Despite a 30-year history as an ASCO volunteer, for Eric J. Small, MD, FASCO, this past year as President-Elect has opened new perspectives on the organization he will soon lead as ASCO’s 62nd President, effective during the 2025 ASCO Annual Meeting, May 30–June 3, 2025, in Chicago. After serving as Scientific Program Committee Chair, founding Scientific Program Chair of the ASCO Genitourinary Cancers Symposium, Associate Editor of the Journal of Clinical Oncology, a member of ASCO’s Board of Directors, and most recently a mentor in ASCO’s Leadership Development Program, Dr. Small acknowledged there are still lessons to be learned about the Society’s influence across the world to conquer cancer’s devastating impact on patients. “I’ve been very fortunate to have had the opportunity to serve as an ASCO volunteer in many roles, which has helped prepare me to serve as President,” said Dr. Small. “However, there’s only so much you can learn from those direct experiences, given the remarkable breadth and depth of ASCO’s work. Over the past year as President-Elect, there hasn’t been a time when I’ve been to an ASCO thematic meeting or a staff meeting at ASCO headquarters in Virginia that I haven’t learned something new about our Society. For me, the most important lesson I’ve learned from my time serving as an ASCO volunteer is that at every step of the way, despite its size and the momentum of the organization, it’s clear there is always room for new ideas to make progress against cancer. It’s a challenge I’m looking forward to addressing.”
“Science matters. Discovery science, translational research, and clinical implementation are the engine that brings life-saving therapies to patients.”— ERIC J. SMALL, MD, FASCO
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Dr. Small began his 4-year term in June 2024 as President-Elect. He will become Chair of the Board in 2026, during the third year of his term, followed by his fourth year as Past President.
Making Scientific Breakthroughs Accessible to Patients Everywhere
Born and raised in Mexico City, Dr. Small’s Presidential theme, “The Science and Practice of Translation: Improving Outcomes Worldwide,” reflects both his and ASCO’s mission to improve outcomes for all patients with cancer, no matter where they live. “To transform the lives of patients with cancer, we have to ensure the continued flow of cancer breakthroughs from the laboratory to the clinic and from the clinic to communities throughout the United States and around the world,” Dr. Small commented. “Science matters. Discovery science, translational research, and clinical implementation are the engine that brings life-saving therapies to patients. In my Presidential theme, I intentionally used the word ‘translation’ to encompass not only scientific translation from bench to bedside to society, but also the translation of these scientific advances across cultures, languages, geography, and practice settings to make them accessible to all communities and improve outcomes for all patients, everywhere.”
Dr. Small’s clinical and translational research interests focus on urologic malignancies. He is Deputy Director and Chief Scientific Officer and Co-Leader of the Prostate Cancer Program at UCSF Helen Diller Family Comprehensive Cancer Center; Professor in Residence of Medicine and Urology at UCSF, as well as holds the Doris and Donald Fisher Distinguished Professorship in Clinical Cancer Research; and Stanford W. Ascherman and Norman R. Ascherman Endowed Chair. He previously served for 10 years as Chief of the Division of Hematology and Oncology in the UCSF Department of Medicine.
In a wide-ranging interview with The ASCO Post, Dr. Small discussed his goals as ASCO President, plans to address the oncology workforce shortage and physician burnout, ASCO’s judicial and legislative advocacy efforts to protect funding for the National Institutes of Health (NIH), and how ASCO’s Regional Councils program is providing a forum to identify the needs of international members.
Increasing Opportunities for ASCO Members
What are the goals you hope to accomplish during your Presidential tenure?
In broad strokes, I hope to make ASCO’s oncology tent even bigger and more welcoming, both in terms of increasing opportunities for our members, as well as building cancer care and cancer research capacity in resource-constrained environments, including low- and middle-income countries and low- and middle-income counties in the United States. Although there are obviously many differences between domestic and global resource-constrained environments, there are also similarities and common issues that provide the opportunity for developing shared approaches and best practices.
Among ASCO’s greatest strengths are its remarkable convening power, global reach, and robust educational and training resources. I am so excited with the opportunity to leverage these amazing assets to work to increase cancer care and research capacity, both domestically and globally.
