Oncology leaders face many challenges in the field, and three in particular are top of mind: timeliness, treatment options and innovations.
Here, four leaders discuss the aspects of cancer care that keep them up at night:
Ken Chaij. Executive Director of Oncology Service Line at Kettering (Ohio) Health: What I worry about the most is timeliness: getting people in as quickly as possible to the correct therapy and professionals and treating them as quickly as we can for the best outcomes possible. We do not want people to sit there and go, "Oh, we can't get you in until XYZ date." We need to get them in as quickly as we can. People are living longer with cancer and we see people coming back over and over for more treatment as the disease returns or progresses. Getting them in at the same time that we see new disease patients coming in — and we're seeing them in our market in greater numbers — is why we are constantly working to open up more time, more chairs and have enough physicians to fit everybody. It's very operational, but it is key to being able to provide great service.
Chris Flowers, MD. Division Head Ad Interim of Cancer Medicine at MD Anderson Cancer Center (Houston): I think that we are at a place in cancer care where we're going to need to innovate more rapidly. I think there are a fair number of things that we do in drug development or therapy development for cancer that are not using the most modern technologies and data that we have available to us in terms of innovating. This would be similar to taking a road trip and pulling out a paper map to plan how you will get there. There are opportunities in designing and performing clinical trials that use existing and available data from prior patients that can help us to innovate more rapidly.
The other component of that is ensuring that all patients that have cancers of various subtypes have access to cancer therapies and access clinical trials. This is not only good for the patients who were able to go on the clinical trial, but it's also good for the clinical trials to reflect the population of patients who will need the therapy for over the long run. It's going to be a challenge to develop clinical trials and execute clinical trials in ways that really address both of those issues. One of the things that we are focusing on at MD Anderson are ways to stand up to this challenge.
Michael Postow, MD. Chief of Melanoma Service at Memorial Sloan Kettering Cancer Center (New York City): Knowing that not every patient is benefiting yet from our current treatments. What more can we do so that everyone benefits and everything we're doing is going to work? It's really disappointing when treatment doesn't work, and remembering stories of people that are not served by the current treatments is motivating for finding and doing new trials, new combinations and understanding better why people don't benefit.
Joanna Sesti, MD. Director of Thoracic Surgery at RWJ Barnabas Health (West Orange, N.J.) and Chief of Thoracic Surgery and Director of Robotic Thoracic Surgery at Cooperman Barnabas Medical Center (Livingston, N.J.): I think the fact that especially for lung cancer, even in early-stage disease, we still have a fair amount of patients that die of cancer. There are still a lot of patients out there that have recurrence and eventually die of lung cancer. So that obviously is bothersome to anybody who treats cancer because what you want to be able to tell your patient is, "Listen, we caught this early. Thank goodness we treated it. You're safe." But that's difficult to say right now. I think it's only a matter of time before these immunotherapeutics are adapted from more advanced diseases to potentially early diseases. And the hope is that it will change the history of lung cancer.
When it comes to esophageal cancer, I don't think we have a great treatment unfortunately, even with immunotherapeutics and chemotherapy and advances in the surgical treatment. I think we're still lagging in helping patients. My hope is that eventually some sort of immunotherapeutic will be discovered that'll make a significant difference in esophageal cancer as it has in lung cancer.