American Society Of Clinical Oncology Members Research Articles

Direct oral anticoagulant (DOACs) prescribing practices of members of the Society of Gynecologic Oncology and American Society of Clinical Oncology

BackgroundCancer associated venous thromboembolism (VTE) is associated with significant morbidity and mortality. Direct oral anticoagulants (DOACs) have emerged as alternatives to injectable medications for both thromboprophylaxis and treatment of VTE. Several recent clinical trials have demonstrated safety and efficacy of DOACs in high risk patients receiving systemic chemotherapy as well as postoperative prophylaxis after surgery for gynecologic cancer. Major consensus guidelines from multiple organizations support the use of DOACs for these indications but prescription practices are not well characterized. MethodsA survey study was sent concurrently to members of the Society of Gynecologic Oncology (SGO) and American Society of Clinical Oncology (ASCO) Research Survey Pool between May and June of 2021. The study was designed to assess DOAC prescription practices amongst members of these societies who routinely prescribe chemotherapy. Bivariate analyses comparing responses from ASCO participants and SGO participants were compared using chi-squared and Fisher exact tests. ResultsA total of 103 physicians were included in the ASCO group and 139 in the SGO group. A majority of participants in both groups reported familiarity with prescribing DOACs (99% of ASCO and 96% of SGO respondents). ASCO respondents were more likely to consider DOACs as first line therapy for treatment of cancer-associated VTE than SGO members (82% vs 63%, p < 0.01) and SGO members were more likely to consider low molecular weight heparin (LMWH) the standard of care treatment (66% vs 25% p < 0.01). Most respondents in both groups (75%) felt DOACs were equally safe and effective compared to LMWH but more ASCO members felt DOACs were cost effective (70% vs 49%, p < 0.01). More SGO respondents reported having prescribed prophylactic anticoagulation during chemotherapy than ASCO members (53% vs 35%, p < 0.01). ConclusionASCO respondents were more likely to prescribe DOACs for both treatment and prophylaxis of cancer-associated VTE than SGO members. However, SGO members were more likely to prescribe prophylactic anticoagulation to high risk patients initiating chemotherapy compared to ASCO members.

Direct oral anticoagulant (DOACs) prescribing practices of members of the Society of Gynecologic Oncology and American Society of Clinical Oncology (374)

<b>Objectives:</b> The risk of venous thromboembolism (VTE) in patients with gynecologic malignancy is 25-38% and is associated with significant morbidity and mortality. Direct oral anticoagulants (DOACs) have emerged as an alternative to injectable medications for thromboprophylaxis and treatment of VTE. Several recent clinical trials have demonstrated the benefit of DOACs in high-risk patients receiving systemic chemotherapy as well as postoperative prophylaxis after surgery for gynecologic cancer. Major consensus guidelines from multiple organizations support the use of DOACs for these indications, but prescription practices are not well characterized. <b>Methods:</b> A survey was sent concurrently to members of the Society of Gynecologic Oncology (SGO) and the American Society of Clinical Oncology (ASCO) Research Survey Pool between May and June of 2021. The study was designed to assess DOAC prescription practices amongst members of these societies who routinely prescribe chemotherapy. Bivariate analyses comparing responses from ASCO and SGO participants were compared using Chi-square and Fisher's exact tests. <b>Results:</b> A total of 103 physicians were included in the ASCO group and 139 in the SGO group (response rates 15% and 8%, respectively). A majority of participants in both groups reported familiarity with prescribing DOACs (99% of ASCO and 96% of SGO respondents). ASCO respondents were more likely to consider DOACs as first-line therapy for the treatment of cancer-associated VTE than SGO members (82% vs 63%, p < 0.01). In comparison, SGO members were more likely to consider low molecular weight heparin (LMWH) (66% vs 25%, p < 0.01). Most respondents in both groups (75%) felt DOACs were equally safe and effective compared to LMWH but more ASCO members felt DOACs were cost-effective (70% vs 49%, p < 0.01). More SGO respondents reported having prescribed prophylactic anticoagulation during chemotherapy than ASCO members (53% vs 35%, p < 0.01). A majority of participants in both groups reported knowledge of the Khorana score as a risk assessment tool (60% and 61%); however, only 30% of respondents felt this scoring system reliably predicts risk of VTE in ambulatory outpatients initiating chemotherapy and at least 70% of participants in both groups had never used this tool. SGO respondents were more likely to feel that there was insufficient evidence to recommend prophylactic anticoagulation to high-risk outpatients initiating chemotherapy for gynecologic cancer (41% vs 29%, p < 0.01). Among the 150 respondents who performed surgery for gynecologic cancer, 80% felt LMWH is the standard of care for postoperative thromboprophylaxis compared to only 15% who felt DOACs were the standard of care. The most commonly cited barriers to DOAC prescription for prevention of cancer-associated VTE were insurance approval for the medication, out-of-pocket expense to the patient, and lack of data to support efficacy. <b>Conclusions:</b> ASCO respondents were more likely to prescribe DOACs for both treatment and prophylaxis of cancer-associated VTE than SGO members. However, SGO members were more likely to prescribe prophylactic anticoagulation to high-risk patients initiating chemotherapy compared to ASCO members. The use of the Khorana scoring system was low amongst respondents from both societies.

