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Shruti Agarwal: Build for the 80%, Not the 20%

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Jul 21, 2025, 15:50

Shruti Agarwal: Build for the 80%, Not the 20%

Shruti Agarwal, Founder and President at NeedleSpotter, shared a post on LinkedIn:

“80% of cancer patients are treated in community settings. Yet 90% of innovation stays trapped in academic centers.

Here’s why I’m betting everything on closing that gap.

After 15 years in pharma, I’ve seen the same pattern repeat:

We launch breakthrough therapies. Celebrate at academic centers. Assume the innovation will trickle down.

It rarely does. Not fast enough.

The disconnect is staggering.

We design sophisticated programs, but the oncologist in rural Nebraska – treating 30% of their county’s cancer patients – often can’t access them.

Their EMR can’t process our specialty pharmacy workflows. Their staff is buried under prior auths.

It’s not about capability. It’s about infrastructure. Support. Recognition.

When I started Together4Cancer, I made a choice:
Build for the 80%, not the 20%.

What pharma gets wrong:

1. We equate complexity with sophistication. Academic centers have teams. Community practices have 2 people doing 10 jobs.

Simplicity isn’t dumbing down – it’s respecting this reality.

2. We design for ideal conditions.

Perfect biomarkers. Instant referrals. Dedicated navigators.
Most community settings have none of these.
Yet we act surprised when ‘standard of care’ isn’t standard.

3. We measure the wrong things.

Conference attendance. Citations. Advisory boards.
Meanwhile, time-to-treatment in community clinics gets worse.
What good is innovation if it doesn’t reach the patient?

Here’s what I’ve learned:

1. Meet them where they are.

Not just at conferences – in their clinics and on digital media during their rare downtime.
Not with 50-slide decks – with 2-page practical guides.
Not assuming knowledge – building it together.

2. Solve real problems.

‘How do I bill for this?’
‘What’s the simplest prior auth path?’
‘How do I manage the AE if it shows up on day 3?’
These aren’t trivial – they’re the difference between hesitation and confident prescribing.

3. Build confidence, not complexity.

Community oncologists need clear, actionable resources to trust the data and feel equipped to prescribe practice-changing therapies – especially when the stakes are high and the support systems are thin.

4. Respect their expertise.

Community oncologists manage everything – every cancer, comorbidity, and social barrier.
They don’t need more education. They need tools that work in their world.

The future of cancer care isn’t in ivory towers.
It’s in strip malls. Rural hospitals. Under-resourced clinics serving real people.

Because a breakthrough therapy that doesn’t reach the community?

That’s not a breakthrough at all.

That’s why I chose community oncology.
Not despite the challenges – because of them.

I’m deeply grateful to the early adopters and collaborators who believe in this mission and are powering its execution. Together, we can shift the standard.”

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