Improving Cancer Diagnosis and Care
Patient Access to
Oncologic Imaging and Pathology
Expertise and Technologies
PROCEEDINGS OF A WORKSHOP
Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs
National Cancer Policy Forum
Board on Health Care Services
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by Contract No. 200-2011-38807 (Task Order No. 0051) and Contract No. HHSN263201200074I (Task Order No. HHSN26300120) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society of Clinical Oncology, Association of American Cancer Institutes, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, Merck, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-47828-1
International Standard Book Number-10: 0-309-47828-6
Digital Object Identifier: https://doi.org/10.17226/25163
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Improving cancer diagnosis and care: Patient access to oncologic imaging and pathology expertise and technologies: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25163.
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WORKSHOP PLANNING COMMITTEE1
HEDVIG HRICAK (Workshop Chair), Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
JAMES A. BRINK, Radiologist-in-Chief, Massachusetts General Hospital; Juan M. Taveras Professor of Radiology, Harvard Medical School; Chair, American College of Radiology Board of Chancellors
CHRISTOPHER R. COGLE, Professor of Medicine, Pierre Chagnon Professor of Stem Cell Biology and Bone Marrow Transplant, University of Florida; Scholar in Clinical Research, Leukemia & Lymphoma Society
MICHAEL B. COHEN, Interim Chair and Director, Anatomic Pathology, Wake Forest School of Medicine
MICHAEL J. DILL, Director, Workforce Studies, Association of American Medical Colleges
KOJO S. J. ELENITOBA-JOHNSON, Professor, Perelman School of Medicine; Director, Center for Personalized Diagnostics and Division of Precision and Computational Diagnostics, University of Pennsylvania
CURTIS P. LANGLOTZ, Professor of Radiology and Biomedical Informatics, Associate Chair for Information Systems, Department of Radiology, Stanford University; Medical Informatics Director, Stanford Hospital and Clinics
RICHARD L. SCHILSKY, Senior Vice President and Chief Medical Officer, American Society of Clinical Oncology
WILLIAM W. STEAD, Chief Strategy Officer and McKesson Foundation Professor of Biomedical Informatics and Medicine, Vanderbilt University Medical Center
ROBERT A. WINN, Associate Vice Chancellor, Community Based-Practice; Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Illinois at Chicago; Director, University of Illinois Cancer Center
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
WENDY A. WOODWARD, Associate Professor and Service Chief, Clinical Breast Radiation, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center
Project Staff
ERIN BALOGH, Senior Program Officer
NATALIE LUBIN, Senior Program Assistant
CYNDI TRANG, Research Assistant
SHARYL J. NASS, Forum Director and Director, Board on Health Care Services
NATIONAL CANCER POLICY FORUM1
EDWARD J. BENZ, JR. (Chair), President and Chief Executive Officer Emeritus, Dana-Farber Cancer Institute; Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School
AMY P. ABERNETHY, Chief Medical Officer, Chief Scientific Officer, and Senior Vice President, Oncology, Flatiron Health
LUCILE L. ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center
GARNET L. ANDERSON, Senior Vice President and Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; Affiliate Professor, Department of Biostatistics, University of Washington
KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute
KAREN BASEN-ENGQUIST, Annie Laurie Howard Research Distinguished Professor, Professor of Behavioral Science, and Director, Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center
CATHY J. BRADLEY, Associate Director, Cancer Prevention and Control, University of Colorado Cancer Center
OTIS W. BRAWLEY, Chief Medical and Scientific Officer, American Cancer Society
ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network
CHRISTOPHER R. COGLE, Professor of Medicine, Pierre Chagnon Professor of Stem Cell Biology and Bone Marrow Transplant, University of Florida; Scholar in Clinical Research, Leukemia & Lymphoma Society
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
NANCY E. DAVIDSON, President and Executive Director, Seattle Cancer Care Alliance; Senior Vice President, Director, and Full Member, Clinical Research Division, Fred Hutchinson Cancer Research Center; Head, Department of Medicine, Division of Medical Oncology, University of Washington
GEORGE D. DEMETRI, Professor of Medicine and Director, Ludwig Center, Harvard Medical School; Senior Vice President for Experimental Therapeutics, Dana-Farber Cancer Institute; Associate Director for Clinical Sciences, Dana-Farber/Harvard Cancer Center
JAMES H. DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute
NICOLE F. DOWLING, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
SCOT W. EBBINGHAUS, Vice President and Therapeutic Area Head, Oncology Clinical Research, Merck Research Laboratories
KOJO S. J. ELENITOBA-JOHNSON, Professor, Perelman School of Medicine; Director, Center for Personalized Diagnostics and Division of Precision and Computational Diagnostics, University of Pennsylvania
STANTON L. GERSON, President, Association of American Cancer Institutes; Director, Case Comprehensive Cancer Center; Professor of Hematological Oncology, Case Western Reserve University; Director, University Hospitals Seidman Cancer Center
LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs
LINDA HOUSE, President, Cancer Support Community
HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
LISA KENNEDY SHELDON, Chief Clinical Officer, Oncology Nursing Society
SAMIR N. KHLEIF, Director, Loop Immuno-Oncology Lab, Biomedical Scholar, and Professor of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center
RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
LEE M. KRUG, Program Leader, NKTR-214, Oncology Clinical Development, Bristol-Myers Squibb
MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine and Director, The University of Chicago Comprehensive Cancer Center
MIA LEVY, Director, Cancer Health Informatics and Strategy; Ingram Associate Professor of Cancer Research; Associate Professor of Biomedical Informatics and Medicine, Vanderbilt-Ingram Cancer Center
MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer
RICHARD PAZDUR, Director, Oncology Center of Excellence; Acting Director, Office of Hematology and Oncology Products, Food and Drug Administration
MACE L. ROTHENBERG, Chief Development Officer, Oncology, Pfizer Global Product Development, Pfizer Inc.
