2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

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LEVERAGING VIRTUAL PATIENT COMMUNITIES FOR OPTIMAL CLINICAL CARE AND RESEARCH CHAIR Howard J. West, MD Swedish Cancer Institute Seattle, WA SPEAKERS George D. Demetri, MD Dana-Farber Cancer Institute, Harvard Medical School Boston, MA Dave deBronkart, SB Boston, MA
A New Model: Physician-Patient Collaboration in Online Communities and the Clinical Practice of Oncology By Howard J. West, MD, Dave deBronkart, SB, and George D. Demetri, MD Overview: The practice of medicine is in the midst of a fundamental transformation based on the new availability of health information through the Internet and other sources accessible by the broad lay public, as well as on the easy sharing of experiences and content through social media. This is occurring at a time when the volume of new information required for optimal medical care is exceeding that which an individual physician can feasibly follow and master. The changes in cancer care are especially acute as we experience an ongoing reclassification of many disease entities to reflect divisions by molecular variables, often with new clinical options now optimized for very limited patient subsets. The increasing complexity of the field, combined with the high stakes of optimizing treatment decisions and the growing THE INTERNET has transformed many industries, ranging from news media to travel, real estate, and politics, with the practice of medicine also in the midst of its own belated disruption as well. For centuries, our dominant medical model has been based on a unidirectional flow of information, in which only physicians had access to the knowledge sufficient to weigh differential diagnoses and to recommend optimal treatments. Patients readily accepted physician wisdom and recommendations as the only readily available source of medical information. Among the factors that have dramatically altered the course of medical practice, and oncology in particular, are two central issues. The first is that the sheer amount of new medical information emerging over the past few decades has ballooned to the point that no single physician could possibly maintain expertise in the full breadth of topics required to care optimally for a full range of patients and clinical problems. In particular, oncology has exploded with new content that is a boon in defining a new era of mechanistic understanding of cancer pathophysiology, as well as necessary for the rational development and use of molecularly targeted therapies; however, it is simply infeasible for an oncologist to internalize the depth and breadth of new content. The second core element is that this content is now readily accessible to the lay public, including patients and caregivers, essentially without limitation and in real time— perhaps even before the clinician has become aware of it. Engaged Patients Usher in a New Model of Medical Practice There is clear evidence that the amount of medical information for any one doctor to consume and digest has grown remarkably. PubMed (www.ncbi.nlm.nih.gov/pubmed/) currently categorizes more than 21 million citations, with new publications being added at a rate of approximately one per minute—a rate that has more than doubled over the past 20 years. 1 The number of medical journals has also increased, and this is especially true for oncology, where there are now approximately 180 journals covering just this one area of clinical subspecialty practice. 2 As new research availability of a wide range of information in the public domain, make oncology an area in which patients and caregivers are most motivated to become active seekers of medical information and participants in their care decisions. The credibility of the available online information in such a situation has emerged as a critical issue, but physicians have historically been reluctant to create content or interact with the lay public in online patient communities. Here we will highlight several examples of collaborative engagement between health care professionals and motivated patients in an online environment that illustrate how a new bidirectional or even networked model that is a product of the Internet age can accelerate clinical research and improve delivery of cancer care. results are released early online and new trial data are often released via a press release long before being presented and/or published in a peer-reviewed setting, physicians only have more sources of practice-changing information to interpret and incorporate into their management recommendations. This broader distribution of medical information is also occurring as physicians are typically pressed to see more patients in less time. Concurrent with these changes, patients and caregivers are seeking both support and medical information online at a rapidly escalating pace—from 25% of U.S. adults in 2,000% to 61% by 2010 3 —with this trend rapidly accelerating as fast Internet connections become more readily available. People also have become increasingly comfortable with seeking and expecting to find relevant content online free of charge. Among health care topics, those that are lifethreatening and/or chronic lend themselves best to online patient communities and to Internet-based searches for information. This is unquestionably a mixed blessing for patients and physicians alike. Internet searches can instantaneously return reliable and timely information but also might deliver content from unreliable sources that instead prey on the desperation of people by peddling the false hope of a “Miracle Cancer Cure” (www.theCancerCureMiracle.com) (Fig. 1). Beyond charlatans misleading patients and caregivers for profit, online communities provide a wide range of recommendations from people who might be knowledgeable and well intended but who might definitively promote treatment ideas that are not proven to be superior to others or are possibly even detrimental. Such information may directly compete with thoughtful recommendations from qualified medical and scientific professionals. The fact that the Inter- From the Department of Thoracic Oncology, Swedish Cancer Institute, Seattle, WA. Authors’ disclosures of potential conflicts of interest are found at the end of this article. Address reprint requests to Howard West, MD, Swedish Cancer Institute, 1221 Madison St., Suite 1020, Seattle, WA 98104; email: howard.west@swedish.org. © 2012 by American Society of Clinical Oncology. 1092-9118/10/1-10 443
