The 2019 American Society for Radiation Oncology (ASTRO) Annual Meeting takes place this year from September 15th through the 18th at McCormick Place West in Chicago. HealthCare Business News spoke with ASTRO president, Dr. Theodore DeWeese, vice dean for the Johns Hopkins School of Medicine and the Sidney Kimmel Professor in the Department of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins University, to learn about his background and to get an update on the organization.

HCB News: What inspired you to get involved in healthcare?
Dr. Theodore DeWeese: When I was in college, I came to realize just how much I loved science in the broadest sense, meaning chemistry and biology and physics. I was very lucky to have an opportunity to work in a laboratory in the School of Medicine in Colorado. I didn’t know at the time, but I was doing what we would now term “translational research”. We were developing an assay for a particular rare disease and came up with a way to do that, and then had an FDA-approved product. As my first research project, and since I had no framework, I just thought it was the coolest thing ever and I had no idea what a rare opportunity that was for me.

I also have always loved people and volunteering and did that in various ways in college and with a variety of organizations in Denver. The linkage of those two things, and really the second in particular, that’s where my heart was — around the notion of helping those who need it, and I have this great interest and love of science and biomedicine — what better place to do that than in medicine? No one in my family had ever been to college, much less medical school, so I rolled the dice and actually was admitted into medical school. All these years later, I have loved every moment.

HCB News: What is on your agenda as president of ASTRO?
TD: Broadly, there are two categories. First, we want to engage all of our members and support them in their role in caring for patients with cancer. It means having to fully educate the public and other physicians about the unique role that radiation oncology plays within the oncology care team – particularly, that we are one of the most effective modalities to cure patients.

There are very high demands for quality and safety that come with the work we do. That’s very important for the broader audience to understand our role as oncologists, and is really key in all of this, so we want to propagate a very clear and positive message about those aspects of who we are.

The second is the continuous learning required of those of us in cancer, generally, and radiation oncology, specifically, because it’s a fast-moving field. We need to make sure our members feel they are as contemporary in their knowledge as possible in areas like biomarker development, cancer genetics and immunotherapy linkages with radiation.

I also would link that emphasis directly with support for the research mission ASTRO provides in order to move the field forward, and to make sure our newest members inherit a thriving and dynamic field that continues to be centered on our patients.

HCB News: What are the biggest challenges facing ASTRO members today?
TD: I think the restrictive coverage policies that payors have is a real issue for us and our patients. It is frequently a challenge obtaining prior authorization for treatment, which is associated with a large administrative burden and cost. ASTRO has done some work recently evaluating this topic across our membership. It’s been very clear that nearly uniformly — over 90 percent of our members have said — patients have been delayed in receiving radiation therapy because of restrictive prior authorization practices that are employed by many insurers. When a patient has a life-threatening illness, the associated threat with delaying their care is just not a healthy situation to be in whatsoever.

As it turns out, about two-thirds of those denials that originally come from these prior authorizations are overturned anyway. So it’s a process that’s stressful, potentially risky for the patient, and extremely expensive and problematic for the healthcare team. Most management of patients today is multi-modality, for example, chemotherapy plus radiation. These treatments have to be sequenced very accurately, and when there’s a delay in either side of that, it can throw everything off track. A week of delay for bureaucratic reasons could turn into a significant delay far beyond a week because everything needs to be resequenced.

HCB News: Other than what you previously mentioned, are there benefits to being a member of ASTRO?
TD: The other portion of education, to be a little more explicit, is the continuous learning through the various journals that ASTRO provides. There’s also the education provided through a myriad meetings we support. And the third major aspect is the linkages ASTRO creates with other professional organizations, which helps to create guidelines and other materials that educate our members and other oncologists on how to manage their patients.

For continuing education, a number of the articles in our publications qualify for self-assessment CME. One can read the article, then take an online questionnaire that asks some questions that show you grasped the key highlights of the article. Being able to support the busy clinicians by having this sort of opportunity directly in the publications they receive as a member of ASTRO, I think, is a very important way to support their needs and ensure a continuous level of education used to the benefit of our patients.