Establishing and Evaluating an ASCO Learning Cohort: a Longitudinal Project Assessing the Learning Needs and Behaviors of Oncology Professionals.

In 2013, the American Society of Clinical Oncology (ASCO)'s Continuing Education Committee recommended establishing an interprofessional, longitudinal cohort pilot project. The main goals of the cohort were to gain feedback from oncology providers on how they use resources to address their learning needs and gain insights into the utility of different ASCO educational activities. The ASCO Learning Cohort Pilot Project included 49 ASCO members that were representative of the overall Society membership demographics and ran from November 2015 through August 2016. Participants documented monthly learning needs and completed monthly feedback activities focused on specific ASCO educational resources. The Learning Cohort Pilot Project proved a viable and innovative cohort model for analyzing the learning process for oncology healthcare professionals. The development, operations, and compliance required unique infrastructure to accomplish this project. Relationships between participant demographic variables and learning preferences are reported elsewhere. The ASCO Learning Cohort Project is a unique educational project that demonstrated feasibility and has met its goals. This paper outlines the processes of establishing a learning cohort, including participant selection, project design, and participant feedback. We evaluate the project model as a means to better understand the learning needs and behaviors of oncology healthcare professionals.

Global Practice and Efficiency of Multidisciplinary Tumor Boards: Results of an American Society of Clinical Oncology International Survey.

PurposeMultidisciplinary tumor boards (MDTBs) are universally recommended, but recent literature has challenged their efficiency.MethodsThe American Society of Clinical Oncology (ASCO) conducted a survey of a randomly selected cohort of international ASCO members. The survey was built on SurveyMonkey and was sent via e-mail to a sample of 5,357 members.ResultsIn all, 501 ASCO members practicing outside the United States responded, and 86% of them participated in MDTBs at their own institutions. Those who attended represented a variety of disciplines in 70% to 86% of all MDTBs. The majority of MDTBs held weekly specialty and/or general meetings. Eighty-nine percent of 409 respondents attended for advice on treatment decisions. Survey respondents reported changes of 1% to 25% in treatment plans for 44% to 49% of patients with breast cancer and in 47% to 50% of patients with colorectal cancer. They reported 25% to 50% changes in surgery type and/or treatment plans for 14% to 21% of patients with breast cancer and 12% to 18% of patients with colorectal cancer. Of the 430 respondents 96% said overall benefit to patients was worth the time and effort spent at MDTBs, and 96% said that MDTBs have teaching value. Mini tumor boards held with whatever types of specialists were available were considered valid. In all, 94.8% (425 of 448) said that MDTBs should be required in institutions in which patients with cancer are treated.ConclusionMDTBs are commonplace worldwide. A majority of respondents attend them to obtain recommendations, and they report changes in patient management. Change occurred more frequently with nonmedical oncologists and with physicians who had less than 15 years in practice. MDTBs helped practitioners make management decisions. Mini tumor boards may improve time efficiency and are favored when the full team is not available. Suggestions for improving MDTBs included making them more efficient, better selection and preparation of cases, choosing an effective team leader, and improving how time is used, but more research is needed on ways to improve the efficiency of MDTBs.

