Each year, the privilege of serving as ASCO president involves the task of crafting much of one’s initiatives, and especially the Annual Meeting, around a theme. The year 2017 represents my 35th as a practicing oncologist, and I have chosen “Making a Difference in Cancer Care WITH You,” as my theme, because that is exactly what ASCO does. This is your Society, and it exists solely to improve the care of patients at risk for, or with, or who have survived this terrible disease that affects so many of us and our loved ones. How does ASCO do so? In partnership between the incredibly talented staff and you, our volunteer members who devote so much of your time to meet our mission.
The ASCO presidential term has traditionally spanned 3 years (starting in 2017, it will be a 4-year term). Historically, the second year is the quintessential “presidency,” whereas the third year is a bit of a wind-down. Importantly, the first, or “president-elect,” year is a ramp-up, so that the incoming president has had 12 months to learn and understand the complexities of this vast organization.
And complex it is! After serving on the Board of Directors (BOD) and on several ASCO committees through the last 20 years, I thought I had a pretty good handle on the workings of our Society. I had no clue. Indeed, what has made this job so interesting has been the task of having to digest reams of information about issues for which I had little or no experience—ranging from government policy to global oncology to public relations. In fact, one of my early initiatives was to have an “ASCO Matrix” put on paper (well, electronically) that illustrates the interface between ASCO departments, run by our incredible staff, and ASCO committees, consisting of you, our members.
Perhaps the most rewarding, and challenging, experience has been my engagement with our newly formed Clinical Affairs Department, led by Dr. Stephen Grubbs. Many of you know Dr. Grubbs, but just a brief backstory: Steve was in community practice and served as managing partner in the Medical Oncology Hematology Consultants, PA, in Newark, Delaware. He also was principal investigator of the Delaware Christiana Care National Cancer Institute (NCI) Community Oncology Research Program (NCORP) for many years. He and I overlapped on the BOD, during which time I learned that rather than talking during committee meetings, a talent many of us in academics have honed to a fine art, listening to the members who represent community practice was a much more productive exercise. Steve’s comments were always thoughtful, well-stated, and productive—never self-serving, but focused on ensuring that whatever our decision on a particular topic, it would result in the best outcomes for our patients. The long list of accomplishments made possible by Steve’s collaboration with state political leaders before and since he joined ASCO staff as vice president of the Clinical Affairs Department highlights the importance of these relationships and the impact they can have on the national stage.
Segue into one of the first meetings I attended as ASCO president-elect: the State Affiliate Council (SAC) meeting at ASCO headquarters in October 2015. State Affiliates are just that—entirely independent state or regional oncology societies to which many of you belong, especially if you are in community practice. These geographically based societies are independent associations that are affiliated with ASCO through the State/Regional Affiliate Program and are represented through the SAC, which was established in 2012 to form a communication bridge between the affiliates and ASCO. They are a vital link between ASCO’s leaders and U.S. members caring for patients with cancer in communities across the country. Each state/regional society has a voting representative on the SAC, which meets twice a year. The SAC is housed within the ASCO Department of Policy and Advocacy, directed by Deborah Kamin, RN, PhD. The SAC performs several roles, including identification of unaddressed needs of our members, disseminating information about ASCO’s public policy priorities to its membership, and understanding and responding to emerging practice and research issues at the state level. Most importantly, it provides a strong line of communication between the ASCO BOD and state leaders/members. To enhance this communication, in 2016 the SAC chair began attending every meeting of the BOD to provide an update of activities and concerns of the SAC.
There are now 48 affiliates representing nearly every state in the Union and Puerto Rico; some states, such as California, having more than one. The affiliates function more or less like “little ASCOs,” but with a closer and more intimate association with issues that are highly relevant to their specific geographic and cultural concerns.
