Community: The Key to Keeping Up-to-Date in Thoracic Oncology

Dr Mark Kris discusses the importance of community in keeping up-to-date with the latest news and data in thoracic cancer.
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-- TRANSCRIPT --
Hello. It's Mark Kris from Memorial Sloan Kettering, talking today about a meeting I attended here in New York City on the 11th of November. Every year, the community of physicians, nurse practitioners, physician assistants, and nurses who care for people with thoracic cancers come together for a 1-day meeting to share our experiences and to use it as an opportunity to get lectures from people who are leading the field.
The meeting is a mixture of lectures. It also includes a tumor board discussion where leaders in surgery, radiation, medical oncology, and imaging talk about cases involving big issues in thoracic cancer. One example in particular is as follows: For somebody with stage II cancer at diagnosis, do you operate and give an adjuvant treatment or do you give neoadjuvant therapy?
The other thing we do is we present cases. We call them our challenging cases. We had eight physicians this year from eight different institutions who talked about cases that they thought brought something unique to their experience. They thought that sharing them could be helpful.
I have a couple of observations about this meeting. Number one, the amount of information that is hitting oncologists and thoracic oncologists in particular, is absolutely amazing. The second thing is the pace of the arrival of this information. We had multiple presentations during our meeting on November 11th from the European Society for Medical Oncology meeting that took place about 2 weeks earlier, including new information, new drugs, and, well, lots of it. We are trying to do our best to keep up with it and the complexity of it.
One example is that it's not EGFR mutations now; it's which EGFR mutation. Exon 20 is different than the sensitizing ones. The rare ones are perhaps different than the normal sensitizing ones. It's more and more that we have to know.
The one thing, though, I was very struck with and sort of the saving grace in all this is the community that we have here. I have to say that I was extremely impressed that people are absolutely committed to learn, they're absolutely committed to collaborate both with their own fellow practitioners and with the larger community here in New York.
They're also very willing to innovate. What I saw in these case presentations was this really important ability that, as the patient's condition changed and as our state of knowledge changed, the plan changed. People are reacting to the patient's condition, people are reacting to new knowledge in the field, and trying to do so - I love that word "iterative." I don't know if people like that. It may confuse people more than it helps them - but this idea that each step informs the next one, we saw example after example of that.
The other thing that we saw was that, in each of these cases, their stress on listening to the patient, finding out what their priorities and wishes were, and trying to include them in their decision-making and in the final decision -making that they would present to the patient and go ahead with. I thought that was a nice thing.
Another thing that came out, and I share this as a caveat: These were big institutions, fancy databases, and for two of the eight cases that they presented, the data from initial molecular testing was in the medical record, but not in a place where you could easily find it. In two cases, there were useful data from molecular testing done at a different institution that got into the medical record, but they got into a place where they were not readily accessible.
Unfortunately, you can't rely on the patient for telling you that that's available, perhaps because it's so complicated, obtuse, and totally incomprehensible to somebody being faced with a newly diagnosed, life-threatening illness and all the decisions that go along with it.
The other thing that was really important about this meeting is that people were very practical. There was a great lecture by Dr Bruna Pellini, from H. Lee Moffitt Cancer Center. She is an expert in minimal residual disease testing. She knows the science, she knows the literature, and she has experience in the area. At the end of her lecture, she was able to say, "By the way, none of the things I've talked about today are things that are ready to be used for individual patients." For people to say that with that depth of knowledge is just a really wonderful thing. That's what people like about this meeting.
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