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?

We need to work with the Centers for Medicare & Medicaid Services, private insurers, and health-care systems to encourage evidence-based quality care. ASCO’s Quality Oncology Practice Initiative (QOPI®) assists oncology practices in measuring and improving their quality standards against a national benchmark. With this information, modification of the system for the appropriate reimbursement of cognitive services and supportive care as well as for procedures, treatment, and quality improvement can be accomplished. Information from clinical trials and large data sets from rapid learning systems, such as CancerLinQ™, will inform this quality care so we can provide state-of-the-art care using evidence-based guidelines and decrease duplication of services throughout the health-care system. 

As far as diminishing federal resources for basic and translational research is concerned, it really is an ever-increasing problem, and ASCO needs to support maintenance of the current programs by working with the National Cancer Institute (NCI) to use research dollars in high-priority oncology research that is most promising for breakthroughs. In addition, innovative support systems to enhance collaboration with advocacy groups and private donors should be encouraged. We can look at alternative resources, such as ASCO’s Conquer Cancer Foundation, private groups, and other foundations, to allow additional funding for research while decreasing the duplication of effort and infrastructure. 

There also needs to be further streamlining of the NCI’s Clinical Trials Cooperative Group–run clinical trials system. The use of a simplified structure would decrease cost and increase efficiency of the Cooperative 

Group trials while focusing on the trials with the most impact potential for patients. Examples of how we could do that would be allowing the use of centralized Institutional Review Board services at cancer care locations, using standardized templates for protocols that are less complicated, and having a simplified and unified contracting system to work with the different universities and cancer centers. 

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?

There are many different opportunities to consider for optimizing interest in cancer research. As far as the direct support of young investigators, the Conquer Cancer Foundation grant process is an excellent example of private funds being utilized to support innovative research. We also need to expand mentorship support through the Foundation for these young individuals because they need to be in an environment where there is a team-based approach to research, education, and translational cancer care. 

ASCO and the Conquer Cancer Foundation should also continue to encourage and support research by pharmaceutical companies, medical diagnostic companies, and medical device companies through innovative collaborations. One example of such collaboration is the Leukemia & Lymphoma Society’s Therapy Acceleration Program in which the society partners with different companies to speed drug development. 

As far as younger college or medical students interested in oncology is concerned, we should support internship and summer programs with oncologists and cancer centers to help students learn early in their careers about the fields of cancer care and oncology research. These programs could be supported by the Conquer Cancer Foundation through its donation program as well as by the institutions and practices. 

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?

Thankfully, more and more patients are surviving cancer for extended periods of time. ASCO’s Oncology Workforce Study demonstrated that oncologists alone are not going to be able to manage both the initial and aftercare of all patients diagnosed with a malignancy. We need to team with primary care physicians, midlevel providers, and other support staff to supply the care that these patients will need. 

There are several ways we need to approach oncology team-based care. One would be by building multidisciplinary teams of oncologists, primary care physicians, midlevel providers (including nurse practitioners and physician assistants), and other support staff (such as dieticians, physical therapists, social workers, psychologists, and psychiatrists) to take care of all patient needs during therapy and beyond. 

There are also provisions in the Patient Protection and Affordable Care Act for the establishment of the Patient-Centered Medical Home. We already have such patient-centered care in oncology to some extent, but formalizing that care into an oncology medical home at institutions and practices would be very beneficial. 

We need to educate primary care physicians about the team-based approach to care to make sure that they understand not only the diagnosis and treatment of cancer, but the follow-up care for patients and long-term survivorship care as well. We also need to do a better job of educating patients about treatment options and toxicities. 

This process needs to be a two-way street. ASCO will need to collaborate with other professional organizations like the Association of Physician Assistants in Oncology and the Oncology Nursing Society, as well as with primary care organizations such as the American College of Physicians. Also, we need to have representatives from the other health-care professional organizations involved with ASCO so we can determine the best way to have an integrated delivery system of care for patients and survivors.

Biggest Opportunity

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

One of ASCO’s initiatives I’m most excited about—and the one that has the potential for the most improvement in quality care—is CancerLinQ™. It brings real-world data on the treatment of thousands of patients through different practices across the country to our desktop. 

ASCO’s research blueprint [Accelerating Progress Against Cancer: ASCO’s Blueprint for Transforming Clinical and Translational Cancer Research, November 2011] laid out a roadmap for the clinical research system to capitalize on new discoveries in cancer biology. This information can be accelerated through the aggregation of data on thousands of patients in the CancerLinQ system. Eventually the analysis of this large dataset will allow the oncology community to modify patients’ treatment to have a much higher chance of success. It will also decrease costs, as therapies predicted to be less successful for an individual patient’s characteristics are avoided.

Biggest Challenge

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

ASCO’s biggest challenge is to assist the oncology health-care team in providing quality cancer care and in keeping up with new information coming out daily, and to do it in a cost-effective environment that meets the needs of the patient. I think the way to overcome that challenge is to continue to develop and update oncology-specific guidelines that can be used as the basis for quality-care management, such as through the QOPI system. As evidence-based guidelines are developed and modified, cost-effective information can be added as it is obtained through clinical trials, registries, and the CancerLinQ system. 

Armed with this information, we can improve the affordability of cancer care by leveraging existing efforts to reform payment and eliminate duplication and waste in oncology care. As part of the quality initiatives, we need to ensure that all oncology professionals have core competencies and work in a collaborative way to enhance comprehensive oncology patient-centered care. 

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?

My initiative would be promoting the art of oncology and quality cancer care. This concept includes a number of different aspects. We want to promote personalized quality care with respect to finding the right treatment for the patient by making sure we are looking at patient-specific prognostic information as well as information about the genetic makeup of the tumor. By understanding the important pathways in the tumor, oncology teams will be better able to make wise treatment decisions with an increased probability of success for the patient.

Another aspect would be the promotion of quality multidisciplinary care using patient-centered oncology medical homes to make sure we are addressing all the short- and long-term issues of care for patients from diagnosis to survivorship. Personalized care also means individualizing and optimizing education, personal, and financial needs, as well as providing comfort and respect for the patient and family. The art of oncology encompasses how to successfully put all of these aspects of oncology care together to benefit an individual patient and support the family through a stressful time. ■