A few years ago I decided to take the leap, try something different with my career. And currently I’m the Chief Medical Officer of a company called Access Hope, which provides second opinions for patients receiving cancer therapy.

Kevin Pho: All right. And your KevinMD article’s about “The personalization of cancer care in 2025.” For those who didn’t get a chance to read it, tell us what it’s about.

Yousuf Zafar: As I was thinking about this article, I realized that cancer care, to no surprise, has become really complex. A mentor of mine once told me that one day every cancer is going to become a rare cancer. Think about that for a second. What that means is that the way we diagnose cancer, the way we categorize it and treat it, is going to become, by orders of magnitude, more complex. And so I was thinking about how that’s happened over the past couple decades that I’ve been in practice.

When I first started, all we had were cytotoxic therapies that hurt patients, sometimes more than they helped. Then there was this first evolution in cancer care, and that happened with targeted therapies and biologic therapies, where the treatment got a little bit less toxic and much more effective. Then there was a second wave of immunotherapy. Everybody’s talking about immunotherapy in cancer care today. And now we are in the midst of this third wave in cancer care, built around precision medicine and technology-enabled care.

And I thought it was really important to think about how this evolution in cancer care impacts providers and has made care better and more complex. We see it: oncologists rely on NCCN guidelines for care delivery. These are nationally recognized guidelines for cancer care. The decision paths per cancer within NCCN has increased by nearly 400 percent since those guidelines came into play. It’s mind-boggling.

Kevin Pho: So tell us about that evolution that you mentioned in terms of its impact, not only on clinicians, but for patients.

Yousuf Zafar: For patients, it’s been tremendously complex because a patient who is trying to figure out what is the best care that I can get doesn’t necessarily have a single source of truth for that. By default, as it should be, their source of truth is the oncologist who’s treating them. Now we know 80 percent of care that happens in the U.S. is happening at community oncology practices. And so what we are doing at Access Hope, for example, is trying to understand how can we support the community oncologist and their patient through these ongoing continuous waves of innovation in cancer care.

One way that we’re helping the patient and the community oncologist is to say, all right, maybe you don’t have to go somewhere else to get that second opinion. We’ll bring it to you. We’ll take an expert subspecialist opinion from an NCI Designated Comprehensive Cancer Center. We’ll have that oncologist review your care and we’ll bring the review back to you to limit delays, travel expenses, and difficulty in decision-making. So that’s, I think, one small piece that we can play. I’m really proud to be at Access Hope to help with that. There’s so much more that we can do as we think about simplifying and honing down the way we deliver cancer care today.

Kevin Pho: So are there disparities in terms of the treatment options patients receive, whether they are treated at a large academic medical center like Duke versus by a rural oncologist, especially with the rapid pace of evolution of cancer treatments like we’ve mentioned?

Yousuf Zafar: It’s a tremendous problem, and we see that just by looking at the data that’s available today. First of all, we know there has been, and sadly will continue to be, inequities in care when it comes to race, gender, and income. One aspect of inequity that we’re seeing very clearly in cancer care is based on geography. We know that there was a really interesting paper that came out in JCO Oncology Practice recently that found that the majority of counties in the U.S. don’t have a clinical trial based in them.

In cancer care, we think about clinical trials as the cutting edge in all of medicine. We think about cancer clinical trials as the cutting edge of therapy, and to not have access to that is a tremendous source of inequity. We also know that patients with cancer who are living in rural areas have less access to the best care than those who are living close to an NCI Designated Comprehensive Cancer Center. So we need to think about these issues further and understand how can we impact them to decrease these disparities in care that you mentioned.

Kevin Pho: So in practical terms, what would that look like? Would that conceivably be, if someone is, say, in a rural setting, they may get a cytotoxic option, whereas someone in an academic setting may get access to a more biologic option or immunotherapy or precision oncology option? Is it something as simple as that which we’re seeing?

Yousuf Zafar: I think there are structural barriers at play. Now, let’s take the example—let’s move away from my world of medical oncology and talk about the world of surgical oncology. We know that there are patients who might be eligible for a pancreatic cancer surgery, a Whipple procedure, which is one of the most complex procedures that you can get, who don’t have access to the procedure because of where they live. And so they don’t get surgery even though they might be eligible for it, again, because of the zip code that they live in, because of their lack of access to a high-volume center where that procedure is performed. So there’s that structural barrier.

Another is just in the volume of patients that are being seen by medical oncologists today. More and more practices and hospitals in rural areas are closing down, and so oncologists are seeing tens and tens of patients, 40-plus patients a day, in some of these smaller rural practices. They have to treat a patient with prostate cancer in one room, go into the next room to treat a patient with breast cancer, next room treat a patient with leukemia. It’s a lot to keep up with as our care is evolving rapidly. It’s practice patterns, it’s structural barriers, and so much more that we have to consider when it comes to optimizing cancer care.

