July 2010 Issue: Before a new ASCO President takes office, he or she serves for one year in the position of President-Elect. Michael P. Link, MD, of Stanford University School of Medicine, stepped into the role of President-Elect at the 2010 ASCO Annual Meeting. In the interview that follows, Dr. Link shares his plans for the year and discusses his unique perspective as a pediatric oncologist.

AC: How did you react when you learned that you had been nominated for the position of ASCO President?
Dr. Link: I never dreamt that I would be nominated to be ASCO President. It’s an honor, and I’m flattered. To be one of the spokespeople for our Society is a big responsibility, and I hope to serve it well. I also realized that ASCO was serious about having a pediatric oncologist as President. Having a “minority” member lead the Society shows exactly how expansive ASCO has become—it is really the Society for all people involved in caring for patients with cancer.

AC: What led you to pediatric oncology as a subspecialty?
Dr. Link: My brother is a pediatrician, so there was some influence from that quarter. During my first pediatric rotation, I just fell in love with caring for children. After my first rotation on oncology, I was hooked. These kids are faced with a very serious illness, but often they brighten my day as opposed to the other way around. You also develop a very special lifelong relationship with the families. I still communicate with many of the patients I cared for 30 years ago. One of my former patients works here at Stanford, actually, and we meet for coffee and talk about childrearing and other issues which we all face. She also never fails to inform me about the consequences of cancer survivorship. Another former patient became a surgeon and called me up a few months ago and asked me for advice on managing a patient—that was the ultimate compliment. What makes pediatrics magical is that your patients come out on the other end of a serious illness and are able to go on with their lives.

AC: What perspective will you bring to Society leadership as a pediatric oncologist?
Dr. Link: I’ve been an advocate for pediatric oncology and children with cancer throughout my career, but it is very true that ASCO leaders should leave our hats at the door—leaders should not feel that they are representatives of a particular specialty or constituency within ASCO. I don’t view myself representing pediatrics the way a senator represents Rhode Island—I bring my experience and point of view to help formulate positions that are best for the Society and best for our patients. I believe that all ASCO leaders do the same.

It’s clear that many of the advances in oncology were pioneered in pediatrics. Although pediatric oncology is a relatively small piece of the action, we have been on the leading edge of cancer care for quite a while. The multidisciplinary approach to the patient with cancer was pioneered in pediatrics. Many of the issues of survivorship and awareness of late effects of treatment have come from pediatrics and long-term follow-up of our cured patients. Pediatricians have also led the way in demonstrating the utility of clinical trials.

Something becoming very clear to all of us who care for patients with cancer is the complex heterogeneity of these diseases on the molecular level—that each cancer type is, in reality, a collection of related diseases that may appear the same under the microscope, but which are quite different on the molecular level. It is thus not surprising that different tumors respond very differently to different therapies. Thirty years ago, we were discovering that the most common cancer that pediatricians treat—acute lymphoblastic leukemia—is a heterogeneous collection of diseases with different molecular underpinnings, different clinical presentation, different outcomes, requiring different intensities of therapy. Something that we’ve known for a long time in pediatrics is now an important theme in medical oncology as well. And because of the heterogeneity of diseases, we need many more patients than we used to think to do robust clinical trials.

AC: What are your goals during your year as President-Elect?
Dr. Link: My job will be to understand the Society and the membership better and grow into the position of President. I plan to participate on a number of key committees. For example, as a member of the Government Relations Committee, I’ll get an in-depth understanding of the key issues that relate to medical care and especially oncology care in the United States. It is obvious that health care reform is going to have an enormous impact on our work, and formulating our positions will be critical because the Society advocates for all of us as practitioners. The science of oncology is advancing at such a rapid pace that it is very difficult to keep up. We have to learn to leverage all of our educational resources to keep our members up to speed. Because ASCO is such a heterogeneous organization, we have to focus on those issues that unify us, such as clinical trials infrastructure and access to care, and be strong advocates for them.

AC: You’ve served on a variety of committees throughout your ASCO membership. Do any experiences stand out?
Dr. Link: Most exciting for me was the time I spent on the Board of Directors [1999-2002], being in a position to learn about the issues confronting the Society and our patients on a strategic level. I’ve been an Associate Editor for the Journal of Clinical Oncology (JCO) for almost 10 years. I’ve watched it grow to be the most influential of all the oncology journals—that is a wonderful development. I’ve served on the faculty for the ASCO/American Association for Cancer Research Workshop: Methods in Clinical Cancer Research, in Vail, Colorado, and it is still one of the most amazing experiences I’ve had. As a result, I’ve brought a Fundamentals of Clinical Trials course to the ASCO Annual Meeting for those who don’t have the chance to go to Vail. I think I’ve gotten more out of ASCO than it’s gotten out of me, which is why it’s a great privilege to serve.