Perspectives from Chicago: The 2022 ASCO Quality Care Symposium
This past weekend I had a lovely 2 days in Chicago at #ASCOQLTY22, as it is known in the Twitterverse, with fellow ASCO staff and 600+ attendees, all passionate to learn and share insights about quality cancer care and innovation. This was the 10th anniversary of the first Symposium, which arose from the 2009 vision of former ASCO President Dr. Doug Blayney and was ultimately enabled by the ASCO Board of Directors.
I’ve had the privilege of attending many of these meetings, which are always efficiently organized and packed with stimulating research and practice findings delivered by brilliant and passionate experts, but in these “post-COVID” times, every in-person meeting has a special significance now.
Here’s just a few insights from the meeting I found particularly compelling:
1. Dr. Otis Brawley, in his address as winner of the Joseph Simone Quality Care Award, shared some terrific pearls, reminding us that “the provision of unnecessary care is a source of health disparities,” and “we live in an era of medical gluttony.” De-escalation and de-implementation are important components of improving quality, and too often it is the poor and underserved who are subjected to disproven, low-value therapies.
2. The Keynote Lecture on Day 1 was delivered by Dr. Zeke Emanuel, who needs no introduction, and he shared the stunning statistic that 42% of patients with cancer spend their entire life savings in the 2 years post-diagnosis. He also highlighted the benefits of the 2022 Inflation Reduction Act but reminded us that the $2000 cap on Part D prescriptions doesn’t kick in until 2025.
3. Dr. Patricia Ganz of UCLA reviewed the past IOM reports proposing the development of a learning health system (LHS) for oncology, including the 2013 recommendation that professional societies should design and implement the necessary digital infrastructure, with ASCO’s development of CancerLinQ as a direct response. She also cautioned that the LHS ≠ big data, and the joining of multiple electronic databases is only as good as the quality of data they contain.
4. Dr. Justin Barnes (Washington Univ.) used data from NPCR/SEER and NCHS and showed that states that had expanded Medicaid under the ACA showed improved late stage cancer diagnoses and cancer mortality compared with those that did not, with ~2600 distant diagnoses and ~1000 deaths averted per year. Significantly, this effect was seen much more so in White populations than Black.
5. Dr. Qasim Hussaini (Johns Hopkins) and colleagues studied the impact of historical housing discrimination (aka “redlining”) on colon cancer outcomes and showed that patients residing in these redlined neighborhoods had a later stage at colon cancer diagnosis, a greater time to adjuvant chemo, and higher mortality for both early and later stage disease.
6. There were lots of updates on patient-reported outcomes. Dr. Michael Hassett (DFCI) and the eSyM investigators concluded that ePROs should employ multiple modalities of PRO collection (mobile app, web, text, etc.) to be more patient-centered and to maximize response rates.
7. And the last speaker of the meeting, Dr. Yousuf Zafar (Change Healthcare), with his usual dynamic and brilliantly precise presentation style, noted that to truly enable precision care delivery and reduce silos, EHR redesign should encompass better visualization tools, decision support, and data integration, but not at the expense of failing to consider patient privacy/security, patient consent, and minimization of bias.
And finally, I want to note how many of the presentations were delivered by oncology fellows and even some medical students. They were all terrific! The future of the oncology workforce is indeed bright.
Robert S. Miller, MD, FACP, FASCO, FAMIA
Chief Medical Science Officer, CancerLinQ