Building Bridges to Conquer Cancer

Welcome, everyone, to the 49th Annual Meeting of the American Society of Clinical Oncology (ASCO). I realize that many of you have traveled a long way to get here, and I am delighted you can be a part of “Building Bridges to Conquer Cancer.” For those of you who know me well, you know that I love movies. What may surprise you is that one of my favorites is The Replacements. It’s the story of a football team whose players have very different backgrounds—and how these unlikely players leverage those differences to create a winning team. During one of the pivotal scenes, someone asks the coach (played by Gene Hackman), “What will it take for this team to win?” His answer is, “HEART. You gotta have heart... MILES and MILES of HEART.” I have to confess that I’ve seen this movie more than once and the coach’s message resonates with me every time. I can draw many parallels to what we, as oncologists, do every day. Like “the Replacements,” we are people of diverse backgrounds. We draw from different cultures and experiences. But we are all passionate about our work. We have a common goal of conquering cancer. I’m confident that through teamwork, and by sharing knowledge, we will connect the pathways that empower us to deliver the best outcomes for our patients. This is an extraordinary time—especially in oncology. An explosion of new data comes weekly. The digital age is changing our world at a rapid pace, democratizing both information and education. There has never been more opportunity and there has never been a greater need to collaborate. In particular, I want to highlight three things. They are: (1) the possibilities and promise of global health equity; (2) the need to strengthen future generations of leaders and practitioners; and (3) the vision for a rapid learning system in oncology. The solutions for all three have at their core the need for connection. If recent events have taught us nothing else, it is that success is made possible by collective effort, by neighbor helping neighbor, and by learning from those who have gone before us. Nowhere is this truer than in oncology. The promise of science, the power of technology, and the strength of an increasingly global community can be leveraged to produce a world free from the fear of cancer. One of the pleasures of the year as ASCO president is the ability to bring personal and professional passions and a sense of what really matters into focus for the work of our membership. This year’s meeting theme, “Building Bridges to Conquer Cancer,” reflects my particular interest in outreach to partners and possibilities that lie beyond the work of our daily practices. What about those bridges? Do we have the capability to build them? Can we strengthen those already in place? Any engineer will tell you that the strongest bridge has solid support, high quality materials, and a good design. ASCO is fortunate to have all three. To be specific, ASCO’s great support comes from a membership of more than 33,000 professionals in every sector of our field. International membership has surpassed 10,000, and we now have ASCO members in more than 100 countries. Our reach and our ability have never been greater. ASCO’s materials—education, scientific publications, guidelines, and many more high-quality programs— come from dedicated committees, boards, and task forces. I take great pride in the work produced by the ASCO volunteers I’ve worked with this year. Special thanks go to Dr Doug Yee and Dr Antoinette Tan, who have prepared an outstanding meeting. A record-breaking 5,306 abstracts were submitted this year, and nearly 2,700 faculty members will present cutting-edge science and education programs over the next few days. Of course, the strongest support and finest quality materials need good design. This is the ASCO mission: to conquer cancer through research, education, prevention, and delivery of high-quality care. ASCO is fortunate to have talented leadership for the more than 143 committees, advisory groups, and task forces whose efforts are aimed at achieving that mission. ASCO volunteers have set a high bar indeed. This year alone, 1,600 volunteers have worked to advance our mission—and I thank each and every one of you for all that you do. Clearly, there is no shortage of challenges deserving our attention. The three issues mentioned earlier—advancing global health equity, mentoring the next generation of leaders, and the need for a JOURNAL OF CLINICAL ONCOLOGY P R E S I D E N T I A L A D D R E S S VOLUME 31 NUMBER 30 OCTOBER 2

Global Initiatives to Enhance Cancer Care in Areas of Limited Resources: What ASCO Members Are Doing and How You Can Become Involved

Cancer is the leading cause of death worldwide. In 2008, 7.6 million deaths were attributable to cancer, representing 13% of all deaths. It is estimated that approximately 30% of cancer deaths are attributable to the five leading behavioral and dietary risks. These include high body mass index, low fruit and vegetable intake, lack of physical activity, and tobacco and alcohol use. A number of viral infections, such as hepatitis B and C and HPV, are responsible for approximately 20% of cancer deaths. Approximately 70% of cancer deaths occurred in low- and middle-income countries. Because of the increased numbers of elderly individuals and improved control of comorbidity, deaths from cancer worldwide are projected to continue rising, with an estimated 13.1 million deaths in 2030. To meet this need, the American Society of Clinical Oncology (ASCO) has evolved into a truly international organization. Over one-third of ASCO members practice in over 100 countries, representing the world's largest collection of expertise and insight into the treatment of cancer. More than one-half of ASCO's Annual Meeting attendees come from outside the United States. The Journal of Clinical Oncology is read by more than 24,000 subscribers worldwide and is available in a number of different languages. To fulfill its mission, ASCO has a number of international programs for sharing knowledge and providing the tools to assist clinicians worldwide in treating their patients. These programs include mentoring and knowledge exchange, education initiatives, and scientific and educational meetings. This provides ample opportunity for involvement to enhance cancer care worldwide.

