Significant changes are taking place in the two major cancer professional organizations, the American Society of Clinical Oncology and the American Assn. for Cancer Research.

The groups held the final of their back-to-back annual meetings in Orlando, FL, last week. AACR, the older organization, decided last year to meet separate from ASCO beginning in 1994. Yet, the leadership of both organizations expressed hope that their ties would not be severed, but strengthened, with greater opportunity for interaction among basic and clinical researchers.

“We feel it is essential to develop areas of regular communication with ASCO,” Lee Wattenberg, who completed his term as AACR president, said to the AACR membership.

The AACR board of directors approved a standing committee on clinical investigations to review and suggest ways of improving the association’s interaction with clinical researchers.

ASCO’s Bernard Fisher urged the society define clinical research broadly.

“Research that is leading edge, has possible clinical relevance, and can be translated, must be included in the ASCO portfolio,” Fisher said. “ASCO must provide a conducive forum for the physician-scientists who are the great translators. It must also embrace the basic scientists, molecular biologists and geneticists who not only have the facility of making their investigations come alive, but will contribute to the milieu that will keep physicians and non-physician scientists coming to ASCO meetings.”

ASCO’s meeting next year will be four days rather than three to include more educational sessions, particularly in so-called “translational research.” Attendance at ASCO this year was 12,500, far exceeding last year’s 9,000. Membership in ASCO is 9,500.

Not only are ASCO-AACR interactions changing. The organizations individually are examining their purposes and directions.

ASCO recently completed a membership survey which will result in major organizational changes, such as the hiring of a chief staff officer and moving its headquarters from Chicago to Bethesda, MD (The Cancer Letter, April 23).

AACR this year will begin a self-assessment, said the association’s new president, Margaret Kripke. Attendance at AACR was 6,500, and the association has 8,700 members, double that of a decade ago.

“What we have achieved in the last 10 years is really breathtaking,” Kripke said to the association’s business meeting. “It’s time to stop and catch our breath. Is the annual meeting really serving the needs of the entire membership?”

The AACR board will hold a retreat in the fall discuss the association’s future, Kripke said. She invited members to submit their ideas to her, at M.D. Anderson Cancer Center.

Reminding the participants why AACR decided to separate its meeting from ASCO’s, Kripke said few AACR members were registering for the ASCO meeting. “The expectation that people would come to both meetings was unreasonable and not happening, and not worth the logistical difficulties,” she said. Next year, AACR meets in San Francisco in April, about four weeks prior to the ASCO meeting in Dallas.

At the business meeting, AACR members Sharon Murphy and John Yarbro argued for holding the AACR meeting in the fall. Kripke asked for a show of hands. The majority favored a spring meeting. Kripke said she may ask for a poll of the full membership on this issue.

‘Who Has A Voice In ASCO?’

Fisher, in his address as ASCO’s 29th president, commented on the question of ASCO’s role:

“At onset of my presidency I was really perplexed. I heard from ASCO members who believed the mission of ASCO is changing. Some claimed it is increasingly concerned with government issues or education at the primary level and has become an advocacy organization speaking for better reimbursement for private practice medical oncologists.

“On the other hand, private practice medical oncologists indicated their concern that ASCO doesn’t speak for them or provide them for a forum to address the issues that most affect them,” Fisher said. “They believe that to meet their needs, they are forced to turn to state oncology societies or political action groups. In their view, ASCO speaks primarily for research and academically oriented oncologists. Radiation, surgical, pediatric, and gynecologic oncologists told me that ASCO doesn’t provide a forum and a voice for their colleagues.

“I began to wonder, who has a voice in ASCO, who is ASCO speaking for, or does everybody have laryngitis?

Since ASCO is growing, these “contradictory complaints might be ignored,” Fisher said. However, two events preclude this : the separation of the ASCO and AACR annual meetings, and public issues including health care reform. “Both could seriously affect the direction of this organization,” Fisher said.

The separation of the meetings “was initiated and carried out unilaterally by the governance of AACR,” Fisher continued. “Whether discontinuing the combined meetings is due to political or economic factors, or because back-to-back meetings are too much of an endurance contest for attendees, is uncertain.

“There is reason to believe, however, that the separation may, at least in part, be related to the perception by AACR that the mission of ASCO is changing, that it is directing its course toward private practice issues and that it is abandoning its scientific objectives, creating a void that needs to be filled by AACR.

