How does one measure the impact of a medical meeting, particularly the ASCO scientific symposia that occur throughout the year and in June the huge international extravaganza attracting more than 30,000 attendees? There are no solid metrics to quantify the effect of a meeting. Yes, CME post-tests seek to measure the value of meetings but it is all based on the subjective responses of attendees filling out those forms for CME credit. And there are Keypad sessions where attendees rate how discussions may alter their practice patterns, but their actual impact is unclear.
Nevertheless, there are many “take home” messages from these symposia and for many attendees, these “messages” could have a lasting effect on kidney cancer care. Studies suggest changes in practice patterns tend to occur in a number of ways, one being the influence of peers through various clinical settings, consensus guidelines, Grand Rounds, and the medical literature. More recently, the introduction of care pathways forces change and limits physician autonomy, but that is a topic for a different day. Symposia, including those sponsored by ASCO, are playing a role as an intervening variable in the equation.
Nevertheless, it is intriguing also to consider a “subjective metric”— how scientific symposia can jolt our perceptions, debunk prevailing myths, and produce counterintuitive findings. A case in point: the 2017 GU ASCO sessions in Orlando in February. From more than 100 abstracts in renal cell carcinoma, we compiled some salient examples of how perceptions can at least begin to change as evolving data emerge on a broad spectrum of topics and controversies. A quick Q&A offers some challenging questions:
True or false: Among patients who discontinue immune checkpoint inhibitor therapy because of immune-related adverse effects, benefits are likely to continue even after treatment is stopped.
Some responding patients—44% in a small series—still had a durable response and remained off of any additional therapy for a median time of 20 months. Thus, the answer calls into question the need for continuous treatment with immunotherapy in all patients.
True or false: Obese patients with RCC experience longer survival than non-obese patients.
Although obesity increases the risk of RCC, obese patients may experience longer survival than non-obese counterparts as reported by the IMDC and a new Japanese study. So the answer is true. The mechanism of this “obesity paradox” is unknown. The Japanese paper examined the impact of obesity, total adiponectin (AD) level, and intratumoral AD receptors expression on RCC aggressiveness and survival, and also investigated the mechanism underlying enhanced cancer aggressiveness in RCC cells with exogenous adiponectin stimulation.
Some findings tend to be counterintuitive and challenge the conventional wisdom. The value of medical symposia, perhaps, is that we are able to find an abundance of them in one place, such as the recent GU ASCO meeting in Orlando. However, counter-intuitive findings take root with difficulty as illustrated in Michael Lewis’ The Undoing Project based on the Nobel-prize winning research of Kahneman and Tversky.
Returning to our original question: do new medical meetings, version 2.0, so to speak, move the needle in kidney cancer and have an impact on our practices?
Like cloud-based technology, health care doesn’t really have a true “2.0.” New knowledge incrementally accumulates and changes practice patterns. Some of this new knowledge comes from medical meetings. It accumulates slowly, just as the acceptance of evidence-based medicine as a paradigm took decades to take root. In an industry where change can bring harm to a vulnerable population, it is no secret that clinics and hospitals always seek to improve care. The part that is less emphasized and perhaps underappreciated, however, is the importance that we improve care in increments. And where do the increments come from, at least to some extent? Medical meetings are just one source, and hopefully, they help us “move the needle” toward improved quality of care.
Kidney Cancer Journal
James Brugarolas, MD, PhD
Director of the Kidney Cancer Program
Associate Professor, Internal Medicine
Cancer Biology, Genetics, Development and Disease
UT Southwestern Medical Center