EP289: The Right Amount of Oncology Screening and Care—In a Pandemic and Not in a Pandemic, With Bishal Gyawali, MD, PhD

In this Episode 289, Stacey Richter talks with Bishal Gyawali, MD, PhD, a medical oncologist and assistant professor at Queen's University, about finding the right amount of oncology screening and care — in a pandemic and not in a pandemic.

WHAT YOU'LL LEARN

✅ Why more care isn't automatically better care, and what to focus on instead

✅ Why the distinction between "survival" and "mortality" matters so much in cancer outcomes research

✅ How financial toxicity from cancer treatment can be as dangerous to patients as the disease itself

✅ Why conflicts of interest on guideline committees can distort what counts as standard of care

✅ What payers, hospitals, and individual clinicians can each do to pay for value instead of volume

WHY THIS MATTERS

Dr. Bishal Gyawali argues that American health care has a cultural bias toward "more is better," when the data often say otherwise — especially in oncology, where aggressive treatment isn't always the highest-value treatment. He makes the case for being data driven rather than reflexively pro- or anti-intervention, for reevaluating cancer screening protocols against the evidence, and for taking financial toxicity as seriously as any other clinical risk factor, since patients who face financial toxicity have been shown to die earlier. His prescription touches every level of the system: guideline committees free of industry conflicts, payers who negotiate drug prices based on clinical benefit, and hospitals that offer real price transparency and financial counseling.

MENTIONED IN THIS EPISODE

🔗 EP282, with Aaron Mitchell, MD, MPH

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

📺 Subscribe to our YouTube channel

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction.

03:18 Oncology decisions on the individual level and oncology policy decision making.

05:10 Reverting to the mean.

06:29 "We're assuming … more care is good care, which is not necessarily true."

06:49 "What we need to focus on is above-average level of health outcomes."

07:55 "Sometimes we forget the goal, and we get so entangled in the path itself that we forget the destination."

11:19 Cutting out low-value care during the pandemic.

12:09 Reevaluating cancer screens and looking at the evidence for appropriate use cases.

13:24 Distinguishing the term "survival" from "mortality."

16:34 "If a person dies, it does not matter what the person died of."

17:26 "A lot of the things that we do routinely in medical practice need to be reevaluated."

18:53 The FDA approval of oncology agents and things that make a difference.

20:37 "What exactly are we gaining from these drugs?"

20:53 EP282 with Aaron Mitchell, MD, MPH.

23:15 Dr. Gyawali's advice to policy decision makers.

23:42 Policy decision-making interventions that are possible.

24:50 "The problem with these guidelines … is that a lot of these people who are on these guidelines, they have huge conflicts of interest to the industry."

26:58 How to pay less for low-value care.

27:42 A better path forward to pay for value.

31:02 Ways to help on the individual level.

32:07 "At the end of the day, the ultimate use of an intervention happens in the clinic."

34:24 "We should never be pro or anti anything; we should just be pro-data."