“Is that perception correct, or is it a misconception?” Fisher asked. “My term in office has convinced me that the primary objective of ASCO remains intact. It’s bruised, it does need cosmetic surgery, and it can use more calories. But the commitment to promote and provide a forum for oncologic research continues.”

Defining Clinical Research

Fisher said he was surprised to learn recently that many ASCO members consider clinical research “a euphemism for clinical trials.”

However, investigation “not employing clinical trials, but having or likely to have clinical relevance must also be included under the rubric of clinical research,” Fisher said. “In essence, there is such an entity as clinical research. It’s readily distinguishable from fundamental research, which is nontargeted and non-goal oriented, with no clinical relevance real or imagined.

“Beyond that distinction, it’s not easy to distinguish between basic and clinical research. How particular research is viewed often depends on the depth of understanding of the research under consideration. To improve that understanding there has come into being what is called translational research or translational science.”

A better term is “translation of research,” Fisher said.

“Simply speaking, its purpose is to convey in understandable language, to scientists working in other areas of investigation or those who take care of patients, what a particular area of research is about and how its findings immediate or future have clinical relevance,” Fisher said.

“A major benefit for those who listen to the translationists is that in the course of listening, something, in a flash, an association between something said and something that the listener may have thought about can occur, giving birth to a new and independent thought and direction for research, as well as to have such knowledge applied to the problems of patients,” Fisher said.

“Many think that those kinds of fresh new ideas and directions can simply be purchased, if only Congress would appropriate yet another $100 million,” Fisher continued. “What a fatuous idea.

“I agree with those who express concern about ASCO and its relation to research. I agree because I passionately believe that the vitality, integrity and justification for this organization as it moves into the next millennium depends on how well clinical research with an expanded definition envelopes the membership of this organization,” Fisher said.

‘Bureaucrats, Administrators & Politicians’

“The widening gap between the clinician and the investigator could be a greater threat to welfare of patients than are the bureaucrats, administrators and politicians, the BAPs,” Fisher continued. “As they become more and more subsumed by the BAPs and what they stand for, clinicians get further and further away from science where the hope for the cure and prevention of cancer resides.

“Greater becomes the threat that the circumstances described by George Orwell in Animal Farm may become a reality. He contended that everything is created to become different, but eventually it all becomes the same. In the end, the farmers and the pigs were indistinguishable. It can be guaranteed that BAPs will not become like clinicians. But without the clinicians’ allegiance to science it cannot be guaranteed that the clinicians will not become indistinguishable from the BAPs.

“I plead with you not to deride any aspect of science, be it fundamental, basic or clinical, and to remember that clinical trials are a mechanism for carrying out clinical research.

“By the same token, to discredit one kind of research to raise money for another, whether such action is perpetrated by the clinicians, laboratory scientists or public advocates, is sophistry at its worst.

“For 25 years, the credo of the NSABP has been that when members enter the meeting hall, their personas change. They become more than clinical oncologists. They become clinical investigators, thinking about and contributing to the research being conducted. Whatever success the NSABP has had relates in no small part to that transformation,” Fisher said.

“ASCO must also be able to transmit that aura to you when you enter these halls, so that you are similarly motivated to become participants rather than voyeurs of science.”

Fisher said the most difficult part of his “journey” as ASCO president was entering “public issues and health care reform country,” characterized by faxes, letters, newspaper clippings, and ringing telephones, “emanating from a spot called the Washington office.”

“How the critics who considered ASCO to be too academic, too research oriented, and not sufficiently concerned about public and practice issues got that idea escapes me,” Fisher said. “I admit that when I started this aspect of my journey I was less than enthusiastic about ASCO’s role in the public issues arena. I was convinced that such involvement could only distract ASCO from its primary mission of supporting research and education directed at curing and preventing cancer. I was fearful that the political process and publicity associated with such efforts could achieve clonal dominance and destroy the host.

“I soon learned, however, that in these chaotic times, one needs a mechanism to fend off the rascals who mine the road to progress with misguided causes they espouse with the fervor of zealots, or with agendas that are totally self-serving.

“I believe that ASCO should be used as a bully pulpit to express its position on selected public issues relevant to its major mission, which is the preservation and promotion of science. But ASCO should be forever vigilant that it is not so involved that it becomes, once again using the metaphor of Animal Farm, indistinguishable from those it is opposing.