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AMERICAN SOCIETY OF CLINICAL ONCOLO
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American Society of Clinical Oncolo
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American Society of Clinical Oncolo
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New Looks and Challenges for Cooper
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Genitourinary Cancer Best Use of Im
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Research and Standard of Care: Lung
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Practice Management and Information
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2012 ASCO Annual Meeting Disclosure
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Matti S. Aapro, MD Clinique De Geno
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Hedy Lee Kindler, MD The University
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Douglas E. Wood, MD University of W
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Mary Lou Smith, JD, MBA Research Ad
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ASCO and Conquer Cancer Foundation
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Letter from the Editor The theme of
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Adjuvant Therapy for Older Women wi
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TREATMENT FOR OLDER WOMEN WITH BREA
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MANAGEMENT OF T1 BREAST CANCERS the
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MANAGEMENT OF T1 BREAST CANCERS Tab
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MANAGEMENT OF T1 BREAST CANCERS Tab
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MANAGEMENT OF T1 BREAST CANCERS 93.
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MANAGEMENT OF T1 BREAST CANCERS 1 c
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ADJUVANT ENDOCRINE THERAPY reductio
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ADJUVANT ENDOCRINE THERAPY which ra
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ADJUVANT ENDOCRINE THERAPY assay is
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A DICKENS TALE OF THE TREATMENT OF
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TREATMENT OF ADVANCED BREAST CANCER
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A FRESH LOOK AT DUCTAL CARCINOMA IN
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DCIS: OPPORTUNITIES AND UNCHARTED W
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DCIS: OPPORTUNITIES AND UNCHARTED W
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Ductal Carcinoma In Situ, and the I
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DCIS AND INFLUENCE OF RISK FACTORS
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KEY QUESTIONS IN THE LOCO-REGIONAL
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POSTMASTECTOMY RADIATION AND PARTIA
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The Appropriate Extent of Surgery f
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SURGERY FOR EARLY-STAGE BREAST CANC
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BIOLOGY AND LOCAL THERAPY DECISIONS
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Clinical and Imaging Surveillance F
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SURVEILLANCE FOLLOWING BREAST CANCE
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SURVEILLANCE FOLLOWING BREAST CANCE
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Advanced Imaging Techniques for the
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IMAGING TECHNIQUES FOR BREAST CANCE
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IMAGING TECHNIQUES FOR BREAST CANCE
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Update of the Oxford Overview: New
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UPDATE OF THE OXFORD OVERVIEW Fig.
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UPDATE OF THE OXFORD OVERVIEW Overv
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Gene Patents and Personalized Medic
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GENE PATENTS AND EFFECTS ON PERSONA
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Chemoprevention for Breast Cancer:
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CHEMOPREVENTION FOR BREAST CANCER T
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CHEMOPREVENTION FOR BREAST CANCER C
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CONTROVERSIES IN PROSTATE CANCER: P
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PROSTATE CANCER RISK REDUCTION men
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PROSTATE CANCER RISK REDUCTION Auth
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PSA SCREENING: HARMS WITHOUT CLEAR
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PSA SCREENING: HARMS WITHOUT CLEAR
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GLIOBLASTOMA: TAKING THE STANDARD O
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GLIOBLASTOMA: BIOLOGY, GENETICS AND
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FUTURE DIRECTIONS IN GBM THERAPY pr
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FUTURE DIRECTIONS IN GBM THERAPY Ch
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ESTABLISHING TREATMENTS FOR GLIOBLA
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Current Concepts in Brain Tumor Ima
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CONCEPTS IN BRAIN TUMOR IMAGING tum
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CONCEPTS IN BRAIN TUMOR IMAGING Aut
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PERSPECTIVES ON HEADLINE-MAKING NEW
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TTF THERAPY IN GLIOBLASTOMA Fig. 1.
