If change is inevitable, let us go out in front of it and lead.
—ASCO President Peter Yu, MD, FASCO
“Illumination” is a provocative word, evoking as it does the banishment of the darkness of ignorance by the light of new knowledge. Today, we are benefiting from a steady stream of new knowledge about the molecular basis of cancer and the interaction between host and tumor immunology. The concept of patient-centered care is illuminating how we view the role of patients in shared decision-making, the definition of quality of care, and the professional responsibility of physicians.
Reassessing Global Cancer Care Needs
At the same time, the challenge of delivering cancer care that incorporates these advances in thinking, both in the United States and globally, are significant societal hurdles. Innovation—the imaginative and creative use of illumination to transform how we improve the lives of cancer patients in a sustainable and scalable manner—is the necessary companion to illumination.
We are the American Society of Clinical Oncology and not the American Society of Oncology. That distinction is critical because it tells the world that we are focused on patients who have or are at special risk for cancer, and that at the end of the day, our goal is not the accumulation of knowledge for its own sake, but rather the application of knowledge to patient care. Learning is simply that, another word for innovation.
We are also the American Society of Clinical Oncology and not the International Society of Clinical Oncology. Yet one-third of our members are international, and I can only assume that is because ASCO is a rich source of learning. But it can and should go both ways; there are opportunities to improve cancer care in America by learning about cancer care in other cultures, ethnicities, and geographies. Indeed, the evolving demographics in the United States are expanding the range of health-care disparity populations with cancer, populations whose unique attributes may be more readily discerned by sharing the global experience.
Over the next 18 months, a task force of domestic and international ASCO leadership will undertake a comprehensive examination of global cancer needs, which in turn provides opportunities for ASCO to work with our sister professional societies across the world to help address those needs and inculcate awareness of ethnography across the Society. While we will not change our name, we will define our place in the global effort to improve the lives of cancer patients.
Rapid Learning Health Systems
Today in the United States, we are challenged to reinvent how we practice medicine in response to society’s demand for higher quality and more affordable health care and a more efficient clinical research enterprise. A shift from reimbursement models based on production to models based on quality and outcomes has started. The survival of existing and the success of developing models of community practice and clinical research will depend on meeting these challenges successfully. At the same time, demands on academic oncologists to increase practice revenues have decreased satisfaction with the balance of academic and clinical work. Now is a time when a willingness to design and carefully study new models of providing cancer care will hold us in good stead. If change is inevitable, let us get out in front of it and lead.
As physician-scientists, we are accustomed to using data to generate and test new models. Propitiously, the arrival of digital health has provided an invaluable source of new data from which to generate knowledge and learning. The blending of big health data and medical informatics now gives us a tool with which to accelerate learning, a concept described as “Rapid Learning Health Systems.” These data sets are derived from real-world patient experiences, and consequently, the data they contain reflect how cancer patients are treated in the daily practice of medicine, the benefit and harm patients experience, the efficiency of care delivery, and most interestingly, the variation in all of this.
If we are able to match these data sets with data on patient outcomes and consumption of medical resources, we will be positioned to contribute new knowledge to the health-care reform discussion.
CancerLinQ™ is ASCO’s version of a Rapid Learning Health System applied to oncology and the first such innovation in medicine. We anticipate that CancerLinQ will provide insights for the design of new models of cancer care delivery that are sustainable and that address societal objectives, provide supportive mechanisms to sustain a thriving community practice base, and allow the voice of the physician to be resonant. By sharing our data, we all receive in return something that is greater than the sum of the parts.
Illuminating the Way in Oncology
My Presidential theme for our 51st year is Illumination to Innovation: Transforming Data into Learning. With the transformation of data into knowledge and thence from knowledge to learning lies an unprecedented opportunity to move our health-care delivery and research systems forward. It begins with a willingness to share our data and involves analysis of that data in ways that will seem foreign and new, along with the agile thinking to accept the knowledge and apply it. The most difficult part will be the recognition that the authority of conventions is often derived more from the comfort of habit than it is from reason.
Illumination and innovation are how the most adaptable will survive in a changing environment. As oncologists, we have always been and always will be at the forefront of creativity and disruptive change; it is the nature of who we are, and why we endeavor in this most difficult of medical specialties to illuminate the path forward. ■
Originally published in ASCO Connection. © American Society of Clinical Oncology. “Illumination to Innovation: Transforming Data into Learning.” connection.asco.org. June 2, 2014. All rights reserved.
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