Application of basic science research in oncology
About The Course
Basic science resides on the lower tiers of EBM's
hierarchy of evidence. Therapeutic decisions, according to proponents of EBM,
should be informed by evidence from randomised studies and their systematic
reviews rather than basic science. Relying on the framework of models, it shows that basic science often plays a role not only in specifying experiments, but also analysing and interpreting the data that is provided.
Clinical medicine is a teleological science. What
matters is the outcome: improving the health of a patient. In this way,
clinical medicine shares challenges with other teleological sciences. The
complexity of cancer and the diverse treatment options available exacerbate the
challenges of developing an evidence base that will adequately support clinical
There are hundreds of different types of cancer,
with multiple stages of disease (e.g., precancer, early-stage disease,
metastatic disease). The multiple treatment modalities and combination
strategies for cancer treatment necessitate coordinated teams of professionals
with multiple skill sets.
Additionally, the toxicity of many treatment options
often requires patients and clinicians to make difficult decisions that weigh
the benefits and harms of alternative treatment approaches. Although cancer
care is evolving quickly, with manufacturers marketing new drugs and devices
that have the potential to improve current treatment, those innovations come
with substantial human and financial costs.
Decisions need to be made, often quickly, and
invariably on limited information. Like many applied sciences, the evidential
inputs into decisions come from a range of ﬁelds.
Clinical medicine relies on the basic medical
sciences of physiology, pathophysiology and immunology, as well as applied
clinical research in the form of observational studies and randomised
trials—not to mention the many additional ﬁelds that complement these sources
While basic medical science provides a rich
theoretical basis for medical decisions, applying the best-supported mechanisms
of basic science to patient care is not straightforward. Learning more about
the pharmacological/pathophysiological mechanisms can help to discern which
patients are more likely to beneﬁt from therapy.
But medical knowledge remains incomplete and relies on observing the average response of therapy in a deﬁned group of patients.