It has been very hot this week, and during spin class this morning—an activity of mine that Charles Sawyers managed to work into his Science of Oncology address at the 2013 ASCO Annual Meeting—my mind drifted away from the instructor’s reminders to “keep up” and “drink that water as you ride” to CancerLinQ and surfing. You may wonder how these are connected.
After three years of planning, ASCO has developed a working prototype of a “rapid learning system” for oncology called CancerLinQ. We demonstrated it at the National Press Club in late March, 2013, and again at the Annual Meeting. Many of our members have contributed patient records, and more than 170,000 individual breast cancer patients are in the system at last count. This phase of the project is a first proof-of-principle: it is possible to analyze trends, benchmark quality, and determine outcomes using multiple electronic record platforms.
Now, as we simultaneously begin to prepare for our 50th Annual Meeting and to take the next and even bigger steps with CancerLinQ, it is important to make sure that ASCO’s membership knows what we envision so that we can work together to build the best possible system. The many members who have contributed thus far can already see that CancerLinQ has the potential to improve care, increase our understanding of the many diseases we treat and study, and simplify how we interact with society in terms of regulations, insurance, and research priorities. The next step, the first “1.0” product for use, will have to be both ambitious and conservative to succeed. We can’t begin by doing everything, but we do have to begin somewhere, and we will need everyone’s advice and guidance to do so.
What does this have to do with surfing? Hold your rails, let the water cool your legs, and just float up and down as the waves pass beneath, and I’ll try to explain.
ASCO approaching 50 reminds me, well, of me approaching 50 a few years back. As that milestone birthday neared, like so many of you, I noted with real satisfaction the emotional and spiritual rewards of a life in medicine and a nurturing and loving family. Taking care of patients is simply one of the greatest privileges I can imagine, and my enthusiasm and optimism have only increased, despite the well-known systemic and societal challenges of the past few years.
At mid-century, I had professional standing, a record of some accomplishments, a supportive and satisfying work environment, and inner peace. With that foundation, I could be expected to leverage my acquired skills and experience to do most of the same things I already did, but even better. That's important and it is good. In fact, it represents for many of us in midlife, the hard-won culmination of society’s broad investment in our education and the infrastructure that, in turn, enables us to serve.
However, at that point, one personal failing increasingly bothered me. I didn't know how to surf, and I always thought it looked like fun. Responding to this “problem,” my family gave me lessons and a brand new surfboard, but they couldn’t make time. That, I had to find myself. I would love to report that I progressed from kook to expert, carving a beautiful series of S turns down the line on perfect wave after perfect wave at Ditch Plains on the tip of Montauk. Other people, usually 12-year-old kids, did exactly that while I tried to catch my breath after merely paddling out.
At any rate, on the rare days that I've been lucky enough to get up early and get out to the beach, stretch on my wetsuit, walk over the sand with my very long board, pick my way through the rocks in the shallows, paddle out against the headwind and the breaking incoming waves, catch my breath, actually see a well-formed incoming curl, time my paddling and place myself just right on the board to avoid nose-diving, pop up and assume the surfer stance while gliding toward the beach, I’ve been rewarded with the unique feeling of bliss that surrounds you as all you hear is the churn of the breaking wave, all you see is the approaching sand, and all you feel is the hum of the board over water beneath your feet.
Of course, on a percentage basis, almost all of the time spent “surfing” is time spent preparing to surf. As you improve, however, the ratio does as well. While I got in one 10- or 15-second ride and paddled back to the break, the 12 year olds lapped me three times.
At this point, you may ask, again, what does this have to do with CancerLinQ? Here it is: like surfing, it is far harder than it looks, much of the time is spent on planning, investment, preparation, and practice, and the result—catching the wave—comes later and fleetingly at first. Of course, there are differences: The only persons benefiting from my surfing are me and my family since I have fun, and they have a break from me. However, CancerLinQ has the potential to benefit all of society.
Like me, ASCO is approaching this new project at its half-century mark, and like me, may experience some mishaps as we begin. But extending the metaphor, the waves are out there, the winds are favorable, and somebody is going to stand-up and have a good ride. ASCO is the best positioned and resourced group to do this, and it can fulfill our mission-driven responsibility to society. As luck would have it, there may be no better time than ASCO's 50th year to commit to and launch this project because now, as when we first began a half century ago, we face a rare milestone and an opportunity to broadly consider our goals and our broad role in the world.
CancerLinQ has the potential to transform the way we learn; the way we measure—and more importantly, establish and maintain and improve quality; and the way we interact with society. In many ways, we have the opportunity to learn from other fields well beyond medicine that have already exploited big data productively. The challenge before us is to do all of this while keeping our focus squarely on our patients’ needs and our responsibilities to them, their families, and society.
All of society and all of the world stands to benefit from this project, and I hope that our members begin to see its central importance to ASCO. It allows us to meet the key challenge our mission contains: addressing the global problem of cancer. These are early days and we have a lot to learn. But if a middle-aged oncologist can catch a wave, ASCO can launch CancerLinQ.