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NCCN Oncology Fellows Program Explores Disease Management, Supportive Care, and Health Care Policy Issues

On Sunday, March 26, 2017, the National Comprehensive Cancer Network® (NCCN®) hosted the 2017 NCCN Oncology Fellows Program: New Horizons in Quality Cancer Care™. More than 60 fellows attended the half-day program, which was held in conjunction with the NCCN 22nd Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care™ in Orlando, Florida. This program is dedicated to providing fellows from leading U.S. cancer centers with the opportunity to hear from world-class specialists about the latest treatment advances in particular disease sites.

The program commenced with a discussion of multidisciplinary management of esophageal and esophagogastric junction (EGJ) cancers. During this presentation, Jaffer Ajani, MD, and Wayne Hofstetter, MD, The University of Texas MD Anderson Cancer Center, discussed the strategy involved in developing individualized treatment plans incorporating multimodality therapy for patients with locoregional esophageal and EGJ cancers based on histology, tumor stage, and anatomic location. They also discussed genetic mutational burdens in the patient population and how to identify patients with advanced disease most likely to respond to targeted therapy.

Javid Moslehi, MD, Vanderbilt-Ingram Cancer Center, followed with strategies for recognition and management of treatment-induced cardiac toxicity in cancer survivors. Dr. Moslehi reviewed risk factors for the development of heart failure in cancer survivors, as well as provided an overview of cardiovascular risk factor management as outlined in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Survivorship. He noted the importance of individualized approaches to screening, as well as the potential cardiac complications associated with immunotherapy.

Just two days after the Trump Administration cancelled the vote on the American Health Care Act (AHCA), Lisa Lentz, MPH, NCCN, and Kavita Patel, MD, Brookings Institution, provided a timely overview and interpretation of the major legislation that has provoked a shift from pay-for-quantity to pay-for-value care. Ms. Lentz and Dr. Patel also discussed the various care models and federal initiatives relevant to improving cancer care delivery, such as the Medicare Access and CHIP Reauthorization Act (MACRA), Merit-Based Incentive Payment Program (MIPS), Advanced Alternative Payment Models (APMs), and the Oncology Care Model (OCM). 

Nadeem Abu-Rustum, MD, Memorial Sloan Kettering Cancer Center, outlined the clinical challenges in the evaluation, treatment, and surveillance of ovarian, uterine, and cervical cancers, noting the essential role that imaging technology plays in improving patient management. Among other topics, Dr. Abu-Rustum discussed the limitations of laparoscopy, as well as the benefits of real-time imaging data, sentinel node mapping, distillation imaging, and image-guided precision surgery.

David Pfister, MD, Memorial Sloan Kettering Cancer Center, and Sharon Spencer, MD, University of Alabama at Birmingham Comprehensive Cancer Center, followed with a presentation on the management of patients with head and neck cancer. Dr. Pfister discussed the specialized screening treatment approaches for patients with HPV-positive head and neck cancers, which often occurs in younger patients and differs at a molecular level from HPV-negative cancers. Dr. Spencer continued by outlining the importance of a proactive, team-based approach to head and neck cancer, during treatment and into survivorship, which includes nutritional support (especially with percutaneous endoscopic gastrostomy), speech and swallowing support, dental support, and support in smoking cessation.

During the final presentation, April Salama, MD, Duke Cancer Institute, discussed developments in combination therapies for advanced melanoma. She outlined both first- and second-line/subsequent treatment approaches, factoring in considerations with combination therapy when compared with single-agent treatment, such as higher response rates, more toxicity, and limited data in the second-line setting.

NCCN plans to hold its next Oncology Fellows Program in conjunction with the NCCN 23rd Annual Conference in March 2018.