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TTF THERAPY IN GLIOBLASTOMA istics.
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TTF THERAPY IN GLIOBLASTOMA because
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Limitations of Adaptive Clinical Tr
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LIMITATIONS OF ADAPTIVE CLINICAL TR
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LIMITATIONS OF ADAPTIVE CLINICAL TR
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Capturing the Patient Perspective:
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PATIENT-REPORTED OUTCOMES AS TRIAL
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PATIENT-REPORTED OUTCOMES AS TRIAL
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NEW LOOKS AND CHALLENGES FOR COOPER
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NCI NATIONAL CLINICAL TRIALS NETWOR
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Successful Integration of Cooperati
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COG: GIVING NEW MEANING TO COOPERAT
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A Critical Review of the Enrollment
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BLACK PATIENTS AND CANCER CLINICAL
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BLACK PATIENTS AND CANCER CLINICAL
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Trastuzumab Emtansine (T-DM1): Hitc
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T-DM1 AND THERAPEUTIC ANTIBODIES ag
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TARGETING CD30 IN HODGKIN LYMPHOMA
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TARGETING CD30 IN HODGKIN LYMPHOMA
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EARLY DRUG DEVELOPMENT: CASTING A W
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Table 1. Response Rates in Expanded
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Drug Development in the Era of Pers
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that the core pathway is not comple
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This situation is not surprising, g
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Practical Management of Immune-Rela
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the anterior pituitary axis is invo
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TARGETING CRITICAL MOLECULAR ABERRA
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Abl suppression; and 3) the early e
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50% 50% 100% Change in Tumor Size m
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vanced solid tumors, even if they a
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Targeting Molecular Aberrations in
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date. With the advent of gene expre
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consortium to facilitate the testin
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ETHICAL CHALLENGES OF HEALTH CARE R
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HEALTH CARE REFORM AND ONCOLOGY dev
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HEALTH CARE REFORM AND ONCOLOGY aut
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INTERNATIONAL VARIATION IN UNDERSTA
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midcareer physician; in one cross-s
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Table 1. Recommendations for Person
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stances (e.g., stage of career, fam
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elationship” is also acknowledged
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Conclusion In more individualistic
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The Oncologist’s Duty to Provide
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an external observer, but to the pe
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MEDICAL ERRORS IN CANCER CARE: PREV
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DISCLOSING MEDICAL ERRORS Disclosur
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DISCLOSING MEDICAL ERRORS Author’
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PREVENTING MEDICAL ERRORS more diff
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“PERSONALIZED” ONCOLOGY FOR COL
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0.001), progression-free survival (
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mately 40% of patients with colorec
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Table 1. Tumor Marker Utility Gradi
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treatment (tx) for metastatic color
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The Interventional Radiologist Role
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effect. The most common drug that h
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gone forever, no further therapy is
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is irrelevant if it is already rese
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Resection and Thermal Ablation of L
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Author’s Disclosures of Potential
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Minimally Invasive Surgery of Recta
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outcomes; local, wound-site, and di
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Authors’ Disclosures of Potential
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CAO/ARO 04 study—which added oxal
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STAGE III COLON CANCER: WHAT WORKS,
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Table 1. Comparison of Fluoropyrimi
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tients with stages II and III color
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ized by high fruit, vegetable, poul
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Exercise Change trial: a randomized
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A New Direction for Pancreatic Canc
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Table 1. FOLFIRINOX versus Gemcitab
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The Southwest Oncology Group (SWOG)
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A Matter of Timing: Is There a Role
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an OS benefit with radiation therap
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a dose of 50.4 Gy to 59.4 Gy of rad
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more commonly given for APC, specia
