Monica M. Bertagnolli, MD, FACS, FASCO
With all the advances in oncology care over the past decade, the most important contribution to high-quality care remains the personal connection between oncologist and patient, said Monica M. Bertagnolli, MD, FACS, FASCO, ASCO President-Elect, who will take the reins as ASCO’s 55th President during the ASCO Annual Meeting, June 1–5, 2018, in Chicago. An active ASCO member since 1995, serving on the ASCO Board of Directors, the Cancer Prevention Committee, and the Strategic Planning Committee, Dr. Bertagnolli will be the first ASCO President to serve a 4-year term on the ASCO Board, serving her first year as President-Elect; second as President and Chair of the Board; third as Chair of the Board; and fourth as Past President. The extra time, she said, gives her a unique opportunity to see the goal of her Presidential theme, “Caring for Every Patient, Learning From Every Patient,” get closer to becoming a reality.
“We need to look at how we care for every patient and how we can configure the health-care environment, so we learn from every patient/physician interaction, especially the 97% of patients who are not participating in clinical trials. We don’t want to lose important knowledge about these patients,” shared Dr. Bertagnolli. “This could mean ensuring expanded access to clinical trials so more people participate in studies. It should also mean improving the electronic health record system so it is not a burden on physicians and allows us to deliver higher-quality care to our patients.”
Serving as ASCO President, noted Dr. Bertagnolli, is not just a personal honor; it also provides her with the opportunity to make a difference in the lives of ASCO members and lend a strong voice to those in the oncology community she considers her particular constituency, including clinical and translational researchers; community and academic oncologists participating in clinical research; and surgical oncologists.
We need to... learn from every patient/physician interaction, especially the 97% of patients who are not participating in clinical trials.— Monica M. Bertagnolli, MD, FACS, FASCO
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A clinician and researcher specializing in the treatment of gastrointestinal malignancies that have genetic links to colon cancer for 20 years, Dr. Bertagnolli has led gastrointestinal correlative science initiatives within the National Cancer Institute–funded Cancer Cooperative groups, where she helped integrate tumor-specific molecular markers of treatment outcome into nationwide clinical cancer treatment protocols. She has also held numerous leadership roles in multi-institutional cancer clinical research consortia, including serving as the Group Chair of the Alliance for Clinical Trials in Oncology. Dr. Bertagnolli is also Chief Executive Officer of Alliance Foundation Trials, a nonprofit corporation that conducts international cancer clinical trials.
The ASCO Post talked with Dr. Bertagnolli, Chief of the Division of Surgical Oncology at Dana-Farber/Brigham and Women’s Cancer Center and Professor of Surgery at Harvard Medical School in Boston, about the goals she hopes to accomplish as ASCO President; the challenges ahead for the cancer community; and the lasting imprint she would like to leave on the Society.
As you look ahead to your term as President of ASCO in 2018–2019, what do you anticipate will be your greatest challenges, and what are the immediate goals you hope to accomplish?
We are in an incredible time in the field of cancer care and research. There is an explosion of new knowledge about how to treat cancer more effectively for individual patients by tailoring treatments based on their tumor’s genetic makeup, but it is still unclear how best to apply this knowledge and how to pay for these increasingly expensive therapies. To meet this challenge, we have to keep to ASCO’s core principles to conquer cancer through research, education, and promotion of the highest-quality patient care.
During my presidential term, I’m going to focus my energies on the initiatives that address access to high-quality care for all patients with cancer and on advancing progress against cancer more quickly by learning from every patient.
Opportunity to Accomplish Long-Term Goals
You will be the first ASCO President to serve a 4-year term on the ASCO Board. Does the extension of your tenure on the Board give you a greater opportunity to accomplish your long-term goals? And what are those goals?
It is a wonderful opportunity to have that extra year as part of ASCO’s leadership team so I can follow through on my goals and, hopefully, see them come closer to fruition. My goals as President include improving access to cancer care with the ultimate goal of ensuring that every patient at every socioeconomic level receives high-quality cancer care—not just in the United States, but around the world—as ASCO is increasingly becoming a global society.
An additional goal is to develop strategies that allow us to learn from every patient’s experience with cancer. This means going far beyond the traditional clinical research approach to develop a functional, learning health-care system.
I know that achieving these goals will take many years beyond my presidency. Fortunately, ASCO has a strategic planning process that allows us to weave these themes into ASCO’s overall long-term goals.
Tackling the Cost of Cancer Care
One of the biggest concerns facing ASCO members and their patients is the increasing cost of cancer care. In ASCO’s National Cancer Opinion Survey (www.asco.org/research-progress/reports-studies/national-cancer-opinion-survey), 91% of respondents said the cost of cancer drugs is too high. What initiatives would you like to see implemented that might improve the dialogue between oncologist and patient on cost of cancer care?
