Advocacy and Quality

Greetings, ASTROnews readers. For this CHAIR’Supdate (sticking with the stylish ASTROnews formatting), we will cover a couple of topics related to some of ASTRO’s most important activities: advocacy and quality.

Recently back from this year’s annual Advocacy Day in Washington, DC, I’m reminded once again about the importance of our advocacy efforts. There are many “voices” petitioning the federal government for action related to their causes, and it remains critical for radiation oncology to have a voice in Congress to explain to the decision makers how important radiation oncology is as a cancer specialty. This year in particular we had the opportunity to describe to Senators, Representatives and their health staffers the introduced ROCR bill. In my own visits with California congressional folks, we had the staff’s interested attention as we described the rationale behind the value-based ROCR proposal, a proposal that if enacted will provide long term stability for radiation oncology services. As noted, there are many voices on Capitol Hill (one time when leaving a California congressional office, we met advocates for the California apple growers entering the office to discuss their issues – this is a continuous process). ASTRO is the leading voice for radiation oncology thanks to those who regularly attend Advocacy Day, to ASTRO staff who are tireless in their advocacy, to those who contact their congressional representatives to weigh in on relevant issues, and to those who support advocacy via the ASTRO PAC. If you’ve not been to ASTRO’s Advocacy Day, please consider attending (and feel free to reach out to me directly – happy to discuss what Advocacy Day is like). There is lots of learning about how the government actually works and how important direct advocacy is for our specialty.

Second topic is ASTRO’s successful guidelines process. Before getting to ASTRO’s process, I’ll recall my role as one of the founding members of the NCCN Prostate Cancer Guidelines panel back 30 years ago in 1996.¹ The University of Michigan was one of the original 13 NCCN members. During those early days, I was deeply skeptical about the benefit of such a project. The Prostate Cancer Guideline panel even kicked off with a sarcoma medical oncologist as panel chair. While the early guidelines were pretty good (and the panels did have excellent radiation oncology representation), there was not a small amount of opinion-based suggestions and some “this is how we do it at our place” guidance. But, that was consistent with the early NCCN vision: how are various cancers currently treated at the NCI-designated cancer centers. My initial skepticism about the value of NCCN was wildly unfounded and ultimately NCCN (now 33 cancer centers) guidelines evolved into hyper-influential documents used worldwide. That said, NCCN is only one model for guideline development and other organizations, ASTRO included, use well established guideline methodology to synthesize data and answer key questions. ASTRO’s cancer guidelines and others (ASCO, ESTRO, SSO, etc.) are also highly influential and in some ways are more important than NCCN due to their evidence backing. ASTRO’s data-driven guidelines take more time to develop and update but also are open to comments from our members, comments that are reviewed and frequently incorporated. I’m sure many of you quote our ASTRO guidelines when you are advocating on behalf of your patients during the authorization process.

While we continue to work on Capitol Hill to get support for the important value-based ROCR legislation, it’s important to reflect on ASTRO’s value to our specialty and our members. Radiation-focused, evidence-based guidelines and radiation-issue-driven advocacy in Washington provide examples of tangible value.