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subcutaneous bolus or infusion. Hal
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patients are cared for completely w
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Varying Lymphadenectomies for Gastr
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Table 1. Regional Lymph Nodes of th
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Conclusion There are clear differen
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Will Disease Heterogeneity Help Def
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prematurely due to poor accrual. 18
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Adjuvant Treatments for Localized A
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ADJUVANT TREATMENT FOR GASTRIC CANC
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LIVER-DIRECTED THERAPEUTIC OPTIONS
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ated with unique dose distributions
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HCC, with encouraging outcomes in e
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tion. Advanced computer-based image
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a 5-year survival rate of 70% follo
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THE MANAGEMENT OF LESS COMMON BUT C
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Fig 1. PubMed publications and clin
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of therapeutic options, patient sel
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less informative than the GRETCH an
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Table 3. New Agents/Regimens under
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combined with concurrent transarter
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to optimize the use of erlotinib by
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Optimal Use of Imaging to Guide Tre
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enhancement seen. Furthermore, the
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CASTRATION-RESISTANT PROSTATE CANCE
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Fig. 1. FDA regulatory approvals in
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Prognostic, Predictive, and Surroga
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adhesion molecule and further chara
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and treatment options are expanding
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KIDNEY CANCER BIOLOGY AND THERAPEUT
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Prognostic Factors in Advanced RCC
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cell immunotherapy in which a small
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New Developments in Urothelial Canc
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Novel Approaches in Advanced Urothe
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10. Albers P, Park SI, Niegisch G,
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700 at a dose of 400 mg twice daily
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therapy for nonmetastatic prostate
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ADJUVANT THERAPY FOR OLDER PATIENTS
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Adjuvant Systemic Therapy Adjuvant
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with early-stage breast cancer were
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clinical trials to generate additio
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Adjuvant Treatment of Older Patient
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OLDER PATIENTS WITH LUNG CANCER Fig
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OLDER PATIENTS WITH LUNG CANCER adj
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Considerations and Controversies in
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OLDER PATIENTS WITH ADVANCED CANCER
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RECENT CLINICAL HIGHLIGHTS IN GYNEC
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GLOBAL ADVANCES IN GYNECOLOGIC ONCO
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GLOBAL ADVANCES IN GYNECOLOGIC ONCO
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The European Society of Gynaecologi
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ESGO EDUCATIONAL AND RESEARCH ACTIV
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UPFRONT TREATMENT OF OVARIAN CANCER
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ANTIANGIOGENICS AND PARP INHIBITORS
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ANTIANGIOGENICS AND PARP INHIBITORS
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Intraperitoneal Treatment in Ovaria
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INTRAPERITONEAL TREATMENT IN OVARIA
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Dose-Dense Chemotherapy and Neoadju
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CHEMOTHERAPY FOR OVARIAN CANCER Fig
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CHEMOTHERAPY FOR OVARIAN CANCER whi
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UTERINE SARCOMA: CHALLENGING CASES
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HISTOLOGIC FEATURES AND MANAGEMENT
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SURGICAL OPTIONS FOR UTERINE SARCOM
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SURGICAL OPTIONS FOR UTERINE SARCOM
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PATIENTS WITH HPV-POSITIVE OROPHARY
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HPV-INDUCED OROPHARYNX CANCER analy
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HPV-INDUCED OROPHARYNX CANCER fract
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Important Early Advances in Squamou
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EARLY ADVANCES IN SCCHN Fig 1. Targ
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Application of Genomic and Proteomi
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GENOMIC AND PROTEOMIC TECHNOLOGIES
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GENOMIC AND PROTEOMIC TECHNOLOGIES
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TREATMENT OF THYROID CANCERS: NEW I
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EVALUATION OF ADVANCED THYROID CANC
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EVALUATION OF ADVANCED THYROID CANC
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Systemic Therapeutic Approaches to
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APPROACHES TO ADVANCED THYROID CANC
