Greatest challenges and opportunities in oncology

Transcription

1 Greatest challenges and opportunities in oncology Clifford Hudis, MD Chief, Breast Medicine Service, MSKCC Professor of Medicine, WCMC Immediate Past-President, ASCO

2 1. Understanding pathways to novel targeted therapies 2. Exploring multidisciplinary clinics 3. Smoking cessation

3 Greatest challenges and opportunities in oncology? Scientific progress: Precision Medicine Research funding Increased complexity (Pharmacology, biomarkers) Smaller markets? Cost to Benefit ratio for new drugs and technologies Informatics & Big Data Demographic trends: obesity

4 ASCO at 50

5 First Meeting.common concern for the patient with cancer. Edgewater Hotel Chicago, Illinois

6 Founders Jane C. Wright, MD Fred J. Ansfield, MD Harry F. Bisel, MD Robert Talley, MD Herman H. Freckman, MD Arnoldus Goudsmit, MD, PhD Edgewater Hotel, Chicago, Illinois William Wilson, MD

7 FBI_Poster_of_Missing_Civil_Rights_Workers.jpg

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9 1 st ASCO Meeting in Chicago November 5, 1964 Development of an annual meeting Building educational material Publication of a specialty journal Collaboration with other organizations Research initiatives, and THEIR GOALS: Development of an organizational framework to support our efforts

10 The ASCO Mission: ASCO is a professional oncology society committed to conquering cancer through research, education, prevention and delivery of high-quality patient care.

11 Vision Statements: Our Intentions All patients with cancer will have lifelong access to high-quality, effective, affordable and compassionate care; The most accurate cancer information will be available so that patients and physicians can make informed decisions about cancer prevention and treatment; Information we learn from every patient will be used to accelerate progress against cancer; Resources will exist to attract the best clinicians and investigators to provide optimal patient care and to conduct transformative research; ASCO will be recognized as the most trusted source of cancer information worldwide.

12 Membership Growth by Year 35,000 30,000 25,000 20,000 15,000 10,000 5, ,616 33,086 34,374 29,955 27,309 28,348 23,004 24,172 24,548 25, Does not include Student/Non-oncology Resident members.

13 Success Story: Improving Cancer Survival

14 Research Funding: FY 14 NIH NCI FDA NCI: FY 14 Final $29.9 billion $4.9 billion $2.6 billion $4.9 billion Increase over FY13 + $1 billion (3.5%) $144 million (3%) $182 million (7.1%) Comparison to Pre-sequester level - $700 million (2.3%) -$200 million (4%) million (3.8%)

15 Stagnant Research Budget

16 2013 US Federal & Cancer Research Budgets 3,800,000,000,000 = Total 5,100,000,000 = NCI

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18 Cost of Cancer Care is Rising. $125 billion in 2010 $175 billion in 2020

19 Increased Demand: ~40% by New Cases Increase 42% Survivors Increase 45% Smith et al J Clin Oncol 27: Guy et al: J Clin Oncol 49:

20 Cumulative % Increase.Faster than the Overall Cost of Healthcare Cancer Drugs Cancer Medical Healthcare US GDP Source: Blue Cross Blue Shield Association

21 Patients with higher copayments are more likely to discontinue or be nonadherent...

22 Monthly & Median Costs Of Cancer Drugs When FDA-Approved

23 Who said it? the biggest hurdle facing efforts to develop new cancer cures might be economics, not science. What you know is not going to happen is the ability to stack therapies on top of each other at the current price and expect people to pay.the whole oncology pricing structure needs to be rethought because it s reached the level that is not going to be sustainable for the long term. (emphasis added) Source: Forbes, May 2014

24 Price is what you pay. Value is what you get. Warren Buffett

25 Value In Cancer Care

26 Stakeholders Align First, we can and must define value in cancer treatments. By Hagop Kantarjan, Lee Newcomer, Newton Crenshaw

27 The Big Picture: State Of Cancer Care in America 530 practices 8,011 physicians

28 State Of Cancer Care New healthcare delivery and payment models Sustainable Growth Rate (SGR), Sequestration Physician-led quality initiatives the proposal aims to improve the quality of cancer care by focusing on the value rather than the volume of services provided"