It is essential for both patients and physicians to have the necessary tools to treat cancers of all types, and skyrocketing costs of cancer care are a threat to this. Many factors drive these high expenses, and drug prices are a particularly visible aspect of this problem. A significant contributor to the issue is the high cost of research to develop new therapeutics. We need to reduce the cost of drugs without sacrificing innovation or quality, and one area where ASCO may have an impact is by promoting strategies to improve the clinical trials process. Ideally, we can look for approaches that not only reduce the cost of therapeutic development, but also make it easier for patients to enroll in clinical trials.
It is essential for both patients and physicians to have the necessary tools to treat cancers of all types, and skyrocketing costs of cancer care are a threat.— Monica M. Bertagnolli, MD, FACS, FASCO
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ASCO’s Targeted Agent and Profiling Utilization Registry (TAPUR) Study (www.tapur.org) is an excellent example of this approach. TAPUR combines access to targeted therapies for patients with advanced cancer whose tumor harbors a genomic variant known to be a drug target with a pragmatic approach to gathering research data.
In addition to promoting research, we need to enlist both physicians and patients in initiatives to address the rising costs of drugs while ensuring patients’ access to care. This past year, ASCO released a position statement to help spur a national dialogue on the affordability of cancer drugs.1 The statement proposed that a diverse group of stakeholders from across the health-care sector identify, prioritize, and test potential solutions to address the affordability of cancer drugs as well as help define a standard approach to assessing the value of drugs that could be applied broadly to inform drug pricing and reimbursement.
One of the tools we have begun to develop is ASCO’s Value Framework,2 which has sparked a national dialogue about the importance of discussions between physicians and patients about the cost and value of specific treatments. Currently, the Value Framework is limited to certain treatments that are defined by clinical trial data. It is crucial to expand the collection of data describing costs and benefits of care to a much broader scope of clinical situations, so physicians and patients have the information they need to make cost-sensitive treatment decisions.
Improving Access to Oncology Care
Do you have specific initiatives you hope to launch during your presidential year that will contribute to the development of solutions and policies to improve access to cancer care and address the health-care disparities experienced by ethnic, racial, and gender minority populations?
I grew up in the middle of Wyoming, where it is not uncommon for patients to drive 100 miles or more to get to the nearest cancer specialist. I can contrast my childhood in a rural area with the health-care environment of Boston, the major U.S. city where I’ve spent much of my academic career. I’m very aware of the data showing that zip code is a major prognostic factor for cancer outcome.
Access to cancer care is a many-layered problem that extends deep into society, and serious solutions must come from many sources, including scientific, political, cultural, and educational initiatives. For ASCO to achieve what we need to for our patients, we must continue to be actively involved in advocacy, because public policy at both the state and national levels has a profound impact on our ability to care for patients.
ASCO has a number of specific efforts under way, all based upon promoting access to high-quality care for every patient with cancer. For example, we are calling for all people with cancer to have access to adequate and affordable health insurance; for Medicare and Medicaid and other commercial health plans to provide coverage for the full range of services needed to prevent, diagnose, and treat cancer; and for patients to be protected from very high–cost saving requirements that target specific anticancer medications and supportive care therapies. In short, all patients with cancer are in an incredibly vulnerable position and need to be protected financially by being fully covered by their health insurance plans.
Another important area involves understanding and addressing health-care disparities. We need to expand research to address access to care and work to ensure clinical trial results are relevant and meaningful to underserved populations, the underinsured, and those living in remote locations.
We can harness the talent of ASCO members and the courage of the patients we serve to create an equitable, learning cancer care system that can achieve the best possible care for all.— Monica M. Bertagnolli, MD, FACS, FASCO
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It is also critical that all patients are afforded the opportunity to participate in clinical trials. In addition to contributing to knowledge, these studies provide patients with access to novel agents. ASCO has been at the forefront of this endeavor by advocating for insurance coverage for clinical trial participation and calling for correction of the fragmented policies within Medicaid related to reimbursement for ancillary costs in clinical trial participation. Eliminating these barriers would go a long way toward reducing disparities in cancer care.
To accomplish these goals, ASCO recently joined with the American Association for Cancer Research, the American Cancer Society, and the National Cancer Institute in releasing a position statement on charting the future of cancer health disparities research. This presents a unified strategy to promote cooperation among investigators in all areas of the cancer health disparities research community to ensure cancer research benefits all populations and patients regardless of race, ethnicity, age, gender identity, sexual orientation, socioeconomic status, or the communities in which they live.3
During my presidential year, I will continue to support the wide-ranging advocacy that ASCO conducts with Congress and the Trump Administration, as well as within the individual states, where many of these policies are having a significant impact. We need to ensure the policymakers understand the realities of the cancer care delivery system we live under today and adopt policies that protect our patients.
