ASCO Connection

July 2017

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are not "chemotherapists" or "radio- therapists"—we are oncologists. Our payment should be because we pro- vide high-quality oncologic care that improves the lives of our patients. We should be rewarded for being well- trained oncologists who provide our cognitive services, our experience, and our compassion to help patients who place their trust in us. The transition to Medicare's new Quality Payment Program is already underway, and it will be transformative for not just how we are reimbursed, but how we practice. ASCO has been at the table as Medicare has imple- mented MACRA. Led by ASCO's newly established Clinical Affairs Depart- ment, directed by Dr. Stephen Grubbs, we have responded. Working with our Clinical Practice Committee, the State Affiliate Council, and other vol- unteer leaders across ASCO, we have developed tools that will support the practice transformation all of us must undertake. For example, ASCO's Qual- ity Oncology Practice Initiative (QOPI ® ) has already served as a model for doc- umenting adherence to quality mea- sures, and ASCO's new COME HOME initiative will help you adapt, survive, and thrive in this new environment. None of us wants more intrusion into our daily practice. But, in today's world of rapidly evolving information, none of us can know the vast amounts nec- essary to deliver the complex care required of a general oncologist. In other words, we need to make it easy to provide standardized care through- out our country, and even the world. To this end, more than two decades ago, ASCO began what is now a highly successful practice guidelines pro- gram. Thanks to many of you who have served on the Clinical Practice Guide- lines Committee, we have generated a set of highly respected practice guide- lines that are recognized worldwide, and have, frankly, raised the bar for how all of us practice. However, ASCO guidelines tend to be deep, evidence-based dives within spe- cific nodes along the care continuum. In this regard, much of our practice sits in the areas between these nodes, and in this case expert consensus pathways can help inform our daily clinical activities. Since several other different organiza- tions have developed oncologic clinical pathways, and rather than reinventing the wheel, ASCO, led by Dr. Robin Zon and colleagues, has proposed a set of criteria that we feel are required for a pathway to be adopted, regardless of who develops it. I have no doubt that when taken together, guidelines and pathways will lessen, if not eliminate, the kinds of geographic and practice- to-practice variations that led to the disturbing mortality map published by Dr. Mokdad. What else is ASCO doing to improve cancer care delivery? CancerLinQ will provide an immediate high-quality analysis that physicians and prac- tices can use to determine if they are compliant with current pathways and guidelines. If not, it will suggest how they can adjust to do so. Moreover, CancerLinQ will also tell us if the path- ways and guidelines themselves are out of sync with good practices. If so, we can then rapidly implement effec- tive revisions to fix them. In my own academic career, I've seen how the ASCO guidelines process can improve oncologic care. I will never for- get sitting in a small hotel room in San Francisco in 1995 with a diverse array of laboratory and clinical investigators, community clinicians, statisticians, and guidelines experts to develop the sec- ond ASCO clinical practice guideline, directed towards tumor biomarkers in breast and colorectal cancer. This experience, now more than 20 years ago, led to one of my favorite mantras: "A bad tumor biomarker test is as bad as a bad drug." As we move into the era of precision medicine, this statement could not be more true. If we are going to use tumor biomarker tests to direct care for our patients, then we need to be sure that the test we are using is technically accurate and truly improves a patient's out- come. ASCO has and will continue to advocate that the diagnostics we use to direct care are just as safe and effective as the therapeutics on which we depend so much. Our patients deserve nothing less. We have come so far over the last 30 years. When I was a fellow in the 1980s, there were few discussions of what sort of quality of life adult cancer survivors might have. Rather, we were more focused on whether they would sur- vive at all! But my friend John Cleland and his family, including his 3 children born after his treatment, are a happy reminder that our patients can, indeed, live productive and healthy lives. ASCO is your Society, and ASCO will work with you to pursue our vision of a world where cancer is prevented or cured, and every survivor is healthy. We want more stories like my friend John Cleland's, and fewer like my cous- in Kim's. • Editor's note: Excerpt has been edited for length and clarity. Watch a video of Dr. Hayes delivering his Presidential Address and read the complete transcript on ASCOconnection.org. In addition to research and care delivery, Dr. Hayes' address highlights ASCO's work in cancer education and survivorship care. ASCOconnection.org I 31

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