Cost of Care and Federal Funding

How can ASCO address the high cost of cancer care and diminishing federal resources for basic and translational research?

In answer to the first part of this question, the rising cost of cancer care has certainly become a focus of national conversation given the enormous increase in the cost of health care, which is making cancer care less affordable for many patients and their families. ASCO has been actively engaged in addressing this issue through several initiatives.

One is ASCO’s Quality Oncology Practice Initiative (QOPI®). I believe that high-quality cancer care will actually result in reducing the cost of oncology care. Initiatives that address the value of cancer care and how to integrate quality improvement into patient-centered clinical practice will have an impact on reducing high costs. ASCO has also proposed a number of new payment models that promote quality and value and discourage unnecessary testing and overtreatment at the end of life, and these strategies will be important in reining in the cost of care.

In addition, ASCO actively participated with the American Board of Internal Medicine (ABIM) Foundation in its Choosing Wisely initiative and identified a Top Five list of common, costly procedures and practices in oncology that are not supported by evidence-based medicine and could reduce widely used and costly procedures and treatments. In the coming years, it will be critical for ASCO members and cancer care providers to embrace and implement the project’s recommendations. Physicians and patients recognize that spiraling costs of cancer is unsustainable, and our collective efforts are required to change the way we deliver cancer care.

For the second part of that question, we are in a very challenging environment with diminishing federal resources for basic and translational research. Resource constraint on multiple dimensions is our collective reality. We are challenged to do more and better with less.

One example of trying to do better in clinical research emerged from ASCO’s Cancer Research Committee this year in a project chaired by Lee M. Ellis, MD [Director of the Colorectal Cancer Translational Research Program and Professor of Surgery at The University of Texas MD Anderson Cancer Center]. “Defining Clinically Meaningful Outcomes: ASCO Recommendations to Raise the Bar for Clinical Trials” was an innovative project aimed at raising the bar on how we design our clinical trials and define clinically meaningful endpoints in clinical trials. This kind of project will likely lead to the development of more strategic and efficient clinical trials in the future.

More effective research collaborations with industry and engaging the philanthropic community will also be necessary to continue to fund what is now likely to be the most promising era for cancer research. However, the federal government has and will continue to play a major and vital role in support of basic and translational research. In addition to promoting the obvious and urgent need to restore funding to the National Institutes of Health, ASCO can deliver another important message by continuing to educate Congress that funding for science and technology is important because it drives economic growth.

Cancer Research Workforce

In ASCO’s Impact Survey: Federal Funding Cuts to Cancer Research, over 38% of respondents said they have reduced the proportion of time they spend on research, 35% said they had to lay off or terminate lab or clinical staff who support their research, and others said they were leaving the field of research entirely. What can ASCO do to prevent cancer researchers from leaving the field and encourage young college graduates thinking about a career in science to consider oncology?

The results from this survey are very distressing because this is our workforce pipeline and we need young scientists and biologists to enter this field, especially at a time when we’re seeing some of the most exciting advances in the diagnosis and treatment of cancer. This is where ASCO’s Conquer Cancer Foundation and its Young Investigator Awards and Career Development Awards can play such an important role in supporting and encouraging young scientists in their pursuit of research in oncology. These types of grants fund young investigators at such a pivotal and vulnerable stage in their career and can make all the difference in those scientists staying in the field of oncology.

Cancer Survivorship

What can ASCO do to educate primary care physicians and their patients living with cancer about long-term cancer survivorship? And how can ASCO collaborate with primary care physicians and help them address the medical needs of survivors in their practice as part of the oncology team-based care model?

This is not a simple question to answer, but I would say a couple of efforts are going to be key. One is ensuring that cancer care providers communicate with primary care physicians about the overall treatment summary and follow-up plan for their patients with cancer. ASCO has been a leader in defining what should be included in a survivorship care plan.

The Commission on Cancer’s manual for cancer programs, Cancer Program Standards 2012: Ensuring Patient-Centered Care, has mandated that by 2015, treatment summaries be provided to all patients at the end of their treatment. Providing treatment summaries to primary care physicians will be a valuable tool for the continuing care of cancer survivors, and having this model of a “shared-care” approach that ASCO has put forward is also very important.

The other key component is to facilitate team-based care and further expand how we collaborate with nurse practitioners and other physician extenders in the care of patients with cancer. Better utilization of oncology nurse practitioners and physician assistants will be key to providing quality cancer survivorship care.

Biggest Opportunity

What is the biggest opportunity for ASCO to help its members improve cancer outcomes?

I would look at that question from two perspectives. One is addressing and defining the issue of quality. What are the metrics to define quality, and how do we measure and improve quality? ASCO is committed to providing this leadership in defining high-quality patient-centered cancer care.

The second area concerns how we realize precision medicine. There have been remarkable advances in the identification of new molecular targets for new treatments. Developing the technology with which to incorporate advances in genomics into treatment plans and into the medical record to allow for informed treatment decision-making is a great opportunity, but also a great challenge. To that end, ASCO’s CancerLinQ™ initiative is incredibly visionary and bold. Once completed, it will be able to link disparate electronic health records with “Big Data,” and that will lead to better decision-making, better treatment, and improved outcomes for patients.

Biggest Challenge

What is ASCO’s biggest challenge, and how do you propose it be addressed?

There are many competing agendas, but I would say that what we are all facing—both individually and as a field—are significant resource constraints. We are looking at enormous costs of cancer care, diminishing financial support for basic and clinical research, and limited support for training, so we all need to learn to do more and better with less. ASCO’s current initiatives and those outlined in its “Shaping the Future of Oncology: Envisioning Cancer Care in 2030” document, as well as ASCO’s proposed symposiums and curriculums, all address these big challenges.

Focused Initiative

ASCO Presidents often have focused initiatives during their term in office. Do you have a particular initiative you would propose putting forward as ASCO President?

One important topic to me is the incorporation of palliative care into the continuum of care for patients with cancer. There are still barriers to the integration of palliative care into oncology care. This area would be a major area of focus for me.

The second topic is related to my research in melanoma. There is a rising epidemic of melanoma, particularly in young women, and despite remarkable advances in therapy for melanoma we still are seeing increases in mortality. I would like to consider advancing both policy initiatives and education regarding the risks of UV exposure and tanning salons associated with this burgeoning epidemic of melanoma. ■