On April 9, 1964, ASCO's original founding committee met in a small room in the Edgewater Beach Hotel in Chicago. The minutes of that meeting indicate they were united by "their common concern for the patient with cancer." ASCO's first meeting in 1964 had slightly more than 70 attendees. This month, an estimated 30,000 people from across the globe will gather in Chicago to attend the 47th Annual Meeting of American Society of Clinical Oncology. The size and scope of ASCO today might have seemed unimaginable to the Society's founders; however, they would be proud that the central core of ASCO's mission has remained unchanged.

To commemorate ASCO's 47th Annual Meeting, The ASCO Post presents reflections from some of the Society's past Presidents. For a complete list of past ASCO Presidents, see page 19.

Personalizing Cancer Care

Richard Schilsky, MD
ASCO President, 2008–2009

During my Presidency we completely revamped the way the ASCO Board of Directors works by creating various subcommittees and a much more deliberate strategic planning process. In effect, the Board members took more ownership of ASCO's agenda, planning the future of the Society rather than dealing with its multiple operational aspects. It was an important change for ASCO.

My theme was Personalizing Cancer Care and I was pleased that my Presidential speech was enthusiastically received. However, as I was leaving the hall a patient advocate stopped me and said that she was very disappointed with my speech. I asked why? She said all I talked about was molecular pathology and genotyping. To her, personalized medicine meant that the doctor gets to know each patient as an individual and delivers the kind of personalized care they need.

As physicians, our goal is to understand the needs of each patient and then provide a treatment plan built around a set of personalized needs and goals. The patient advocate's comment made me remember that sometimes in our desire to reach a scientific understanding of cancer, we forget that our main objective is to connect with and care for the patient. I'll never forget that encounter. ■

One Community

Nancy E. Davidson, MD
ASCO President, 2007–2008

My Presidential theme was One Community. I think that theme continues to express much of our goal in oncology, which is to make sure that all members of the cancer care team work together—oncologists, nurses, scientists, nutritionists, psychologists, social workers, administrators, and others.

I also had the privilege to be the first President to work an entire term with our CEO, Dr. Allen Lichter. Allen and I talked a lot about the likelihood that cost was going to be ever more important in the overall discussion of how we deliver health care in this country. Some ASCO members felt that doctors and patients shouldn't talk about money; they should only focus on care.

However, we decided that it was unrealistic to avoid that conversation. So we launched the Cost of Care Task Force, and its first challenge was to tackle something I brought up, which was that cost is a side effect, just like losing your hair or having low blood cell counts, and as health-care providers it is our obligation to talk about costs with our patients. I'm proud of the role that ASCO is continuing to play in advocating ways to provide the highest quality of oncology care in the most cost-effective manner. ■

Multidisciplinary Interactions

Gabriel N. Hortobagyi, MD, FACP
ASCO President, 2006–2007

As my Presidency gradually fades into the past, it is sobering to reminisce on how exciting it was. ASCO is a great organization with an amazing staff and a solid mission. Chairing the Board meetings was clearly a highlight of my Presidency because of the vast talent and collective wisdom that is brought to bear with each issue under discussion.

Recruiting Allen Lichter, MD, as CEO was a thrill. In partnership with Allen, we took the first steps to make ASCO less dependent on Pharma support. Future ASCO Presidents should continue to seek alternative sources of revenue for our Society, to avoid the appearance of any conflict of interest.

My theme was multidisciplinary interactions and the emphasis on serving all ASCO constituencies, especially the international membership, which had been an "orphan" contingent for many years. Today, thanks to a vigorous International Affairs Committee, ASCO influences oncology services on all four corners of the world, and partners with multiple regional societies in educational conferences, and the training of young oncologists.

Looking forward, ASCO Presidents should use their bully pulpit to emphasize issues of quality of care, rapid translation of research into practice, championing the rights of cancer patients, and partnering with patient advocates to positively influence the political process. Despite the regulatory maze and increased bureaucracy, oncology continues to be the greatest of professions, enormously rewarding for those who practice for the right reasons—combining patient care, research, and the training of our next generation of cancer care providers. ■

Medicare Modernization Act

Margaret A. Tempero, MD
ASCO President, 2003–2004

Being an ASCO President is one of the best experiences anyone in our field can have. There's a sense that you can really make a difference in the world, and it was truly a privilege. However, I had sort of a Jekyll and Hyde experience during my Presidency in that my original agenda was sideswiped by the passage of the Medicare Modernization Act (MMA), which produced a time of sudden turmoil within ASCO.

We understood that the bill, as it was originally written, threatened access to care by putting undo stress on the existing financial models of many community practices—it needed an immediate response from the Society. I was fortunate to have strong individuals to rely on, Drs. Jack Keech and Joe Bailes. Through long and hard work, we were able to have a provision added to MMA that offered adequate financial protection to community practices.

