2024 President’s Address: “The Art and Science of Cancer Care: From Comfort to Cure”

Jun 01, 2024

Excerpt From the 2024 ASCO Annual Meeting Opening Session Presentation

By 2023-2024 ASCO President Lynn M. Schuchter, MD, FASCO

We open the 2024 ASCO Annual Meeting at a critical juncture in oncology, one that my presidential theme, “The Art and Science of Cancer Care: From Comfort to Cure,” seeks to capture. It’s a time when we’ve made and continue to make extraordinary progress in cancer treatment, leading to better outcomes, even cures, for many patients. But my theme also recognizes that these advances are not benefiting all patients. Sometimes our best treatments don’t work, or the cancer becomes resistant, or, tragically, too many patients lack access to treatment. This discordant reality means that while we continue advancing oncology science and fully leveraging the latest technologies, we must ensure these innovations benefit all patients, wherever they live, and we must increase our emphasis on the art of cancer care for all patients.

Address continues below video.

By the art of care, I mean the human side of cancer medicine: engaging with patients and their families with deep compassion and understanding, weaving in supportive or palliative care as an integral part of treatment as we try to achieve the best possible outcome for our patients.

My passion for integrating the art and science of cancer care comes from my patients. For more than 35 years, I’ve specialized in melanoma, a cancer once considered hopeless. In fact, when I began my fellowship, people often asked why I chose melanoma. There were no treatments beyond surgery. Outcomes were bleak. In the early days, I was essentially a hospice doctor.

But even then, there were clues from the emerging science which suggested the potential power of immunotherapy and of targeted therapy directed at specific driver mutations. And indeed, gradually, over decades, laboratory and clinical researchers—many of you here today—translated this promising basic science into new, powerful therapies, turning what was once a treatment desert into a tropical rainforest of options for our patients with melanoma.

It was in melanoma that we first experienced the significant efficacy of PD1 antibodies and turned our evolving understanding of the genetic defects in melanoma into effectively targeting BRAF. I can still vividly remember the excitement of enrolling our first patient in a BRAF-targeted therapy clinical trial. As we enrolled more and more patients in clinical trials, and as targeted therapies and new checkpoint inhibitor immunotherapies began to achieve FDA approval, suddenly, our patients were getting better, fast: coming off oxygen or pain medications, often within 3 days of starting therapy.

Fast forward to today, in my clinic:

Composite image of photos of Dr. Schuchter's patients.

These patients all had stage IV melanoma, some even with brain metastases. They are now melanoma-free and off all therapy, some for longer than 10 years! I see these success stories every day. We’re seeing similar progress in other cancers, like lung, renal cell, and breast cancer, demonstrating the power of research, translation, drug discovery, and clinical trials.

We know we can cure cancer; we now need to cure more cancers. We all have far too many patients whose outcomes are not so positive—patients we will never forget.

Tara Miller was one such patient, for me. This brilliant, beautiful, and loving 28-year-old woman was just beginning her career as an attorney when she was diagnosed with metastatic melanoma. Tara received every possible advance: the latest immunotherapies, BRAF-targeted therapy. She loved being part of the research. Initially, the treatments worked. But over time, the disease progressed, and metastasized to her brain. Tara died a little more than a year after her diagnosis. It was heartbreaking.

Photo collage of Tara Miller.

I know you all have patients like Tara. Despite all the advances, too many patients with metastatic melanoma and many other cancers still die. That’s one reason the art of care is so important.

It has been 25 years since an ASCO president’s theme has touched on palliative care. [1997-1998 ASCO president] Dr. Robert J. Mayer focused then on the critically important topic of end-of-life care. What we know now is that palliative care is essential throughout cancer care’s trajectory, not just at the end of life. By integrating palliative care early in the treatment process, we can honor patient and family preferences and provide meaningful support throughout the cancer experience.

What I’m advocating is a reemphasis on a fundamental concept in medicine. It dates back to Hippocrates, who said, “To cure sometimes, to relieve often, and to comfort always is all that may reasonably be expected of medicine.”

These words, “to comfort always,” tell us that whether or not we cure a disease, or even succeed in relieving symptoms, comfort is not optional. It’s an essential part of patient care.

As clinicians, providing comfort requires mastering the delicate art of communicating extremely difficult information. Anyone who has ever had to discuss prognosis or share the devastating news that treatments are no longer working knows that these conversations are amongst the toughest. According to a 2020 article in the Journal of Clinical Oncology, oncologists must deliver bad news to patients an average of 35 times a month. Yet, many have not had the opportunity for training or mentoring in these critical communication skills. In fact, oncology fellows report getting more coaching in technical skills like performing a bone marrow biopsy than in how to conduct a family meeting.