ASCO's International Programs and How You Can Become Involved

The American Society of Clinical Oncology (ASCO) is dedicated to serving its members and to reducing disparities in the treatment of patients with cancer and their outcome. ASCO has a portfolio of international programs called ASCO International that aims to improve clinical practice by sharing oncology knowledge through a network of ASCO members and partners. In order to achieve its goals, ASCO has an International Affairs Committee that oversees many programs that involve a global exchange of knowledge through courses and workshops, mentoring, initiatives promoting research, and specialty training standards. All of these programs depend on ASCO member volunteers in one capacity or another.

Physician and Stakeholder Perceptions of Conflict of Interest Policies in Oncology

The landscape of managing potential conflicts of interest (COIs) has evolved substantially across many disciplines in recent years, but rarely are the issues more intertwined with financial and ethical implications than in the health care setting. Cancer care is a highly technologic arena, with numerous physician-industry interactions. The American Society of Clinical Oncology (ASCO) recognizes the role of a professional organization to facilitate management of these interactions and the need for periodic review of its COI policy (Policy). To gauge the sentiments of ASCO members and nonphysician stakeholders, two surveys were performed. The first asked ASCO members to estimate opinions of the Policy as it relates to presentation of industry-sponsored research. Respondents were classified as consumers or producers of research material based on demographic responses. A similar survey solicited opinions of nonphysician stakeholders, including patients with cancer, survivors, family members, and advocates. The ASCO survey was responded to by 1,967 members (1% of those solicited); 80% were producers, and 20% were consumers. Most respondents (93% of producers; 66% of consumers) reported familiarity with the Policy. Only a small proportion regularly evaluated COIs for presented research. Members favored increased transparency about relationships over restrictions on presentations of research. Stakeholders (n = 264) indicated that disclosure was "very important" to "extremely important" and preferred written disclosure (77%) over other methods. COI policies are an important and relevant topic among physicians and patient advocates. Methods to simplify the disclosure process, improve transparency, and facilitate responsiveness are critical for COI management.

American Society of Clinical Oncology Statement: Achieving High-Quality Cancer Survivorship Care

American Society of Clinical Oncology Statement: Achieving High-Quality Cancer Survivorship Care

Global Initiatives to Enhance Cancer Care in Areas of Limited Resources: What ASCO Members Are Doing and How You Can Become Involved

Cancer is the leading cause of death worldwide. In 2008, 7.6 million deaths were attributable to cancer, representing 13% of all deaths. It is estimated that approximately 30% of cancer deaths are attributable to the five leading behavioral and dietary risks. These include high body mass index, low fruit and vegetable intake, lack of physical activity, and tobacco and alcohol use. A number of viral infections, such as hepatitis B and C and HPV, are responsible for approximately 20% of cancer deaths. Approximately 70% of cancer deaths occurred in low- and middle-income countries. Because of the increased numbers of elderly individuals and improved control of comorbidity, deaths from cancer worldwide are projected to continue rising, with an estimated 13.1 million deaths in 2030. To meet this need, the American Society of Clinical Oncology (ASCO) has evolved into a truly international organization. Over one-third of ASCO members practice in over 100 countries, representing the world's largest collection of expertise and insight into the treatment of cancer. More than one-half of ASCO's Annual Meeting attendees come from outside the United States. The Journal of Clinical Oncology is read by more than 24,000 subscribers worldwide and is available in a number of different languages. To fulfill its mission, ASCO has a number of international programs for sharing knowledge and providing the tools to assist clinicians worldwide in treating their patients. These programs include mentoring and knowledge exchange, education initiatives, and scientific and educational meetings. This provides ample opportunity for involvement to enhance cancer care worldwide.

