July 2010 Issue

Change and Innovation...
The size and pace of this meeting is a small reflection of change in the world around us. As clinical oncologists, we’re all interested in what changes we can make to better treat our patients when we go home next week. Some of the change is reflected in the 850 anticancer agents currently in clinical development—a 70% increase in the past three years. Those agents that make it to the clinic will continue our momentum toward truly personalized cancer therapies, and that’s the change we’ll see next week and next year.

In past annual meetings, we focused on clinical advances made by drugs developed for their ability to interfere with DNA synthesis. Application of these classic cytotoxic drugs, along with endocrine therapies and application of proven screening strategies, has started bending the cancer mortality curve downward.

However, at the last several meetings, we have come to terms with the ever more complex world of cancer signaling pathways—we have new targets for our therapies, and thus new ways of classifying cancers. Last year we learned that there are two kinds of gastric cancer: Her2 overexpressed and Her2 normal. At this meeting, we will learn the importance of further subclassifying nonsmall cell lung cancer occurring in nonsmokers. We are moving away from classifying tumors based upon what they look like under the microscope, and toward classifying them dynamically—based upon which signaling pathways are active in driving the malignancy at that particular moment in the continuum.

We don’t practice in a vacuum, of course—change is not limited to the science of our field. Our economy, reflecting the world around us, also continues its fast-paced change. A stable political and social environment—a necessity for improving the public’s health and reducing the cancer burden—is a distant hope in many places throughout the world where our fellow members practice.

Many of us were drawn to this field because it is constantly changing and because the pace of change is rapid. And surely our desire is to see the pace of discovery accelerate further. But some of us are concerned that changes in today’s research and practice environment may not be positive—or that they are overwhelming our ability to cope. Can we participate—and even accelerate—innovation and change without losing the human connection and healing spirit that drew us to a career as physicians?

My answer is “yes.” Innovation and quality are essential partners—the keys to providing the patients we will see next week and next year with the highest quality care and the hope for realization of a cancer-free world.

The Challenges...
ASCO has called upon the National Cancer Institute to double the clinical cooperative research budget over the next five years. This is a goal that will sustain the cooperative system and stop the erosion in participation we have observed over the past few years. We have used numerous channels to deliver the message that this system is in crisis and must be preserved. We will continue this work in the months ahead.

The crisis in clinical cancer research is accompanied by an equally daunting set of challenges in community oncology practice. The infrastructure that has been key to both delivering and testing cutting-edge therapies is in turbulence. In this unstable economic environment, practices—particularly small practices and those in rural areas—are finding it difficult to survive. Many have closed their doors; others continue to struggle or have joined larger, centralized systems. Cancer treatment is now being forced back into hospitals, reversing a two-decade trend that brought lower cost, convenient treatment and personalized care to patients and families in communities across the country.

To fully understand how these trends will impact access and quality of care—and how policy decisions will affect our patients and our profession—ASCO has undertaken several initiatives to analyze practice and workforce demographics, identify successful practice models, and determine potential gaps in access. Armed with solid information, we can better advocate on your behalf.

This brings me to one of the most important changes in the United States health care system this year: legislation reordering, in fundamental ways, the way health care will be delivered. On March 23, President Obama signed into law the Patient Protection and Affordable Care Act. Fundamental changes to health insurance practices are part of this new law, but there is also heavy emphasis on quality, accountability, and value...

Over the next several years, the Department of Health and Human Services—led by Secretary Kathleen Sebelius—will set the standards and rules that implement the more than two thousand page statute. ASCO has a sound scientifically based reputation and will be a credible voice as the regulations are developed and the law is changed. No matter which way the pendulum swings, ASCO will provide a credible, evidence-based voice on behalf of you and our patients.