I also want to broaden our oncology tent and increase opportunities for members. ASCO has had a defining impact on my professional career development, helping me to frame scientific and medical issues as well as ethical perspectives that inform everything I do professionally. My hope is to find ways as President to increase access to ASCO’s research and development programs that have meant so much to my career, including its mentoring initiatives, which support members’ professional development needs; ASCO’s distinct leadership programs, which are designed to train future leaders in medicine by providing practicing oncologists with training from executive coaches and networking opportunities with colleagues; and ASCO’s volunteer opportunities.
I am acutely aware that my ability to leverage all these amazing opportunities, and even my ability to serve as ASCO President, is a privilege. Among my goals is to ensure that all of our members, both domestically and internationally—whether they practice in rural or urban areas or come from community or academic settings—have the same chance I’ve had to grow professionally.
Addressing the Impact of NIH Funding Cuts on Research and Patient Care
Research is among the tenets of ASCO’s mission: “Conquering cancer through research, education, and promotion of the highest quality patient care.” Please talk about the unique challenges you face this year, including the proposed cuts to funding and staff at the NIH and the National Cancer Institute (NCI), and how they may impact care for patients with cancer.
Of course, both ASCO leadership and I have given this tremendous thought. ASCO remains deeply committed to its mission to ensure access to high-quality research and cancer care for every patient, everywhere. We are absolutely steadfast in our conviction that sustaining consistent federal funding in NIH and NCI is essential to ensuring that cancer advances continue, especially now when so much progress is being made.
Here are some stunning numbers I’d like to share. It is estimated that, by 2050, the number of new cases of cancer diagnosed each year in the United States will surpass 2.5 million, a 20% increase from 2022.1
This year, it is predicted that cancer will claim the lives of nearly 1,700 Americans every day, 365 days a year. This is outrageous and simply not acceptable. They aren’t just numbers; they are lives that potentially could be saved with increased advances in cancer treatment. Our nation’s cancer burden requires sustained federal investment in cancer research. Without it, we risk losing ground against this disease, which has a very personal and direct impact on all of us.
It means losing your close friend and colleague to a rare cancer at age 48, which recently happened to me. It means losing your partner, parent, child, or sibling to this disease. We can talk in the abstract about how important federal funding is to the NCI, but the reality is scientific research saves lives.
We are facing unique times and challenges, but cancer knows no boundaries. It cuts across party lines. ASCO will do whatever it can to work with the government to ensure that adequate funding for these agencies continues. We know that federal funding in cancer research and prevention programs has saved millions of American lives. It is estimated that there were 18.1 million cancer survivors in 2022, and that number is expected to increase to 21.6 million by 2030 and to 26 million by 2040.2
We have to keep reminding people that NCI fulfills the urgent, unmet needs of patients, and that can’t be accomplished by private industry. We will continue expressing our concern about what these funding cuts will mean for patients with cancer. There are too many lives at stake.
Overcoming Physician Burnout
The Association of American Medical Colleges is predicting that the United States could face a shortage of more than 10,000 oncologists by 2030, especially in the field of hematology-oncology.3 How is ASCO tackling the need to improve workforce diversity and the looming oncology workforce shortage?
These areas of concern are very important to us. ASCO is addressing the workforce diversity issue through its programs and initiatives focused on recruiting early-career individuals from all backgrounds into the oncology workforce. For example, ASCO supports oncology trainees and early-career oncologists by offering free Member-in-Training membership and discounted full-member membership dues for oncologists within their first 3 years after oncology subspecialty training, as well as grants to support young investigators in clinical and translational cancer research (www.asco.org/career-development/trainee-fellow-resources).
Earlier this year, ASCO published new research on the state of professional well-being among oncologists, burnout trends among oncology fellows in training, and strategies to improve professional wellness.4 When you ask oncologists about burnout, they report it is not primarily from caring for patients, but rather from how difficult the health-care system has made it for us to care for our patients. The corporatization of medicine—and oncology is certainly no exception—in which profit supersedes patient well-being, has the potential to result in an alienated workforce, contributing to feelings of burnout.