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AVOIDING OVERDIAGNOSIS AND OVERTREA
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Table 1. Prevalence of Prostate Can
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Table 3. Potential Risks and Benefi
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Overdiagnosis and Overtreatment of
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een reached by other modeling effor
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east cancer community have FDA-appr
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COSTS OF CANCER CARE: AFFORDABILITY
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REDUCING THE COST OF CANCER CARE Fi
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REDUCING THE COST OF CANCER CARE Th
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REDUCING THE COST OF CANCER CARE de
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Why Hasn’t Genomic Testing Change
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Page 487 and 488: MANAGEMENT OF CHRONIC LYMPHOCYTIC L
Page 489 and 490: PREDICTIVE PARAMETERS IN CLL Table
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Page 495 and 496: WHEN TO OFFER TRANSPLANTATION IN CL
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Page 499 and 500: NEW DEVELOPMENTS IN MYELOPROLIFERAT
Page 501 and 502: SMALL-MOLECULE INHIBITORS FOR MPN S
Page 503 and 504: SMALL-MOLECULE INHIBITORS FOR MPN L
Page 505 and 506: Insights into the Molecular Genetic
Page 507 and 508: GENETICS OF MYELOPROLIFERATIVE NEOP
Page 513 and 514: Classification of Myeloproliferativ
Page 515 and 516: CLASSIFICATION AND PROGNOSIS OF MPN
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Page 519 and 520: AROUND THE WORLD IN ALMOST 80 MINUT
Page 521 and 522: LUNG CANCER IN BRAZIL Fig. 1. Relat
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Page 531 and 532: Research and Standard of Care: Lung
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Page 539 and 540: PHYSICIAN ENGAGEMENT IN ONLINE PATI
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Page 543 and 544: LUNG CANCER SCREENING 101 CHAIR Chr
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Page 547 and 548: LUNG CANCER SCREENING Fig. 1. Guide
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Page 551 and 552: LUNG CANCER SCREENING 19. Montes RP
Page 553 and 554: Molecular Testing of Non-Small Cell
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Page 557 and 558: MOLECULAR TESTING AND NSCLC logic d
Page 559 and 560: THYMOMA AND THYMIC CARCINOMA: UPDAT
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Page 565 and 566: The Creation of the International T
Page 567 and 568: ITMIG AS A MODEL FOR RARE DISEASES
Page 569 and 570: Thymoma: From Chemotherapy to Targe
Page 571 and 572: SYSTEMIC TREATMENT OF THYMOMA Study
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Page 575 and 576: What Is the Best Strategy for Incor
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TREATMENT OPTIONS IN INDOLENT LYMPH
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ROLE OF HCT FOR INDOLENT LYMPHOMA T
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ROLE OF HCT FOR INDOLENT LYMPHOMA T
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ROLE OF HCT FOR INDOLENT LYMPHOMA e
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CONTROVERSIES IN MYELOMA: INDUCTION
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TRANSPLANTATION FOR MYELOMA Alterna
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TRANSPLANTATION FOR MYELOMA compare
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TRANSPLANTATION FOR MYELOMA autolog
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CURRENT STATUS OF MYELOMA THERAPY K
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CURRENT STATUS OF MYELOMA THERAPY F
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CURRENT STATUS OF MYELOMA THERAPY T
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Maintenance Therapy for Myeloma: Ho
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MAINTENANCE THERAPY FOR MULTIPLE MY
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NEW OPTIONS, NEW QUESTIONS: HOW TO
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THERAPIES FOR PATIENTS WITH METASTA
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ANTIEMETICS: CURRENT STANDARDS, EME
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ANTIEMETICS: ASCO GUIDELINE UPDATE
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Chemotherapy-Induced Nausea and Vom
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INCIDENCE AND PREVALENCE OF CHEMOTH
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New Frontiers in Mucositis By Dougl
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MUCOSAL INJURY CAUSED BY CANCER THE
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Short- and Long-term Cardiovascular
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Recent Advances in Cardiotoxicity o
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CARDIOTOXICITY OF ANTICANCER THERAP
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CARDIOTOXICITY OF ANTICANCER THERAP
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The Oncologist as the Patient with
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THE ONCOLOGIST AS THE PATIENT OR RE
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Prolonged Febrile Neutropenia in th
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FEBRILE NEUTROPENIA IN PEDIATRIC CA
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FEBRILE NEUTROPENIA IN PEDIATRIC CA
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TREATMENT APPROACHES IN CHILDREN wh
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TREATMENT APPROACHES IN CHILDREN th
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GENETIC COUNSELING OF THE PATIENT W
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CANCER PREDISPOSITION IN CHILDHOOD
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HOW TO MANAGE VERY RARE PEDIATRIC C
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RARE CANCER IN CHILDREN Registries
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Genetic Alterations in Childhood Me
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GENETIC ALTERATIONS IN CHILDHOOD ME
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Desmoid-Type Fibromatosis in Childr
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CHEMOTHERAPY FOR DESMOID TUMOR Tabl
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CHEMOTHERAPY FOR DESMOID TUMOR 14.