My first SAC meeting, led by then-chair Dr. James Frame, was an eye-opener. My clinical days over the last 35 years have been spent in academic centers, where everything but seeing my patients is taken care of by someone else. I had little or no experience with medicine as a business. Reimbursement reform was a foreign language to me. In fact, when I saw the algorithmic pathway graph of how clinicians get paid, I remarked that the familiar cartoon showing biological pathways of a cancer cell, and where different therapeutics might hit them, was simple in comparison! The coup de grace of the day was an elegant presentation on the Medicare Access and CHIP Reauthorization Act (MACRA) by Sybil Green, JD, RPh, MHA, director of Coverage and Reimbursement for ASCO, who began her lecture by noting that MACRA “is not a dance you do at a 1980s theme party!”
Subsequently, my appreciation of what the State/Regional Affiliates do, with ASCO’s support and advocacy, has grown exponentially. In the last year alone, ASCO ramped up its partnerships with the affiliates, advocating on a wide range of policy and practice issues that unfolded state by state. Working with the State Affiliates, ASCO produced draft legislative language, talking points, comment letters, testimony, grassroots alerts, social media postings, and more on important issues that affect each of us in practice, and of course our patients as well. These issues include the following concerns, among others:
- Oral parity: ASCO has worked closely with several State/Regional Affiliates, and oral parity laws have been enacted in 42 of the 50 states
- Opioid control: ASCO understands the devastation of the current opioid epidemic, but has fought strongly to ensure that our patients are not adversely affected in the rush to control pain medication prescriptions
- Clinical pathways: ASCO legislative language supports adoption of pathways, but only if they meet the criteria laid out by an ASCO task force that included several leaders of the SAC
- Safe handling of chemotherapy drugs: ASCO supports efforts to improve the safe handling of hazardous drugs used in cancer treatment, but wants to ensure that these efforts include input from medical oncologists with expertise in the day-to-day operation of modern oncology practices
- Medicaid coverage of clinical trials participation
For each of these, ASCO has prepared toolkits designed to make advocacy at the state level as easy as possible for our members and the members of our affiliates.
Even I have gotten into the act. Working with Ms. Green and Dr. Grubbs, not only have I learned what MACRA is, I’ve actually led several town hall–style meetings to explain the new policy and describe what ASCO is doing to help you embrace it.
A second example is even more specific to my own State Affiliate, the Michigan Society of Hematology Oncology (MSHO). While in clinic in early December, I received an email from MSHO urging me to take advantage of the easily submitted email to my local state representative supporting passage of oral parity. I did so (this took me 30 seconds!), thinking, “Well, nothing good will come of this, but it can’t hurt.” Two hours later I received a personally written email response from my representative, telling me he had been previously unaware of the issue, had done homework over the last 2 hours regarding it, and if the bill was returned to the state floor, he would vote for it! I felt like Jimmy Stewart in Mr. Smith Goes to Washington. Sadly, the Speaker of the Michigan House saw fit not to release it for a vote, but with ASCO’s state advocacy team’s help, MSHO vows to fight on in the next session.
This is but one small example of what our State Affiliates offer their members. Please take a moment and review this summary of affiliate and ASCO state advocacy partnerships this year, and visit the ASCO State Advocacy Site to view helpful resources. Visit this webpage to learn more about the SAC’s recent meeting, its priorities for the year, and identify your council representative. You’ll be blown away—and like me, you’ll want to add the State/Regional Affiliate Program website to your favorites.
I cannot emphasize enough how much ASCO does to improve the care of patients and survivors of cancer. In this regard, the State/Regional Affiliate Program, led by the SAC Executive Subcommittee, is key among our efforts. Our Policy and Advocacy Department, along with the newly formed Clinical Affairs Department, work closely with the Affiliates to ensure we stay in front of issues that affect our members and the patients they serve. My hat is off to Dr. Thomas Marsland, inaugural SAC chair, subsequent chairs Drs. Ray Page, James Frame, and Paul Celano, current chair Dr. Tracey Weisberg, and incoming chair Dr. Melissa Dillmon, for their leadership of this important body and its many accomplishments.
Do you belong to your ASCO State/Regional Affiliate? If not, you should! Do you take advantage of all they have to offer? If not, you should! You, and more importantly your patients, will benefit enormously.