Burnout is often the culmination of oncologists being subjected to a barrage of small, slowly demoralizing events, such as delays in authorization for approved services, performative peer-to-peer reviews, and use of prior authorization. For example, a 2022 ASCO survey of oncology providers found that nearly all respondents reported having a patient who has experienced harm due to prior authorization and the ensuing treatment delays.5
According to ASCO’s research on professional well-being, three out of five oncologists (59%) reported symptoms of burnout, which is defined as a syndrome resulting from chronic workplace stress that has not been successfully managed.4
Some recommendations from this research to improve oncology workforce well-being include the following:
- Eliminate low-value work (eg, processes related to electronic health);
- Restructure teams to improve efficiency;
- Promote clinician work-life balance;
- Ensure psychological safety in the workplace;
- Identify individual practice stressors;
- Foster community within an organization.
Burnout is a complicated issue, and it’s not going to be solved with a single response, but we must address the root causes everywhere we can. For example, ASCO has lobbied strongly for prior authorization reform. In addition, the Society has published a position paper in the Journal of Clinical Oncology encouraging academic medical centers to establish career expectations that enhance and promote the professional fulfillment of academic medical oncologists and provide flexibility in career choices.6
Engaging Members in Advocacy Efforts to Preserve NIH Funding
Please talk about ASCO’s efforts to protect NIH funding. What results are you seeing so far?
ASCO, like many other medical organizations, is trying to understand the very rapidly changing environment we are currently facing. The Trump Administration’s executive orders are altering the research and health-care fields, including massive federal workforce changes and cuts in federal funding.
ASCO is engaging in judicial and legislative advocacy to protect NIH and NCI funding from cuts that may result in possible interruptions in research, which will have negative consequences for patients with cancer and in our scientific advances for years to come. Judicial advocacy is perhaps where the most action is right now, because many cases are winding up in court.
For example, on February 18, 2025, ASCO joined a dozen other leading medical and patient advocacy groups in submitting affidavits in a case that is seeking to halt funding changes at the NIH. ASCO’s affidavit detailed the significant potential resulting damage from these funding cuts, including the disproportionate burden it would place on rural and community health clinics, as well as on pediatric patients with cancer.7 On February 20, a federal judge extended a temporary restraining order blocking the cuts until she rules on the underlying case.
ASCO also signed onto a letter with Research!America urging the leadership of the Senate and House Appropriations Committees to prioritize robust funding at the NIH in any final fiscal year 2025 funding bill and reiterated the significant risks of continuing the proposed grant funding changes. We also held our 10th Annual Advocacy Summit in Washington, DC, this spring, with nearly 200 ASCO volunteers from 48 states and the District of Columbia participating in legislative advocacy by meeting with lawmakers and their staffs. We have established strong relationships with elected officials on both sides of the aisle in these efforts, because, again, cancer doesn’t care if you are a Republican or a Democrat. Cancer affects us all.
Lastly, we continue to build our grassroots advocacy mobilization with ASCO’s ACT Network (https://asco.quorum.us/action_center/), where members can learn about and take action on ASCO’s cancer care priorities. ACT Network provides an easy and streamlined way for all domestic ASCO members to communicate with their elected lawmakers on important issues affecting our profession. I strongly urge every ASCO member to get involved with the ACT Network.
Providing High-Quality Cancer Care Worldwide
Approximately one-third of ASCO members practice outside the United States, and one-quarter practice in low- and middle-income countries. Two years ago, ASCO expanded free membership to physicians from low- and middle-income countries. What has been the response so far?
Actually, nearly 40% of ASCO members currently practice outside the United States, so we are continuing to grow our international membership. The response to our expanded free membership to physicians from resource-constrained countries has been overwhelmingly positive, with rapidly growing membership and participation in our meetings. We have relationships and agreements with oncology societies in multiple countries and regions, where we have the opportunity to interface deeply with our colleagues, support their work, and help them develop the environment-appropriate resources to further high-quality cancer care and research in their countries.
