The Tennessee Oncology Practice Society (TOPS) is among the oldest and one of many politically active ASCO State Affiliates. Founded in 1990, the organization has since been a voice for Tennessee’s diverse community of oncology professionals, advocating for patient access to the best available care and providing members with innovative resources to help them stay ahead of the shifting health-care landscape. TOPS became an ASCO Affiliate in March 1994, as one of 23 societies to submit an application for Affiliate status that was approved by the ASCO Board of Directors that year.

Frankly, many things are possible on the state level that just aren’t as easy to accomplish on the federal level.

— Jill Gilbert, MD

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As President, Jill Gilbert, MD, has reenergized TOPS by engaging in advocacy efforts both nationally and locally, meeting with legislators and their staff to represent the interests of TOPS members, which now number 234. She has also worked to grow the organization’s membership by taking the time to travel around the state and meet prospective members in person. Dr. Gilbert is Professor of Medicine at Vanderbilt University Medical Center, Nashville.

The ASCO Post talked with Dr. Gilbert about the challenges currently facing the organization and her goals for its future.

Key Issues

TOPS is very active in state legislation and public policy issues that impact cancer care in the state. What was the impetus for that involvement, and what has your group accomplished?

Over the past several years, we’ve faced many different challenges in terms of providing care to our patients with cancer—not just oncology care, but also the supportive care surrounding their oncology needs. So starting in December 2016, we recognized the need for TOPS to have a place at the table in the state legislature.

We felt that many of the health-care decisions that were going to be made, especially with this new administration, were going to be made at the state level, so we hired a seasoned, local lobbyist, who has developed relationships with many of the legislators who deal with health-care decisions.

As a board and with our lobbyist, we identified key issues that were going to be of significance in the legislative session starting in January 2018, and we started traveling around the state, meeting with legislators in their home territories and at the capitol building in Nashville. We didn’t ask anything of them at that time, but we did open the path for them to call on us should bills or issues arise that needed input from the cancer community. It was sort of a two-way street in that sense. We wanted to put a face to TOPS—to introduce ourselves and start building relationships—so that when the inevitable “ask” came in January, they knew who we were.

The key issue this year in the Tennessee legislature was the opioid bill (H.B. 1831/S.B. 2257), which will place more guidelines for and checkpoints between health-care practitioners and patients before an individual is put on a chronic regimen of opioids. We, along with ASCO and several other advocacy organizations, were able to provide recommendations and verbiage for the bill to satisfy the needs of our patients with cancer.

We also created a cancer caucus that will be in place prior to the next legislative session. The caucus is a ready community of state officials—“cancer warriors” so to speak—who can fight for our patients with cancer, for providers who care for them and to help us when we have a bill in need of support.

Strengthening the Society

You’ve recently managed to reenergize the organization and grow its membership. How did you do it?

You have to be a cheerleader for the state organization, reach out to colleagues throughout the state, and ask them to make an effort to join. There’s a lot of “bang for the buck” in the big cities, but we’re also trying hard to encourage members in the rural communities to join so they have a voice. Let’s be clear: We still have work to do on that front, but our upcoming annual meeting in Nashville will help address that.

At the meeting we’ll have a government relations update to discuss where we are with our lobbying activities in the legislature. We’ll also have an invited speaker talk about the marijuana legislation that did not pass this year, but which I think is going to be one of the big-ticket items next year. The two sponsors of the bill are anesthesiologists; we want to better understand the science behind medical marijuana as it relates to cancer patients so we can potentially put our support behind their efforts.

Another goal of the meeting is to expose our trainees to what the state society is all about. We have three academic institutions in the state, and each institution has a representative on the board as a nonvoting member. It helps us groom the next generation of participants in these activities, who will also be present at the meeting.

Looking Ahead

What are some of the key issues TOPS will be focusing on in the future?

I think next year we’ll be looking at oral parity (ie, insurance coverage for oral chemotherapy agents) as well as Medicaid work requirements. We’ll be meeting with TennCare (Tennessee’s Medicaid program) to make sure there is some type of carve-out for our patients and their caregivers in the throes of cancer treatment or late effects of therapy.

Significance of State-Level Activities

Why is it important to have an ASCO affiliate organization at the state level?

I think the state society is important because more and more, we’re seeing that health-care decisions are being made at a state level, and state representatives are often accessible and open to learning about a particular issue. I think it’s in our court to continue the dialogue, and it’s a missed opportunity if we are not involved. Frankly, many things are possible on the state level that just aren’t as easy to accomplish on the federal level.

DISCLOSURE: Dr. Gilbert reported no conflicts of interest.