We must do better at communicating prognosis so that patients can assess trade-offs of different treatments. We must be alert to potential misunderstandings. For example, patients often interpret a 20% response rate as a 20% cure rate unless given more explicit information. These types of misunderstandings can cause patients to decline palliative care services until quite late in their illness. Importantly, these serious illness conversations must be conducted repeatedly over a span of time, so that patients can cope with the information and to best allow for advance care planning.

The art of cancer care also means recognizing and managing the important turning point in a patient’s course: when anticancer treatments should give way to measures that prioritize comfort, dignity, and emotional support. Studies tell us that while this work is difficult, it is also rewarding and fulfilling for oncologists—that, in fact, we enjoy high levels of job satisfaction because of these relationships with our patients. But it is hard work. It’s often exhausting and draining to be there on our patients’ journeys.

That’s why ASCO is committed to helping our members become just as skilled in the art of care as they are in the science. At this meeting, in the same sessions where you learn the latest treatment advances in a particular cancer, you’ll also learn expert symptom management, effective communication skills, and supportive care.

ASCO is increasing the numbers of clinicians dual-certified in oncology and palliative care. This is important, because only 3% to 4% of us are dual certified now. Under the leadership of Dr. Jamie H. Von Roen, we’re piloting an ACGME-approved combined Hematology/Oncology and Hospice and Palliative Medicine Fellowship. It’s for oncologists who want to integrate palliative care into their practices and conduct palliative care research. The inaugural class will complete their first year in June, and that’s really exciting.

Updated ASCO palliative care guidelines have just been published to emphasize the essential role of all oncologists in providing palliative care as an integrated, holistic part of patient treatment, beginning at diagnosis. Let me say that again. Integrating palliative care early, from the time of diagnosis is key. Research indicates that such early integration significantly improves patients’ quality of life and overall well-being, with some studies suggesting a potential for longer survival times. This tells me that patients on the road to cure need symptom palliation just as much as those with more advanced cancer.

As I have traveled the world on behalf of ASCO, I’ve been inspired to see that palliative care is becoming a greater priority worldwide. At the Emirates Oncology Society’s Annual Meeting, I met the first licensed palliative care physician in Abu Dhabi, Dr. Neil Arun Nijhawan. In Senegal, at the AORTIC meeting, I met Dr. Christian Ntizimira, who leads a research center on end-of-life care in Rwanda and has written a groundbreaking book on the topic. At the 2023 ASCO Breakthrough Meeting in Yokohama, Japan, I met Dr. Wah Wah Myint Zu, who was the recipient of a Conquer Cancer International Development and Education Award in Palliative Care for her work in Myanmar. I want to commend these physicians and others like them who are lighting a path for all of us to follow, providing access to palliative care for patients at all stages in their cancer journey.

This integration of palliative care globally is more important than ever because we are facing a worldwide health crisis in oncology. By 2040, the World Health Organization estimates 29.5 million new cancer diagnoses a year. Many patients will be diagnosed far too late, which means cancer-related deaths will skyrocket as well, with projections of more than 16 million a year by 2040.

ASCO has made reducing the global burden of cancer a top priority. Our approach is aimed at lowering mortality and easing suffering through education, research, and professional development. In the last 5 years, we have created regional councils in Asia Pacific, Latin America, Sub-Saharan Africa, and Central and Eastern Europe to share best practices and address region-specific cancer challenges. We’ve expanded ASCO’s flagship Leadership Development Program to Asia and Latin America. This will empower more clinicians than ever to effect meaningful change in their areas. We’re now providing free ASCO membership to all oncology care professionals from low- and lower-middle-resource countries. This means that ASCO’s valuable research, education, and quality care tools will be more accessible than ever.

Collaboration is key to reducing cancer rates across countries and borders, but also between cancer organizations and care teams. To that end, I am proud that ASCO is championing the new National Cancer Plan. We have a growing partnership with the American Cancer Society, to jointly provide trusted, expert-approved education on cancer prevention, screening, and survivorship for patients.

We are actively reaching out to engage more members of the oncology care team in our ASCO programs. Nurses, for example.

Photos of nurse Doris Schuchter at work.

My mother was a public health nurse, so my immense respect for nurses began at very early age and has only increased throughout my career. I have worked with so many amazing nurses. Our patients trust you. Your voices are essential. I recently met with the leadership of the Oncology Nursing Society, and I and ASCO look forward to our ongoing collaborations on issues ranging from palliative care to ensuring a healthy work force.

