I have been a member of ASCO since the early 1970s when the annual meeting was an attachment to the annual AACR meeting; it was relatively easy then to attend the AACR-ASCO meeting in the Spring and ASH the first weekend in December. That was my routine and that of many others. I served on the board of directors of ASCO for two terms and have served on many committees. I grew professionally as ASCO grew in membership and influence. I was an associate editor of the JCO for 18 years. I ran for president of ASCO twice and lost both times to Dr. Bob Young and Dr. Bernie Fisher. ASCO supported my idea for the development of the Quality Oncology Practice Initiative (QOPI) starting in 2003. The point of this paragraph is that I have had a long association and affinity with ASCO; over the years, I have worked for it and it has worked for me.
ASCO meetings and office functions were initially farmed out to a for-profit organization based in Chicago until 1995 when ASCO decided to take all functions in-house and Dr. John Durant, a distinguished oncologist and academic leader, served as the first Executive Director of ASCO. Several years later, the publication of JCO was also brought in-house, with Deborah Whippen leading that effort.
From that point on, ASCO grew rapidly into a large and influential organization. From 2003 to 2011, its membership has grown from 20,000 to 31,000; attendance at the annual meeting, from 26,500 to 31,800; annual meeting abstracts, from 2,000 to nearly 5,000; JCO impact factor (citations and such), from 10.8 to 18.97; JCO manuscript submissions rose from 1,808 to 5,089; JCO translations into non-English languages rose from 3 to 11; and the operating revenues of ASCO have risen from $45.8M to $83.8M.
By any measure of success, ASCO has grown and excelled.
Two Major Concerns
However (there always seems to be a “however,” I guess), about 10–15 years ago I became disillusioned with ASCO. I cannot pick the exact times when this began to happen, but two major factors seemed to have a negative effect on me.
The first was the overwhelming dependence on pharmaceutical company money to support ASCO operations. The for-profit exhibits at the annual meeting seemed to become almost obscene in their size and cost, with a plethora of giveaways, cheap and not so cheap. ASCO was paid handsomely for these exhibits, but they were so over the top that I became concerned that those exhibits were dominating the meeting. The commercial exhibit areas seemed to me to have more people milling around than the poster sessions. It was an uncomfortable feeling for me.
Though others were concerned, the first public concern regarding this dependence that I remember hearing was from Larry Norton during his 2002–2003 presidential term. He made it a key provision of his term to try to reduce the dependence of ASCO daily operations pharmaceutical money. One of the actions taken around that time was the creation of the ASCO Foundation (now the Conquer Cancer Foundation), formed to raise philanthropic funds for the support of ASCO projects such as fellowships and seed grants for young people.
Since then the commercial exhibit atmosphere has changed. This was partly due to the new restrictions on what drug companies were allowed to give out as well as ASCO's actions. The exhibits are still there and some are very large, but the area no longer looks and feels like a county fair. There are many fewer giveaways now and more “educational” presentations. Pharmaceutical funds are still important, but less so than in the past. This change, whatever the cause, has been very positive because the quantitative focus has shifted more to science and clinical studies, which has now restored a more satisfying balance.
Improving Quality of Cancer Care
The second concern I had was the lack of any activity to help members improve the quality of their cancer care. I had served on the Institute of Medicine's National Cancer Policy Board for a number of years. Its first major product was a seminal report called, “Ensuring the Quality of Cancer Care,” released in 1999. During the presidential term of Dr. Joseph Bailes, he instituted a study called the National Initiative on Cancer Care Quality (NICCQ) from 1999 to 2004. This study, which was contracted to the Rand Corporation and Harvard, did a snapshot examination of the quality of cancer care in several metropolitan areas. This was the first quality initiative of ASCO. However, it was a study that did not address current members' practices.
In 2003 ASCO formed an ad hoc committee to address the quality issue and make recommendations for moving forward. Not much came of it. Finally, several individuals complained that there was lots of talk but no action. I was asked to make a proposal to the board of directors in November 2003. Thus, QOPI was started with seven private oncology practices. Champions for each practice met regularly by phone and email and gradually built the structure that now has over 800 practice members, including community and academic practices and fellowship programs.
Today, twice a year more than 20,000 charts are reviewed for compliance with quality measures developed by participating oncologists. Since 2006 when QOPI was ready for opening participation to any ASCO member, it has become a major pillar in ASCO's mission to improve the quality of care.
Changing Dialogue and Atmosphere
These activities and many other ASCO efforts have gradually changed the dialogue and atmosphere at ASCO and, in my view, restored the primacy of promoting high-quality cancer care. In addition to QOPI, numerous conferences and training supplements have been made available to a wide variety of geographic areas and institutions. Several years ago a leadership training program was designed for young oncologists to help them develop leadership skills and to make networking contacts. Publications have expanded in number and depth in many areas, most notably the Journal of Oncology Practice (JOP).
These efforts have had a broad impact on programs that address the quality of care, controversial clinical issues, and the production of materials to help patients negotiate the difficult road to successful therapy and post-therapy survival of cancer care.
This change has gradually taken place over the past decade or so as a result of efforts by many officers and members nudging ASCO in the “right” direction. Under the leadership for the past six years of former president Dr. Allen Lichter, ASCO has accelerated this movement. I am more proud of being an ASCO member today than ever. Its focus on the patient first and the oncologist second is evident, and a refreshing evolution of a great organization.