HCB News: Are there any recent developments in the field you’re particularly excited about?
TD: There are actually quite a number. One of the most important advances over the last six or seven years is the role of immuno-oncology. It’s been clear by several publications that the combination of radiation therapy with some of the so-called checkpoint inhibitors — the immuno-oncology drugs — is more beneficial than the drug alone. Melanoma, for example, is a disease where this has been seen. Moreover, I think it’s extremely exciting, we are beginning to understand the molecular underpinnings of how the radiation-checkpoint inhibitor interaction is occurring. We are now coming to a place where we can start to think about screening patients to determine who would most benefit from a particular approach.

Another development is molecularly targeted radiation. This involves tiny molecules that target cancer cells and have a radioisotope linked to them. These small radiolabeled molecules are injected into a patient's bloodstream and circulate in the blood, binding to the cancer cells and delivering radiation right to the cancer. Prostate cancer is one of the places this is being developed.

There’s also the notion that radiation oncology is performed in what is termed, “closed loop medicine”. That is to say, you see patients, do all the tests, design a plan, test the plan before you deliver to the patient, the patient comes, and you reevaluate right before you give it to them, and then you treat them. That’s repeated every day. So our field generates a tremendous amount of data that can be mined with deep-learning algorithms and other artificial intelligence models. These models will to help us learn who might need more or less radiation, based on certain features seen in thousands of patients before them that we mine from these huge data repositories.

HCB News: What are you most excited about seeing or experiencing at this year’s conference?
TD: There is a whole new learning style we’re putting forward for the meeting — the presidential course in particular. It’s meant to be much more interactive. We are starting with a topic that is somewhat controversial: radiation therapy in the curative treatment of metastatic disease. Our goal is to really engage the audience in the topic with several “level setting” talks with the goal of getting all of the audience on the same page as to the state-of-the-state of metastatic cancer. This will be followed by an Oxford-style debate between experts, which we will use as a platform for much smaller breakout sessions where the various aspects of that topic can continue to be discussed and debated. It’s more interactive between audience participants and the lecturers and educators. We are excited to bring this new format to ASTRO this year and really hope it is a more enjoyable and engaging way to educate our members.

This year’s conference has more focus on health and healthy living, with activities like morning yoga and more healthy eating options. The schedule is less compressed, too, and there’ll be much more time for people to network.

HCB News: Can you give your prediction as to how you think radiation oncology will change over the next 10 years?
TD: I think, number one, radiation oncologists are natural conveners — bringing other medical disciplines together to work on behalf of patients. I think this is both a result of just the nature of those who enter our field as well as how we are trained. So I believe you’ll see multidisciplinary teams across the country more often being led by the radiation oncologist.

I think you’ll see growing importance of the management of patients with more advanced disease. Radiation therapy will be used in combination with immunotherapy, as one example. I don’t just mean for palliative care, but curative care.

I anticipate a growing involvement with radiation pharmaceuticals. This is just another way to deliver radiation therapy to our patients but one where we have great expertise in who to treat, given our oncologic training, as well as in the dosimetry necessary to provide efficacious and safe treatment. Genetic medicine, as I noted before, is going to be a really significant portion of our field — in the research we conduct, the education we provide and the use of it in daily management to guide us to the most optimal and precise care for our patients.

Another growth area for us is research in AI. We need to push forward in this arena to learn how and where AI can be used in our field to guide care we provide, and to do so in an ethical way and in a manner that preserves and enhances the physician-patient relationship.

Something that is very important to me is that we will push hard to create a more diverse radiation oncology workforce-one that will allow ASTRO to have all voices around the table, so that the best decisions can be made. It is also key so we look far more like the patients we see and treat every day. Ultimately, creating change that improves the lives of our patients is most important.