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Targeting the Insulin-Like Growth F
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TARGETING THE IGF SYSTEM Fig. 1. Th
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TARGETING THE IGF SYSTEM malignanci
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Hedgehog Pathway in Pediatric Cance
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HEDGEHOG PATHWAY IN PEDIATRIC CANCE
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HEDGEHOG PATHWAY IN PEDIATRIC CANCE
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Development and Refinement of Augme
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ABFM THERAPY FOR PEDIATRIC ALL than
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ABFM THERAPY FOR PEDIATRIC ALL Auth
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RADIOTHERAPY FOR PEDIATRIC HODGKIN
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RADIOTHERAPY FOR PEDIATRIC HODGKIN
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Role of Doxorubicin in Rhabdomyosar
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DOXORUBICIN IN RHABDOMYOSARCOMA 8.
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Identification of Novel Biologic Ta
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NOVEL TARGETS IN THE TREATMENT OF D
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Is Biopsy Safe in Children with New
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SAFETY OF DIPG BIOPSY IN CHILDREN F
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SAFETY OF DIPG BIOPSY IN CHILDREN 1
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CHILDREN WITH DIFFUSE INTRINSIC PON
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Communication and Decision Support
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COMMUNICATION AND DECISION SUPPORT
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Planning for the Future: The Role o
Page 741 and 742:
present in the office suite but doe
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Summary and Care Plan are provided.
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DOING IT RIGHT, AND FOR LESS: IMPLE
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CLINICAL PATHWAYS STANDARDIZING PER
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CLINICAL PATHWAYS STANDARDIZING PER
Page 751 and 752:
The Future of Oncology Care with Pe
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quantity. Determining the appropria
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THE ASCO QUALITY ONCOLOGY PRACTICE
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IMPROVING VALUE OF CARE IN ONCOLOGY
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Page 761 and 762:
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PHYSICIAN WELLNESS: COPING WITH REP
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also provides insight on how clinic
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good resource for exploring the pri
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of death or following death and inc
Page 771 and 772:
telephone call to the family, sendi
Page 773 and 774:
New Insights in Cross-Cultural Comm
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CROSS-CULTURAL COMMUNICATION Sideba
Page 777 and 778:
THE ONCOLOGIST, THE PATIENT, AND TH
Page 779 and 780:
estimate of the proportion of their
Page 781 and 782:
exactly the same treatment, even th
Page 783 and 784:
How to Decide Whether to Offer and
Page 785 and 786:
NONSTANDARD THERAPIES FOR ADVANCED
Page 787 and 788:
NONSTANDARD THERAPIES FOR ADVANCED
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TARGETED THERAPIES IN TARGETED OR U
Page 791 and 792:
TARGETED THERAPY IN SARCOMA rates a
Page 793 and 794:
TARGETED THERAPY IN SARCOMA seen in
Page 795 and 796:
TARGETED THERAPY IN SARCOMA recepto
Page 797 and 798:
Adjuvant Treatment of Gastrointesti
Page 799 and 800:
ADJUVANT THERAPY IN HIGH-RISK GASTR
Page 801 and 802:
Management of Tyrosine Kinase Inhib
Page 803 and 804:
TKI-RESISTANT GIST Primary Imatinib
Page 805 and 806:
TKI-RESISTANT GIST Table 2. Clinica
Page 807 and 808:
BIOLOGIC PRINCIPLES OF TARGETED COM
Page 809 and 810:
COMBINING TARGETED AGENTS IN CLINIC
Page 811 and 812:
COMBINING TARGETED AGENTS IN CLINIC
Page 813 and 814:
Combination Therapies Building on t
Page 815 and 816:
COMBINATIONS FOR MELANOMA agents th
Page 817 and 818:
MECHANISMS OF RESISTANCE TO TARGETE
Page 819 and 820:
RESISTANCE MECHANISMS TO MAPK INHIB
Page 821 and 822:
RESISTANCE MECHANISMS TO MAPK INHIB
Page 823 and 824:
Mechanisms of Resistance to Targete
Page 825 and 826:
RESISTANCE TO TARGETED THERAPIES IN
Page 827 and 828:
RESISTANCE TO TARGETED THERAPIES IN
Page 829 and 830:
Translating PI3K-Delta Inhibitors t
Page 831 and 832:
THE STORY OF CAL-101 6% of patients
Page 833 and 834:
PI3 Kinase in Cancer: From Biology
Page 835 and 836:
PI3 KINASE IN CANCER Fig. 1. The PI
Page 837 and 838:
PI3 KINASE IN CANCER Fig. 3. In viv
Page 840:
This publication is supported by an
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2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

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