Implementing Strategies to Prevent Cancer
ASCO is committed to promoting cancer prevention and integrating evidence-based prevention strategies into oncology practice. Do you have plans to expand cancer prevention approaches, education, and training for ASCO members?
Cancer prevention is near and dear to my heart because of my own research and early clinical experience within the field of cancer prevention, so I’m very pleased to see the many programs ASCO has implemented through its prevention and survivorship committees. So much of cancer prevention involves adoption of a healthy lifestyle and requires we develop and implement strategies to expand education and promote adherence. This has been a challenge for our Society, because it demands we reach individuals who are not cared for by our member physicians.
ASCO has joined with sister societies, such as the American Academy of Family Physicians, to educate not just oncologists but primary care physicians as well concerning effective cancer prevention strategies, including tobacco cessation, obesity control, reducing ultraviolet radiation exposure, and increasing the rates of human papillomavirus vaccination. Expanding these programs globally is an important component of ASCO’s strategy to reduce the impact of cancer worldwide.
Increasing ASCO’s Global Impact
Approximately one-third of ASCO members practice outside the United States, and, of these members, one-quarter practice in low- and middle-income countries. Noncommunicable diseases, such as cancer, are now the leading cause of death and disability in low- and middle-income countries.4 Please talk about how ASCO is planning to address the oncology care needs of these members and their patients.
ASCO’s priorities of promoting research, education, and access to quality oncology care are transferable globally, and, in addition, the Society has a large and expanding portfolio of international programs to address these issues directly. For example, ASCO International through the Conquer Cancer Foundation supports the professional development of early-career oncologists worldwide with such programs as the International Development and Education Award [www.conquer.org/international-development-and-education-award], which has awarded 328 grants to recipients in 60 countries.
This program is especially exciting because it allows the exchange of knowledge between oncologists in low- and middle-income countries and senior ASCO members. ASCO also created the International Innovation Grant [www.conquer.org/international-innovation-grants3], which provides research funding for innovative projects that can have a significant impact on cancer control in low- and middle-income countries. Most recently, ASCO launched the Journal of Global Oncology [ascopubs.org/journal/jgo], an open-source online journal that provides information on the latest cancer research, oncology care, and delivery issues unique to countries with limited health-care resources.
Expanding research globally is an important part of ASCO’s mission, and I plan to participate in furthering these goals. It’s wonderful to see the enthusiasm among ASCO members about these international programs and our continued interactions in these countries, which are growing every year.
Leaving a Lasting Legacy
What legacy would you like to leave on the Society?
ASCO’s mission focuses on the partnership between the physician and other health-care providers and the patient and how to ensure this partnership has all the tools necessary to overcome the deadly disease of cancer. The theme of “Caring for Every Patient, Learning From Every Patient” focuses upon strengthening this physician/patient partnership, especially for patients who are underserved and for those who are most vulnerable.
During my next 3 years as a member of ASCO’s leadership team, I hope to foster the development of programs and tools to support these goals. To succeed, we must challenge every aspect of society that prevents us from achieving the highest quality of care for every patient with cancer. ASCO has a voice in this that is more than 45,000 members strong.
My belief is we can harness the talent of ASCO members and the courage of the patients we serve to create an equitable, learning cancer care system that can achieve the best possible care for all, not just in 2018, but in every successive year as advances in cancer accelerate. ■
DISCLOSURE: Dr. Bertagnolli reported no conflicts of interest.
1. American Society of Clinical Oncology Position Statement on Addressing the Affordability of Cancer Drugs. Approved by the ASCO Board of Directors, June 1, 2017. Available at www.asco.org/sites/new-www.asco.org/files/content-files/blog-release/documents/2017-ASCO-Position-Statement-Affordability-Cancer-Drugs.pdf?et_cid=39454952&et_rid=1760459169&linkid=position+statement. Accessed April 26, 2018.
2. Schnipper LE, Davidson NE, Wollins DS, et al: Updating the American Society of Clinical Oncology Value Framework: Revisions and reflections in response to comments received. J Clin Oncol 34:2925-2934, 2016.
3. Polite BN, Adams-Campbell LL, Brawley OW, et al: Charting the future of cancer health disparities research: A position statement from the American Association for Cancer Research, the American Cancer Society, the American Society of Clinical Oncology, and the National Cancer Institute. J Clin Oncol 35:3075-3082, 2017.
4. Independent Task Force on Noncommunicable Diseases: The emerging global health crisis: Noncommunicable diseases in low- and middle-income countries, Task Force Report No. 72. New York, Council on Foreign Relations Press, 2014.