January 2015 Edition Vol.9, Issue 1

2015 Forecast Series—ASCO Priorities and Objectives with Peter Paul Yu, MD, ASCO President

2015 Forecast Series—ASCO Priorities and Objectives with Peter Paul Yu, MD, ASCO President

Peter Paul Yu, MD, FACP, FASCO, Director of Cancer Research, Palo Alto Medical Foundation, Palo Alto, CA, and President, American Society of Clinical Oncology (ASCO)  

OBR: What would you say were the bigger accomplishments for the ASCO membership in 2014 and what are the primary goals for ASCO in 2015?

PY: ASCO membership has now reached 36,000. As a professional society, ASCO is dedicated to supporting our members in their oncology careers wherever they are located in the world and in whatever aspect of oncology they have chosen to pursue, be that patient care, research and/or education. At this point in time, ASCO domestic membership is facing a rapidly changing and challenging environment that is transforming the very definition of what it means to be a community-based clinical oncologist. In 2014, we published our “State of Cancer Care in America” study, which is a deep dive into the status of community oncology and allows comparison to a similar study we performed in 2013. In 2015, look for ASCO’s response to what we have learned as we continue to mark these trends. Recognizing our responsibility to do more than just observe and document, ASCO is launching a new department of Clinical Affairs whose focus will be on actively assisting oncologists in improving healthcare delivery operations at the practice level.

International oncologists comprise 30% of ASCO members, and in 2015 we will be increasing attention to global health. A Presidential Global Oncology Leadership Task Force led by past-ASCO President Gabriel Hortobagyi is now examining how ASCO can make a difference across the world, working in partnership with other organizations to meet unmet needs where ASCO has resources to contribute. These findings will be incorporated into ASCO’s three year strategic plan which we will unveil in Chicago at the 2015 ASCO Annual Meeting.

OBR: In your role as President of ASCO, you see the big picture of how cancer care is changing in various healthcare systems across the nation. What impresses you the most, both positive and negative, in regards to quality cancer care?

PY: Over the last decade, ASCO has presciently developed a robust quality improvement program, QOPI, in which over one-third of practicing US oncologists have participated. Quality, however, bears a close relationship to cost of care. High quality at an unaffordable cost is meaningless, because access to that high quality care will be unavailable. Fortunately, done correctly, high quality of care can reduce costs by providing better patient outcomes that end up reducing downstream costs due to progression of disease or long-term toxicities as well reduction of iatrogenic errors. This means that quality measures need to move beyond measures that track the process of care delivery to include measures that document improved disease outcomes. 

OBR: What is ASCO doing to reach out to medical schools and entice medical students to pursue oncology as a specialty?

PY: This year ASCO will implement a pilot program to sponsor medical student interest groups. This initiative will help students interested in oncology to organize, learn more about cancer and the field of oncology, develop lasting professional relationships, and provide a forum for students to meet and discuss important cancer topics. ASCO is developing guidelines to help student interest groups be productive and effective, creating educational materials to support the student interest groups’ educational needs, as well as provide funding to be used by groups to purchase supplies and food for meetings. The program’s goal is to increase medical student membership in oncology student interest groups which will lead to greater medical student engagement and interest in oncology.

OBR: We understand that research is key to making incremental gains in oncology. How do you see ASCO helping to improve access to clinical studies?

PY:  Our academic-based colleagues face continuing constriction in NCI funding for clinical research and the cooperative groups in particular. ASCO is fortunate to have two Cooperative Group Chairs, Dr. Charles Blanke from SWOG and Dr. Wally Curran from NRG sitting on the ASCO Board, as well as former CALGB Chair, Dr. Richard Schilsky as ASCO’s Chief Medical Officer. We will continue our strong advocacy for clinical research and financial support for young academicians dedicated to careers in cancer research. 

A great challenge to the efficient conduct of clinical trials—be they federal or industry funded—is re-engineering the drug development process so that the bandwidth of the clinical trials enterprise expands to accommodate the outpouring of new science and technology that is resulting from two decades of Precision Medicine. ASCO has proposed a new clinical trial model to match FDA approved targeted therapies to biomarkers found to be present in other cancers as a way to detect early strong signals that will enable us to open phase 2 trials that are much more likely to result in positive findings. One of our goals should be to strive for more than incremental gains through research.

OBR: Are you happy with the adoption of EMRs amongst the membership? What are the benefits of EMR adoption, and what are the pitfalls you are seeing?

PY: EMRs are enablers of more rapid learning and quality improvement. However, to realize this benefit we need to change how we practice medicine and how we learn from our experiences simultaneous with our implementation of EMRs. In other words, placing an EMR on top of inefficient, wasteful delivery systems will only further exacerbate those deficiencies.  Implementing an EMR should be seen as an opportunity to re-examine why and how we practice medicine, to ask why is there so much variation in how we practice, and in turn, drive best practices from shared learning.

We need to understand that improving documentation is critical because the digital medical record is a tool that is accessed and contributed to by the entire cancer team and underlies the communication that is critical for improving patient outcomes. Whether data must be entered in a standardized format, which is more readily extracted but more time consuming, or can be documented in an unstructured but still machine searchable format, is dependent on technical solutions now being designed. But ensuring that the data are complete and accurate is the clinician’s responsibility.

OBR: We’d like to hear more about your impressions of CancerLinQ. How is the project progressing? How will the information be used? Who can access the data?

PY: ASCO will launch the first production version of CancerLinQ in 2015. We will be announcing early in 2015 a partnership with an industry leading technology firm, and we already have more than a dozen cancer practices signed on to contribute their EMR data—practices that range from private community practices to community and academic healthcare systems. Initially the data will be analyzed for quality and operational improvement in cancer care delivery and result in detailed reports and clinical decision support tools, but we envision that in the near future the data will be mined for genotypic-phenotypic correlations, allowing us to more rapidly learn about the intersection of precision medicine and personalized medicine.

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