It was a tough time, but a period that showcased the brilliance of the ASCO staff and the resoluteness of the membership in ensuring that our patients could continue to receive high-quality care in their community doctors' offices. At the time, many people didn't see the relationship between MMA and access to care. However, it was not about money, it was about community practices retaining enough fiscal integrity to be able to serve their cancer patients. Working through this crucial issue was a powerful experience during my Presidency. ■

Cancer Prevention

Paul A. Bunn, Jr, MD
ASCO President, 2002–2003

One highlight of serving as ASCO President is working with the outstanding staff—to name just a few, Executive Vice President Charles M. Balch, MD; Chief Operating Officer Ron Beller, PhD; Jean Colvard; Roseanna Thoman; and all the Department heads. During my Presidency, we undertook some very exciting initiatives. One was the elevation of the Cancer Prevention Task Force to full committee status, which allows the Society to focus more effectively on the creation of cancer education and prevention initiatives.

Part of ASCO's strategic planning was to become the authoritative resource for cancer. Since lung cancer is the number one cancer killer worldwide, I thought that we should lead in prevention initiatives. So we set about revising the ASCO tobacco control policy; the ultimate goal was the global elimination of tobacco products. In part, the policy called for efforts to increase tobacco taxes, expand prevention programs, limit promotions, and impose trade restrictions. It was a bold move, and one that I am proud of. ■

Quality of Cancer Care

Joseph S. Bailes, MD
ASCO President, 1999–2000

Under my leadership as President, ASCO initiated the largest quality of cancer care study ever done. Called the National Initiative for Cancer Care Quality (NICCQ), we looked at more than 60 quality measures for stage I to III breast cancer and stage II to III colorectal cancer. We identified areas in need of improvement and suggested follow-up efforts to target and improve the quality of cancer care. Supported largely by Susan G. Komen for the Cure, the study was a major undertaking that actually became the springboard for ASCO into cancer care quality research and education.

Now, the Society is globally recognized as the leader in cancer care quality. If I reflect back on my Presidency, I think my part in launching NICCQ was the highlight of an extremely rewarding year. And the reason that ASCO continues to grow is that we are viewed as an evidence-based international organization that puts the patient with cancer first. ■

International Affairs

Karen H. Antman, MD
ASCO President, 1994–1995

Cancer is a global problem. One advantage of academic medicine is that faculty get to travel to various universities internationally and see a country though the eyes of their colleagues, and not as a tourist. Therefore, during my Presidency, I established the ad hoc International Affairs Committee which evolved into the standing committee that has become a vital part of the organization. At the time, attendance at our Annual Meeting was already about 50% international. I felt that including our international colleagues in ASCO was important so we could communicate and collaborate globally and increase the organization's global presence. And we have. ■

AACR–ASCO Transition

George P. Canellos, MD
ASCO President, 1993–1994

My Presidency was a transitional year; it was the first time that ASCO had a meeting separate from the American Association for Cancer Research. Since ASCO was thought to be simply a science-light organization that focused solely on clinical trials, the pressure was on to establish an independent scientific presence. I planned for our Annual Meeting to have more science than usual, and ASCO has continued to maintain that solid scientific presence.

A contract group was managing ASCO at the time, and it became apparent that we needed to take a permanent role in the organization's continuous activities. So we offered Dr. John Durant the position of Executive Vice President, and he was later confirmed in the position by my successor. ASCO's road to independence and eventually to self-publishing the Journal of Clinical Oncology had begun.

Also during my term, Dr. Bernard Fisher was wrongly accused of running an organization that had some problems with its data. Breast cancer advocates were up in arms; the NCI was upset—a real mess. Dr. Fisher was subsequently vindicated. At the ASCO Annual Meeting that I chaired, there were inquiries about having him speak at the Plenary Session. Naturally the presentations were already booked, but we altered the session, eliminating certain talks to make room for Dr. Fisher. I gave him a big hug when he stepped to the lectern, and it set off a roaring ovation from the packed hall. He did a marvelous job. ■

Science vs Practice

Bernard Fisher, MD
ASCO President, 1992-1993

My year as President was a busy one. Aside from continuing my research and directing the activities of the National Surgical Adjuvant Breast and Bowel Project, I was drowned by the vast amount of information that was sent to me by ASCO headquarters (see page 10).

At the onset of my Presidency, I discovered that a crisis was brewing regarding ASCO's mission. Since subsequent Annual Meetings of the Society were no longer to be held in conjunction with the American Association for Cancer Research, many members felt that ASCO was abandoning its scientific objectives and directing its course toward private-practice issues. On the other hand, private-practice oncologists were concerned that ASCO was not providing them with a platform for discussing their problems related to reimbursement, government affairs, and education of oncologists.