Kevin Pho: And are we seeing things like mortality disparities because there is such a geographic disparity when it comes to different cancer treatment options?

Yousuf Zafar: There is evidence out there that lack of access to the best care possible can impact outcomes, including survival. And that’s not just related to some of the structural barriers I’ve talked about. Something that’s near-and-dear to my heart is the financial toxicity of cancer care. That’s something that I spent most of my career as a researcher working on.

We know for sure that patients who are experiencing greater inequity when it comes to the financial aspects of cancer treatment do worse and their survival is impacted. Cancer care is complex, and there are so many factors that contribute to how well a patient does, but that doesn’t mean we can’t think about and address all of them.

Kevin Pho: Let’s talk about some of the paths forward. For those patients that may have a geographical barrier to the best cancer care, what kind of options do they have?

Yousuf Zafar: This is where again, I’m so proud to work at a company that is impacting that very barrier. What we do is we provide that remote second opinion to an oncologist and their patient who may benefit from it in real time. But that’s not it. We have so much more that we can look to. I think there’s a lot of progress being made taking advantage of technology. What about remote multidisciplinary conferences? Remote tumor boards, where we can take in data from across an entire state, across an entire geography, and look at complex genomic reporting in oncology, and identify a targetable mutation that maybe a community oncologist who’s up to their neck in just keeping up with first- and second-line treatment might not realize is a targetable option in the third line.

So I think there’s a lot that we can do to take advantage of technology today to lessen the burden on community, to either one, validate the outstanding care that they are providing—which is really what should happen most of the time—or provide additional options that they might not have seen before. The key to that though, Kevin, will be to do it in their workflow. And this has been one of the biggest challenges when it comes to technology today. Somebody told me once, and I completely identify with this, and you will too, as a practicing doc: the minute you have to have a physician look at a second piece of glass, the odds of that physician adopting what’s happening on that other screen not integrated in the EHR starts to drop. So whatever we do, however we deliver these solutions, whether it’s second opinions, whether it’s multidisciplinary conferences or genomic interpretation, we have to figure out how to do that within the clinical workflow as it exists today.

Kevin Pho: So tell us a success story. What would that look like? It could be hypothetical, it could be a real story where a patient would use one of your second opinion services or use some of these technological options to overcome some of those obstacles to receiving the best cancer care. Tell us a story of what that would look like.

Yousuf Zafar: This is something that happened to us at our company a few weeks ago. We performed an expert opinion on a patient who was living in a rural county and had an advanced complex cancer. When our reviewer at an NCI Designated Comprehensive Cancer Center reviewed these patient records, they realized that the patient’s care was not aligned with the standard of care by any means. The reviewer reached out to us and said, “I’m looking at this case. I’m really concerned.”

We said, “Do the review.” We got the review and, in a matter of hours, we were then talking to the community oncologist who was treating this patient and sharing this expert review. And the community oncologist said, “Your timing is perfect. I was really unsure about what to do next with this patient. I’d reached the end of what I expected to be the standard of care. The opinion that you’re providing is helping me in real time.” And we also provided a clinical trial option for this patient, and that oncologist said, “This trial is something that I think my patient would be interested in. I’m going to investigate it.”

So, in this case, we were able to pick up that needle in a haystack, that patient who was getting care with an incredibly intelligent and well-meaning oncologist who needed help. And so I was really proud that we were able to help that patient and that oncologist using our technologic capabilities and our expertise.

Kevin Pho: We’re talking to Yousuf Zafar. He’s a hematology-oncology physician. Today’s KevinMD article is “The personalization of cancer care in 2025.” Yousuf, let’s end with some take-home messages that you would like to leave with the KevinMD audience.

Yousuf Zafar: If I think of a take-home message for me as a still-practicing physician who had a long career in academic medicine and has now transitioned into industry, I think the key is, for clinicians who are listening, to deliver the best care possible, we have to align all stakeholders in our health care delivery system. That includes patients, clinicians, payers, and employers. With that in mind, I think of three key lessons that I listen to myself.

Number one: Don’t silo yourself. Care delivery has to have the benefit of interdisciplinary minds. We have to talk to others outside of where we live to understand how to improve care.

Number two: Don’t underestimate your power as a clinician in impacting systemic change. There’s so much happening out there that’s supposedly impacting health care without the voice of the clinician. Be that voice. Step up and be a part of the tremendous change that’s happening around us.

Third, I would say, it’s still OK to start small in changing your practice. Paying attention to the potential disparities and inequities in your patient population, paying attention to how technology may or may not be helping your population—that’s a step towards changing our system for the best.

Kevin Pho: Yousuf, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Yousuf Zafar: My pleasure, Kevin. Thank you so much for having me.