Do Physicians/Researchers Trade Stock Based on Privileged Information? A Closer Look at Trading Patterns Surrounding the Annual ASCO Conference

The goal of this paper was to assess whether, given the opportunity, physicians/researchers would try to profit (by trading stocks) from information that only they were made privy to. The Annual ASCO (American Society of Clinical Oncology) Conference, the largest annual oncology conference, provided the perfect venue to fully explore this question. Up until 2008, ASCO abstracts were released exclusively to ASCO members (i.e., physicians, oncologists) two weeks prior to the conference, and many speculated about unusual trading patterns during these two weeks. In 2008, in response to concerns about such illicit activities, ASCO changed this policy (by distributing these abstracts instead to the general public). We decided to take a closer look at these trading patterns to determine the true impact of ASCO's 2008 decision and whether the differences prior to and following 2008 reveal something about the likelihood of physicians/researchers to profit from "privileged information."

Revisions to the 2009 American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards: Expanding the Scope to Include Inpatient Settings

In November 2009, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) jointly published a set of 31 voluntary chemotherapy safety standards for adult patients with cancer, as the end result of a highly structured, multistakeholder process. The standards were explicitly created to address patient safety in the administration of parenteral and oral chemotherapeutic agents in outpatient oncology settings. In January 2011, a workgroup consisting of ASCO and ONS members was convened to review feedback received since publication of the standards, to address interim changes in practice, and to modify the standards as needed. The most significant change to the standards is to extend their scope to the inpatient setting. This change reflects the conviction that the same standards for chemotherapy administration safety should apply in all settings. The proposed set of standards has been approved by the Board of Directors for both ASCO and ONS and has been posted for public comment. Comments were used as the basis for final editing of the revised standards. The workgroup recognizes that the safety of oral chemotherapy usage, nononcology medication reconciliation, and home chemotherapy administration are not adequately addressed in the original or revised standards. A separate process, cosponsored by ASCO and ONS, will address the development of safety standards for these areas.

Personalizing Cancer Care: American Society of Clinical Oncology Presidential Address 2009

I would like to welcome you all to Orlando, FL, and the 2009 American Society of Clinical Oncology (ASCO) Annual Meeting. This has been a challenging year for people everywhere due to the global economic recession and the resulting unemployment and loss of health care benefits. But it has also been a year of great hope for a new administration in Washington, DC, that is very supportive of biomedical research and committed to curing cancer. I am pleased to see so many of you gathered here to share our common goal to improve the outcomes of cancer patients through research and the delivery of high-quality care. The next few days will present an extraordinary array of educational sessions and scientific presentations that focus on our vision to deliver the right care to the right person at the right time. We hear much today about “personalized medicine.” Thus, as the theme of this year’s Annual Meeting, I have chosen “Personalizing Cancer Care,” and you will see it, in its many dimensions, in every session of the Meeting. Personalization is the new buzzword in health care and health policy— but what does it mean for cancer patients and oncologists? For the next few minutes, I’ll share with you what I think this means for our community, why it’s important, and how ASCO members can bring this concept to life for our patients.

Palliative Cancer Care a Decade Later: Accomplishments, the Need, Next Steps—From the American Society of Clinical Oncology

In 1998, the American Society of Clinical Oncology (ASCO) published a special article regarding palliative care and companion recommendations. Herein we summarize the major accomplishments of ASCO regarding palliative cancer and highlight current needs and make recommendations to realize the Society's vision of comprehensive cancer care by 2020. ASCO convened a task force of palliative care experts to assess the state of palliative cancer care in the Society's programs. We reviewed accomplishments, assessed current needs, and developed a definition of palliative cancer. Senior ASCO members and the Board of Directors reviewed and endorsed this article for submission to Journal of Clinical Oncology. Palliative cancer care is the integration into cancer care of therapies that address the multiple issues that cause suffering for patients and their families and impact their life quality. Effective provision of palliative cancer care requires an interdisciplinary team that can provide care in all patient settings, including outpatient clinics, acute and long-term care facilities, and private homes. Changes in current policy, drug availability, and education are necessary for the integration of palliative care throughout the experience of cancer, for the achievement of quality improvement initiatives, and for effective palliative cancer care research. The need for palliative cancer care is greater than ever notwithstanding the strides made over the last decade. Further efforts are needed to realize the integration of palliative care in the model and vision of comprehensive cancer care by 2020.

Provisional Clinical Opinion

Provisional Clinical Opinion

The ASCO Cancer Foundation.