During my tenure, I was more concerned with ASCO's relation with research. I firmly believed that the future vitality, integrity, and justification for the Society would depend on how well research enveloped its membership. I thought that a widening gap between physicians and investigators could not only threaten the welfare of patients, but as clinicians got further away from science, the hope for progress in curing and preventing cancer would diminish. In my Presidential address, I noted a statement by Nobel Laureate Sir Peter Medewar, indicating that to deride any aspect of science, be it fundamental, basic, or clinical, is the ultimate foolishness, the last word in poverty of spirit and meanness of mind.

While I was less than enthusiastic about ASCO's role in the public issues arena, I did believe that ASCO should be used as a bully pulpit to express its positions on selected public issues related to its major goal, ie, promoting medical care based on science. Two decades later, I still maintain that all members of ASCO must have the same objectives relating to the prevention and cure of cancer: They must base therapeutic decision-making on information obtained using scientific methodology rather than empiricism, anecdotalism, and inductivism, which, unfortunately, continue to be used by too many physicians. ■

The Past Quarter Century

Philip Schein, MD
ASCO President, 1983–1984

Reflecting on the years since my Presidency, I have been deeply impressed with the advances that have been made in our fundamental understanding of cancer biology and in our capacity to translate discoveries into new, mechanism-based therapeutics. A much broader range of therapeutic tools has emerged than was available to investigators in the past, and prospective patient selection is becoming a reality. The result has been a significant improved outcome for patients with specific tumor types. However, the past decades of research have also brought a humbling appreciation of the continuing challenge: a bewildering array of molecular expressions of tumor heterogeneity and the barriers posed by complex mechanisms of resistance.

A significant upward revision in the estimate of the number and quality of new therapeutics will be required to match the growing catalog of tumor subtypes. We must also face the reality that a disappointingly low number of new molecular entities survive the development and regulatory processes, and reach the public in form of FDA-approved products.

So while there have been unquestioned and important advances over the past quarter century, current survival statistics for most common forms of cancer and the success rate in developmental therapeutics demonstrate that there is much work to be done and no justification for self-congratulatory complacency. Instead we should be encouraged by our successes and intensify our efforts. ASCO, in fulfillment of its commitments to patients with cancer and their families, is well positioned to assume a leadership role in this endeavor. ■

Journal of Clinical Oncology

Emil J. Freireich, MD
ASCO President, 1980–1981

During my Presidency, we decided to increase ASCO's size to give clinical investigators a better position in the medical world. To that end, I decided that the Society needed its own journal. At that time, we sent our papers to Blood or Cancer Research, where, in my estimation, they received poor treatment. I charged the Science and Publications Committee to develop a plan for the new journal. Led by Emil Frei III, MD, the committee worked long and hard to design guidelines for the journal and to select its first editor, Joseph R. Bertino, MD. The Journal of Clinical Oncology was born, and its continued success as one of the nation's top-ranked journals is very satisfying.

I also felt that ASCO needed to generate more income than it was getting from membership dues. I decided to bring in commercial exhibits, which helped transform the Society. For one, we now had enough money to support our publication and help us initiate grants and educational programs.

Unlike other scientific societies, ASCO focused on patient-oriented studies. It's great to cure mice and treat cell lines and isolate genes, but if we're going to cure cancer, it is going to take talented physicians working at the bedside and in clinical trials. All of our patients are battling a lethal disease, and my advice to young oncologists coming into this great field is to retain a sense of urgency! ■

The Consequence Is Cure

Vincent T. DeVita, Jr, MD
ASCO President, 1977–1978

My Presidency was the first year that the Annual Meeting hit 10,000 attendees, which at the time we thought was a huge number—it seemed that we'd hit the ceiling. It was about 9 years after we published the results from our study of combination chemotherapy (MOPP) in the treatment of advanced Hodgkin's disease, which was the first example of the ability to cure advanced cancer in adults with drugs. So I titled my Presidential speech "The Consequences of the Chemotherapy of Hodgkin's Disease." Given the use of the word "consequences," everyone in the audience assumed that I was going to speak about the bad effects of the chemotherapy. Remember, at that time most people were still skeptical about the curative value of chemotherapy.

The title turned out to be an interesting play on words, because the central point of the speech was that the most important consequence of using chemotherapy for Hodgkin's disease was its cure. To give the speech's meaning historical perspective, the original paper we published in 1970 on MOPP was the most cited paper in the history of the Annals of Internal Medicine. It took another 11 years for MOPP to fully diffuse into the practice of oncology, so when I gave my Presidential speech it was not fully out there. Nevertheless, it remained the standard of care for 25 years. ■