RICHARD L. SCHILSKY, Senior Vice President and Chief Medical Officer, American Society of Clinical Oncology
DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute
LAWRENCE N. SHULMAN, Professor of Medicine, Deputy Director for Clinical Services, and Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania
DAN THEODORESCU, Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center
VERENA VOELTER, Head, United States Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation
GEORGE J. WEINER, C.E. Block Chair of Cancer Research, Professor of Internal Medicine, and Director, Holden Comprehensive Cancer Center, The University of Iowa
ROBERT A. WINN, Associate Vice Chancellor, Community Based-Practice; Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Illinois at Chicago; Director, University of Illinois Cancer Center
National Cancer Policy Forum Staff
ERIN BALOGH, Senior Program Officer
PATRICK BURKE, Financial Officer
NATALIE LUBIN, Senior Program Assistant
CYNDI TRANG, Research Assistant
SHARYL J. NASS, Forum Director and Director, Board on Health Care Services
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
BIBB ALLEN, JR., Grandview Medical Center
JEFFREY MYERS, University of Michigan
RITU NAYAR, Northwestern University
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DANIEL R. MASYS, University of Washington. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society of Clinical Oncology, Association of American Cancer Institutes, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, Merck, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc.
The forum wishes to express its gratitude to the expert speakers whose presentations helped further the dialogue and advance progress in improving patient access to appropriate expertise and technologies in oncologic pathology and imaging. The forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
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Contents
CURRENT DIAGNOSTIC CHALLENGES IN CANCER CARE
Diagnostic Errors and Uncertainty in Diagnostic Findings
The Changing Landscape of Oncologic Imaging, Pathology, and Precision Oncology Care
Uneven Access to Oncologic Imaging and Pathology Expertise and Technologies
Lack of Collaboration Among Radiologists, Pathologists, and Oncologists
ENSURING THE QUALITY AND ACCESSIBILITY OF DIAGNOSTIC EXPERTISE AND TECHNOLOGIES
Improving Education and Training
Improved Communication and Collaboration
Molecular Diagnostics and Pathology Informatics
Competency-Based Medical Education
Pathology and Radiology Training, Subspecialization, and Integration
Training for Practice in Community Versus Academic Settings of Care
Oncology Expertise Within Practices and Academic Departments
Challenges with Developing and Implementing Clinical Decision Support Tools
Peer Learning and Second Reviews
Continuous Learning and Assessment
INTEGRATION AND COLLABORATION OF SPECIALTIES
Rationale for Collaboration and Integration
Alternative Payment Models to Promote Collaboration and High-Quality Care
Real-World Data and Computational Oncology
Computational Oncology and Machine Learning
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Acronyms and Abbreviations
ACR | American College of Radiology |
AI | artificial intelligence |
ASCO | American Society of Clinical Oncology |
CME | continuing medical education |
CMS | Centers for Medicare & Medicaid Services |
CPT | Current Procedural Terminology |
CRICO | Controlled Risk Insurance Company |
CT | computed tomography |
DMT | Diagnostic Management Team |
ECHO | Extension for Community Healthcare Outcomes |
EHR | electronic health record |
EPA | entrustable professional activity |
FAIR | findable, accessible, interoperable, and reusable |
FDA | Food and Drug Administration |
FHIR | Fast Healthcare Interoperability Resources |
GENIE | Genomics Evidence Neoplasia Information Exchange |
MOC | Maintenance of Certification |
MRI | magnetic resonance imaging |
OCM | Oncology Care Model |
PET | positron emission tomography |
PROM | patient-reported outcome measure |
TIES | Text Information Extraction System |