Expanding ASCO’s Global Outreach
ASCO has also expanded its outreach in the global community, including the launch of four Regional Councils in Asia-Pacific, Latin America, Central and Eastern Europe, and sub-Saharan Africa. What progress are you seeing? Are there plans to increase the number of ASCO Regional Councils in the future?
This is an area of our work that I’m very excited about. As mentioned, I was born and raised in Mexico City, and although I’ve spent my professional life in the United States, I have a deep appreciation for cultures and oncology practices outside this country.
We understand that ASCO members face unique challenges in delivering high-quality patient care around the world. ASCO serves as a convener with our Regional Councils to identify the issues of greatest concern to them, and then we provide the resources to help them accomplish their goals.
For example, our Asia-Pacific Regional Council just celebrated its 5-year anniversary. That council identified the need to support young oncologists across the region and develop the next generation of oncology leaders. They adapted the ASCO’s Leadership Development Program to accomplish that goal and have already produced their first graduates.
In addition, we helped to develop a similar leadership program with our Latin America Regional Council members. That council was also interested in developing funding for clinical cancer research in the region. As a result, the council adapted ASCO’s International Clinical Research Course to help members develop and implement their research ideas. One outcome is the development of a research funding mechanism using medical grants from Pfizer to support innovative approaches to diagnosing metastatic breast cancer and improving the quality of life for these patients in Latin America. Following the success of that program, Pfizer is now funding similar research in breast cancer treatment in sub-Saharan Africa in partnership with the sub-Saharan Africa Regional Council.
Our newest council is the Central and Eastern Europe Regional Council. That council is interested in educating oncology professionals in the use of molecular tumor boards and potentially establishing molecular tumor boards to collaborate with colleagues across the region.
Over the past year, I’ve been meeting with members of these Regional Councils. Their work is impressive and inspirational. It is such an exciting program that gets to the issue of matching ASCO resources with members’ needs around the world, and it’s been very successful. We are currently evaluating other regions to see where this program can be expanded, and those decisions will be forthcoming.
Although there are many challenges, with so much going on in the cancer community both here and internationally, this is a very exciting time to be ASCO President. I’m profoundly grateful for this opportunity and look forward to building upon our past successes and addressing our new challenges.
DISCLOSURE: Dr. Small reported no conflicts of interest.
REFERENCES
1. American Association for Cancer Research: AACR 2024 Cancer Progress Report. Available at https://cancerprogressreport.aacr.org/progress/cpr24-contents/cpr24-cancer-in-2024/#:~:text=In%20the%20United%20States%20alone%2C%20the%20number,2.5%20million%20by%202050%20(46)World%20Health%20Organization. Accessed April 16, 2025.
2. Tonorezos E, Devasia T, Mariotto AB, et al: Prevalence of cancer survivors in the United States. J Natl Cancer Inst 116:1784-1790, 2024.
3. Cancer CarePoint: Shaping the future of cancer treatment: Key oncology staffing trends for 2025. Available at https://cancercarepoint.com/resources/2025-oncology-staffing-trends/#:~:text=Looming%20Oncologist%20Shortage:%20Supply%20&%20Demand,deficits%20in%20other%20oncology%20subspecialties. Accessed April 16, 2025.
4. ASCO: New reports assess oncology workforce well-being, propose solutions to address burnout. January 29, 2025. Available at www.asco.org/news-initiatives/policy-news-analysis/new-reports-assess-oncology-workforce-well-being-propose. Accessed April 16, 2025.
5. ASCO: Nearly all oncology providers report prior authorization causing delayed care, other patient harms: ASCO survey shows negative impact of prior authorization on cancer care. November 22, 2022. Available at www.asco.org/news-initiatives/policy-news-analysis/nearly-all-oncology-providers-report-prior-authorization. Accessed April 16, 2025.
7. Case 1:25-cv-10340-AK, Document 37, Filed 2/18/25: In the United States District Court for the District of Massachusetts. Available at https://cdn.bfldr.com/KOIHB2Q3/as/kvk6bpf34kxqvwjphcsqt/AAMC-Plaintiffs-Declarations-As-Filed. Accessed April 16, 2025.
