Proceedings of a Workshop
Rapid advances in cancer research, the development of new and more sophisticated approaches to diagnostic testing,2 and the growth in targeted cancer therapies are transforming the landscape of cancer diagnosis and care (Lowy and Collins, 2016; NASEM, 2016). Hedvig Hricak, chair of the department of radiology at Memorial Sloan Kettering Cancer Center, said these innovations have contributed to improved outcomes for patients with cancer, but they have also increased the complexity involved in diagnosis and subsequent care decisions.
The National Academies of Sciences, Engineering, and Medicine define the diagnostic process as “a complex, patient-centered, collaborative activity that involves information gathering and clinical reasoning with the goal of determining a patient’s health problem. This process occurs over time, within the context of a larger health care work system” (NASEM,
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
2 In this proceedings, the term “diagnostic testing” is intended to be broadly inclusive of all types of testing, including medical imaging, anatomic pathology, and laboratory medicine.
2015, p. 32). Hricak stressed that “the diagnostic process is complex and it’s getting even more complex.” In the context of high-quality cancer care, the diagnostic process requires a high degree of specialized knowledge and effective collaboration among the members of a patient’s care team in order to inform diagnostic test selection; sample collection, preparation, and analysis; and the interpretation and communication of results and the implications for subsequent care decisions. Radiologists and pathologists are essential members of the care team because accurate imaging and pathology results are critical for establishing a correct diagnosis and treatment plan for patients with cancer, as well as assessing prognosis, treatment response, disease progression, and recurrence (Harris and McCormick, 2010; IOM, 2013b; NASEM, 2015).
To examine opportunities to improve cancer diagnosis and care, the National Cancer Policy Forum developed a two-workshop series.3 The first workshop, held on February 12–13, 2018, in Washington, DC, focused on potential strategies to ensure that patients have access to appropriate expertise and technologies in oncologic pathology and imaging to inform their cancer diagnosis and treatment planning, as well as assessment of treatment response and surveillance. This proceedings chronicles the presentations and discussions at the workshop.
The workshop convened a number of stakeholders with a broad range of views and perspectives, including radiologists, pathologists, oncologists, and patient advocates, as well as representatives of health care organizations, academic medical centers, community practices, and federal agencies. These thought leaders were asked to discuss current challenges to cancer diagnosis and to share their insights and perspectives—based on their involvement in efforts to improve cancer diagnosis and care—on opportunities to expand access to high-quality diagnostic expertise and technologies in cancer care. Presentations and panel discussions examined
- Current diagnostic challenges and the risk for diagnostic errors;
- The changing landscape of pathology and radiology in cancer care;
- Ways to improve cancer diagnosis through education, training, and quality improvement efforts;
3 The second workshop, The Clinical Application of Computational Methods in Precision Oncology, is planned for October 29–30, 2018. See http://nationalacademies.org/hmd/Activities/Disease/NCPF/2018-OCT-29.aspx (accessed July 16, 2018).
- Opportunities to ensure the quality and accessibility of diagnostic expertise and technologies, including clinical decision support, telementoring, and telemedicine;
- Strategies to improve collaboration among the pathologists, radiologists, and oncologists involved in cancer diagnosis; and
- The role of computational oncology and integrated diagnostics in cancer care, including recent developments in artificial intelligence (AI).
This workshop proceedings highlights a number of suggestions from individual participants regarding potential ways to improve patient access to expertise and technologies in oncologic imaging and pathology. These suggestions are discussed throughout the proceedings and are summarized in Box 1. Appendix A includes the Statement of Task for the workshop. The