It is a privilege to be invited to contribute to the Partners in Cancer Care column in this issue of Journal of Oncology Practice. Participating in this edition of JOP gives us an opportunity to express our gratitude for the work the American Society of Clinical Oncology (ASCO) members do and for member support of the mission of the ASCO Cancer Foundation (TACF), to reflect on our partnership, and to share some of our accomplishments and plans to improve the lives of people with cancer. First, I would to acknowledge the leadership of the ASCO Clinical Practice Committee (CPC) in supporting the ASCO Cancer Foundation Grants Program by funding a Young Investigator Award (YIA). In 2007, the CPC made ASCO history by funding the first-ever committee-supported YIA. They repeated their generosity and funded another YIA awarded in June. Dr Richard T. Lee from the University of Chicago became the recipient of the 2008 CPC YIA for his abstract titled “Cancer Patients Use of and Communication Patterns about Complementary and Alternative Medicines During Clinical Trials.” The grants program celebrated its 25th anniversary at the 2008 ASCO Annual Meeting recognizing more than $48 million that has been awarded in grant funding since 1984. This year, more than $7.6 million was awarded to support clinical and translational research designed to improve cancer prevention, treatment, and care. Several new grants were awarded this year including three Clinical Oncology Research Awards (CORA), three Advanced Clinical Research Awards (ACRA), and two Translational Research Professorships. Dr Nancy Davidson, Immediate Past President of ASCO, announced TACF's establishment of a mission endowment at the 2008 Annual Meeting. This fund will enhance our ability to continue ASCO's important work. The endowment will ensure that the extraordinary promise of the ever-increasing lifesaving advances of new research be made available to oncologists, and ultimately to patients around the world. Our mission endowment was established to provide a long-term base of support in five key areas: research, patient education, physician education, international outreach, and access to care. The mission endowment's founding supporters are: Genentech, GlaxoSmithKline Oncology, Novartis Oncology, and sanofi-aventis US. There are several ways individuals, groups, corporations, and foundations can participate. One way is to establish a named endowed fund. Please contact the development office to talk about leaving a legacy through TACF. TACF has hosted several events to educate patients and the public about important developments and progress in cancer medicine. Inaugural Public Forums were held in conjunction with the 2007 Breast Cancer Symposium and the 2008 Genitourinary Cancer Symposiums. Other critical expanded patient education offerings are being supported through the foundation including Cancer.Net, print materials, and advocate scholarships. The new TACF brand and name were officially introduced April 1, 2008, as was the Foundation's new Web site: www.ascocancerfoundation.org. Our name has changed slightly, but our charitable mission continues to be founded on four core tenets: research is at the heart of progress against cancer; cutting-edge knowledge is essential when to comes to treating people with cancer; getting good cancer care starts with getting good cancer information; and all patients with cancer deserve access to the best possible care. Thank you ASCO members for your role in making ASCO the world's authoritative body on cancer. You provide the inspiration, knowledge, and hope for those who are teaching, researching, and providing patients with the highest stand of care worldwide. TACF raises funds that help make those achievements possible. Collaborating with TACF will ensure that today's achievements reach those who need them, as quickly as possible. Together we are making a world of difference in cancer care. Figure 1

American Society of Clinical Oncology Clinical Practice Guidelines: Opportunities and Challenges

The American Society of Clinical Oncology (ASCO) published its first clinical practice guideline, which focused on the use of hematopoietic colony-stimulating factors, in 1994. Since then, ASCO has published 24 additional guidelines or technology assessments on a range of topics and is developing 11 additional guidelines. Guidelines are among ASCO's most valued products, according to membership surveys and data from the JCO.org Web site. However, the same data from ASCO members have highlighted a number of limitations to the guideline program. These relate to the timelines of guideline updates, difficulties locating guidelines and related products, and challenges to implementing ASCO guidelines in everyday clinical practice. This article outlines the concrete steps that the ASCO Health Services Committee (HSC) is taking to address these limitations, including the institution of a more aggressive guideline updating schedule, a transition from narrative to systematic literature reviews to support the practice recommendations, a new Board of Directors-approved policy to permit endorsement of other groups' guidelines, and a robust Clinical Tools and Resources program that offers a range of guideline dissemination and implementation aids. Additional work is underway to establish stronger and deeper collaborations with practicing oncologists to expand their role in the review, field testing, and implementation of guideline clinical tools and resources. Finally, the HSC is discussing evaluation of the guidelines program to maximize the impact of ASCO clinical practice guidelines on clinical decision making and, ultimately, the quality of cancer care.