These efforts I’ve been describing, individually and collectively, will advance us towards the goal of higher quality and holistic care for all patients around the world.

Again, we are at a critical juncture in oncology. Scientific innovations like artificial intelligence (AI) are dramatically altering and advancing all aspects of our field. ASCO is working to help our members better understand and navigate AI to benefit patients and our practices, because this is not a distant concept; it’s a present reality. AI tools are being integrated into every aspect of cancer research and care. To meet this opportunity, ASCO recently adopted a framework of principles for responsibly using AI in oncology care.

AI algorithms can now analyze complex brain MRI scans in minutes, leading to faster and more accurate diagnoses. AI can assess a tumor’s genetic makeup to help us choose the best treatment course for an individual patient and identify a clinical trial.

Importantly, we hope that AI will help reduce burnout by automating routine electronic health record tasks. Imagine keyboard liberation! More eye contact, more face time with our patients.

Because, even as we stand on the brink of this new scientific and technological era in medicine, remember that no algorithm, no robot, no machine can explain to a patient, with human compassion, what their cancer is, what their choices are, and what their future may hold. Nor can AI replace us in understanding what a patient wants: their values, needs, and desires, and those of their loved ones. Those are things that we—not just as clinician, but as human beings—must do for our patients.

This is the art of cancer care. There is no substitute.

Just as we’ve always integrated new science into oncology, let us embrace AI as a new tool while prioritizing the compassionate, ethical, empathetic, and personalized care that defines our profession. Let us dedicate ourselves to practicing both the art and the science of cancer care, from comfort to cure.

Let me now take a few moments to recognize those to whom I am grateful, beginning with you, the people who care for our patients every day. I want you to know how much we at ASCO, and I personally, appreciate you and all you do. Always know that ASCO is here to support your hard work.

I thank my patients. Every day, I am awed by their courage and spirit. It has been my greatest honor to know and care for so many patients over the past 35 years.

I’d like to thank the ASCO staff who have gone above and beyond to put together this outstanding meeting and for all their meaningful work throughout the year.

A special thanks to Dr. Von Roenn, ASCO vice president of Education, Science, and Professional Development, a dear friend and colleague, who is retiring after an amazing career. This meeting will be the last one she shepherds. Her magnificent imprint is on almost everything we do at ASCO. Jamie, thank you.

Thank you to the current ASCO leadership team: 2023-2024 past president Dr. Everett E. Vokes, 2023-2024 chair of the Board Dr. Eric P. Winer, 2023-2024 president-elect Dr. Robin Zon, and of course, ASCO CEO Dr. Clifford A. Hudis, ASCO chief operating officer Dina L. Michels, and past president Dr. Lori J. Pierce. Lori, we continue to see your influence and impact at ASCO and remain dedicated to your theme of ensuring equity for every patient, every day, everywhere.

Thank you to Dr. John H. Glick, my mentor, dear friend, and past ASCO president, for more than 30 years of unwavering friendship and personal and professional support.

Thank you to my Penn Medicine family of colleagues, especially the melanoma team, including Dr. DuPont Guerry, whose approach to teaching and medicine has deeply shaped my own style. Suzanne McGettigan, nurse practitioner extraordinaire, thank you—you have made this year possible for me.

Thank you to my incredible family, including my sister, Janet, and brother, Phil, who are here with my nieces and nephews. To my husband, John, thank you for your love, patience, and understanding—you have been there for me every step of the way. To my twin 24-year-old sons, Ethan and Andrew, I am so proud of the young men you have become. I am excited to see your passions in life and expect they will be as deeply satisfying as medicine is for me.

Finally, a special thanks to Tara Miller’s family: Debbie, George, Lauren, who are with us in person today, and Kristy and Josh. Thank you for your exceptional support for our center that bears Tara’s name and for the Tara Miller Melanoma Foundation, which supports our breakthrough melanoma research.

Tara died on October 14, 2014, at 5 PM. At that moment, her family raised a glass in her honor. And for the past 10 years, on the 14th of every month at 5 PM, the family gathers to toast, to remember and to honor Tara. So, if you could all join me now for a virtual toast:

To Tara Miller, and to all those we have lost to cancer, and to our survivors as well. In your honor, we will continue to fight cancer and comfort those who suffer from it all over the world.

Dr. Schuchter raising a toast to conclude her address.

*Editor’s note: Excerpt has been edited for length, style, and clarity.

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