The Moonlight Shift: Dr Maurie Markman on Oncology's Biggest Problems

In the inaugural episode of The Moonlight Shift, Maurie Markman, MD, president of medicine and science at City of Hope and editor-in-chief of OncologyLive, offers a candid assessment of where precision oncology stands today — and where it is quietly failing.

The Community Gap

Markman draws a sharp contrast between precision medicine as practiced in academic subspecialty centers and the reality facing the roughly 90% of patients with cancer treated in community settings. With hundreds of molecular subtypes now recognized across cancer types, new drugs approved weekly, and no adequate decision-support infrastructure in place, community oncologists face a complexity that no individual clinician can fully absorb. He cites recent data showing fewer than half of eligible patients with non–small cell lung cancer in the community received molecularly targeted therapy when indicated.

The Cost Crisis

Asked what the field is reluctant to say publicly, Markman identifies drug cost as oncology's most consequential unaddressed reality. With regimens now reaching $20,000 to $30,000 per month — and combination strategies pushing those figures higher — he argues the current trajectory is simply unsustainable, particularly as cancer is increasingly managed as a chronic illness requiring years of continuous therapy.

Decision Support and What Has to Change

Markman closes by returning to a theme he has addressed in previous columns with OncologyLive: the absence of a national owner for oncology decision support. He calls for payment reform that incentivizes treatment optimization and targeted HIPAA reform to enable anonymized real-world data sharing — arguing that the tools to build meaningful decision support already exist, but the structural will to deploy them does not.

The Moonlight Shift is available on YouTube and across MJH Life Sciences’ oncology platforms. New episodes, released bi-weekly, feature leading and early-career oncologists from the Tri-State corridor in peer-level conversations about where the field is going — and what it still has to work out.