The Role of Prevention in Oncology Practice: Results From a 2004 Survey of American Society of Clinical Oncology Members

In 2004, the American Society of Clinical Oncology (ASCO) Cancer Prevention Committee surveyed the members to describe involvement in clinical prevention activities. A previously administered survey, with updated items on genetics, chemoprevention, and survivorship, was mailed to a stratified random sample of 2,000 domestic members and a convenience sample of 3,144 international members. A total of 49.7% of domestic members contacted and survey eligible responded (n = 851). Nonresponders were younger (50.5 v 51.7 years; P < .01); 465 international members responded. Overall, 35% had received formal instruction in cancer prevention and control, and most respondents expected increased use of prevention, screening/early detection, and risk reduction/genetic counseling in their practices in the next 5 years. Most reported caring for cancer survivors, including providing general medical care. They also either directly provide or refer patients for cancer prevention and control services (eg, cancer screening, tobacco and nutrition counseling, risk reduction, and chemoprevention). Multivariable modeling found fewer perceived barriers to inclusion of cancer prevention activities in clinical practice among those practicing in an academic setting, seeing a higher proportion of patients without a cancer diagnosis, having formal training in prevention and control, expecting an increase in prevention activities in the next 5 years, and providing community advice on prevention. Barriers to the inclusion of cancer prevention and control activities in oncology clinical practice exist. Nevertheless, a substantial proportion of both domestic and international ASCO members report an interest in cancer prevention and control activities, with a desire for more specific educational programs in this emerging area of oncology practice.

Attitudes and practices among pediatric oncologists regarding end-of-life care: results of the 1998 American Society of Clinical Oncology survey.

In 1998, the American Society of Clinical Oncology (ASCO) surveyed its membership to assess the attitudes, practices, and challenges associated with end-of-life care of patients with cancer. In this report, we summarize the responses of pediatric oncologists and the implications for care of children dying from cancer. The survey consisted of 118 questions, covering eight categories. All ASCO members in the United States, Canada, and the United Kingdom were mailed a survey, which was completed by 228 pediatric oncologists. Predictors of particular attitudes and practices were identified using stepwise logistic regression analysis. Potential predictors were age, sex, religious affiliation, importance of religious beliefs, recent death of a relative, specialty, type of practice (rural or urban, academic or nonacademic), amount of time spent in patient care, number of new patients in the past 6 months, and number of patients who died in the past year. Pediatric oncologists reported a lack of formal courses in pediatric palliative care, a strikingly high reliance on trial and error in learning to care for dying children, and a need for strong role models in this area. The lack of an accessible palliative care team or pain service was often identified as a barrier to good care. Communication difficulties exist between parents and oncologists, especially regarding the shift to end-of-life care and adequate pain control. Pediatric oncologists are working to integrate symptom control, psychosocial support, and palliative care into the routine care of the seriously ill child, although barriers exist that make such comprehensive care a challenge.

The association between physician reimbursement in the US and use of hematopoietic colony stimulating factors as adjunct therapy for older patients with acute myeloid leukemia: Results from the 1997 American Society of Clinical Oncology survey

Financial considerations play an important role in the delivery of medical care in the US. In 1996, revised guidelines from the American Society of Clinical Oncology (ASCO) indicated that granulocyte colony-stimulating factor (G-CSF) and granulocyte macrophage-colony stimulating factor (GM-CSF) were unlikely to be harmful for older acute myeloid leukemia (AML) patients and suggested that physicians could consider their use in this setting. In 1997, the ASCO health services research committee evaluated whether physician reimbursement was a primary determinant in the decision to use G-CSF and GM-CSF in this clinical situation. A questionnaire describing clinical scenarios for a 67-year-old man with newly diagnosed de novo AML was mailed to 1500 ASCO members who practiced medical oncology and hematology. Physicians were queried about their preferences for adjunctive CSF use following induction and consolidation chemotherapy. Of 1020 potentially eligible respondents, returned surveys were received from 672. Following induction chemotherapy, support for CSF use was 40%, similar in magnitude for that for non-use of these agents. The most important determinant of support for CSF use was being in a fee-for-service practice (P < 0.001). Physicians in the US are mixed in their support for CSFs for older AML patients. Support was high in settings where CSF use was accompanied by financial profit to the physician practice, and support was low otherwise.