29 Early Computing IBM Front Panel

30 Growth in QOPI Since 2006

31 Concordance Overall Performance Improvement KRAS testing for patients with metastatic colorectal cancer who received anti-egfr MoAb therapy 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 30% Fall 2008 Spring 2009 Fall 2009 Spring 2010 Fall 2010 Spring 2011 Fall 2011 Spring 2012 Fall 2012 Spring 2013 KRAS Testing 43.89% 63.36% 70.35% 84.36% 83.07% 80.83% 82.09% 88.34% 86.54% 88.43% 2014 American Society of Clinical Oncology (ASCO). All Rights Reserved Worldwide 31

32 What is CancerLinQ? CancerLinQ connects the experiences of many people with cancer to help all people with cancer by collecting and analyzing that knowledge to provide realtime access to information for doctors and patients 32

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34 The HIT Revolution in Cancer Care Widespread adoption of EHRs by physicians and hospitals Improved data processing and storage capacities Rapid analysis tools Advances in natural language processing 2012: EHR/EMR Use in U.S. Oncology Practices 14.9% 16.2% 8% 60.8% of practices already have advanced EHRs/EMRs Has basic EHR/EMR Looking to implement EHR/EMR in next 6 months No EHR/EMR Source: Forte, GJ, et al. American Society of Clinical Oncology National Census of Oncology Practices: Preliminary Report. JOP January 2013 vol. 9 no

35 Clin. Pharm. Ther. Vol 91, March, 2012

36 CancerLinQ prototype Development began in June of Completed in eight months. Included more than 170,000 de-identified patient records. Demonstrated that the full CancerLinQ system could be a reality. 36

37 Tamoxifen Duration & Survival In CLQ Pilot

38 The Prototype: Achievements Demonstrated value-added tools, such as the ability to measure a clinician s performance on a subset of QOPI measures in real-time Created new ways of exploring clinical data and hypotheses generation Demonstrated ASCO s capability to develop rapid, real-time, clinical decision support based on clinical guidelines and integrate them into a demonstration EHR system Provided lessons learned about the technological and logistical challenges involved in a fullscale CancerLinQ implementation Demonstrated the ability to capture and aggregate complete longitudinal patient records from any source, in any format, and make use of the data 38

39 CLQ Promises: Confirm the results of large studies.in understudied populations Support accelerated approval.with real world data Expand post-marketing surveillance

40 A global alliance with the mission to: Encourage interoperability of technology standards for managing and sharing genomic data in clinical samples; Facilitate harmonization of approaches to privacy and ethics in the international regulatory context; Engage stakeholders across sectors to encourage the responsible and voluntary sharing of data and of methods.

41 Obesity Trends* Among U.S. Adults BRFSS, 1990, 2000, 2010 (*BMI 30, or about 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%

42 Predicted Obesity in 2030 Accessed 26 May >60% are Obese

43 Increasing Obesity Since 1980 Ng et al, Lancet Published Online May 29, S (14)

44 Summary of Mortality from Cancer According to BMI for U.S. Men & Women in the Cancer Prevention Study II Adapted from E.E. Calle et al. N Engl J Med 2003;348:

45 Summary of Mortality from Cancer According to BMI for U.S. Men & Women in the Cancer Prevention Study II Adapted from E.E. Calle et al. N Engl J Med 2003;348:

46 ASCO s Obesity Initiative Key Initiatives: Obesity Provider & Patient Guides: Published Spring 2014 Position Statement on Obesity & Cancer- Fall 2014 Obesity Research Summit- Fall 2014 The Energy Balance Work Group, a joint group of the Cancer Survivorship and Prevention committees, has been leading the development of these initiatives with support from the Cancer Research Committee

47 ASCO Obesity Initiative Provide and Patient Guides Contain: Evidence linking obesity to cancer Strategies to reduce weight in cancer survivors Implementation of weight loss strategies in cancer survivors Challenges to weight loss articulated by patients and sample provider responses Information on practice guidelines Coverage and reimbursement resources

48 ASCO s Intention is to use science to transform society by making a world free from the fear of cancer.