publication date: Jun. 5, 2020

Conversation with The Cancer Letter

Clifford Hudis: What a virtual meeting can accomplish—and what a virtual meeting cannot accomplish

Clifford A. Hudis, MD Chief, Breast Cancer Medicine Service

Clifford A. Hudis, MD, FACP, FASCO

Chief executive officer,

American Society of Clinical Oncology

 

This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. A full list of our coverage, as well as the latest meeting cancellations, is available here.

If you look at attendance, COVID-19 didn’t derail ASCO20.

Registrations at the virtual annual meeting of the American Society of Clinical Oncology were a bit above the usual:

Total attendees—42,700; professional attendees—40,000.

“The final numbers are coming in, but it looks like we will end up with registered attendance that exceeds our typical attendance for the face-to-face meeting,” Clifford Hudis, chief executive officer of the American Society of Clinical Oncology, said to The Cancer Letter.

Even more importantly, the makeup of that attendees appears to have shifted in ways that are consistent with our mission,” Hudis said. “For example, the number of professional attendees, as a proportion and raw number, went up. The number of international attendees went up. And even beyond that, the number of non-member attendees—all those three categories went up.”

If you look at the academic medical record years from now, you will not find any appreciable difference between this ASCO and all the other ASCOs.

“The scientific program that you saw over the weekend contained 100% of the normal expected scientific program of any annual meeting. We did not drop any sessions. We recorded everything and put it all up,” Hudis said. “Our goal, when we went into this, was that in the future when somebody looks back at ASCO20, they should not be able to tell that it was a different year from any other in terms of the science. There should not need to be any asterisk on the citations or discussions of it.”

If you look at receipts, well, they aren’t all in. There is still an educational meeting coming in August.

“Economically, we’re not yet ready to talk about. It’s no secret, of course, that like for many professional societies, along with publishing and membership dues, an annual meeting is an important source of revenue—and ours was profoundly compromised this year,” Hudis said.

“Going virtual, compared to in-person, represented a huge financial hit. We have insurance, for the loss, but the size of our claim will have to be determined by how big a loss we end up with. So, to answer your question, in isolation, the meeting may be able to break even, or even better this year. But it will not offer the positive margin that a traditional meeting would have offered, at least not this year.”

And then there is another flavor of loss—an intangible loss.

“If we were robots, and our job was to vacuum up all of the information in the most efficient way possible, the virtual meeting gets us in that direction pretty successfully. But that is not, really, what makes the ASCO meeting useful to the world,” Hudis said. “What makes it useful to the world is you bump into people, you sit down, and over a cup of coffee, you talk about some ideas you have. Out of those happenstance and planned meetings, new collaborations are born.

“They lead to grants and research projects, and, ultimately, they lead to the generation of the very content that brings somebody to ASCO anyway. Most importantly, they lead to breakthroughs for patients of ASCO. How do you recapture all of that in a virtual format?

“We even offered online networking, but sometimes it helps to just bump into somebody that you just hadn’t thought about for two years,and have a discussion.

“Maybe this is ultimately why, like in the prior pandemics that have racked the world over the eons, humans still come back to the same behaviors they enjoy. And this is why I would expect that we will get back to face-to-face meetings when it is safe.”

 

Hudis spoke with Alexandria Carolan, a reporter at The Cancer Letter, and Paul Goldberg, editor and publisher of The Cancer Letter.

 

Paul Goldberg:

How did it go? The first virtual ASCO…

Clifford Hudis:

It was our first virtual ASCO meeting, but we had to plan it just as we were converting ASCO to remote working. Both of these efforts were eased because of our foundation of a results-oriented work environment. But regardless, converting the meeting to virtual represented lots of strain and stress—so we can talk about that.

On the other hand, we started with a very good foundation on which we could build the virtual format. We’ve had the Meeting Library for years. We’ve been recording all of our lectures for years. This is a good bit of the infrastructure that you would need to put on a virtual meeting. Said more simply, we weren’t starting from scratch, but we were for sure changing the way we prepared.

 

PG:

That must have been extraordinarily difficult.

CH:

We had six weeks, when you really think about it. It was tight.

 

Alex Carolan:

How did attendance compare with your expectations for what usually happens at the annual meeting?

CH:

First of all, I had no idea what to expect for a variety of reasons. But when we talk about numbers, it’s important for me to point out that, of course, the reason we have the annual meeting is to make a difference in the lives of patients with cancer.

We do that by disseminating knowledge and information, and that dissemination means reaching as many of the right audience members as we can.

The final numbers are coming in, but it looks like we will end up with registered attendance that exceeds our typical attendance for the face-to-face meeting.

Even more importantly, the makeup of that attendees appears to have shifted in ways that are consistent with our mission. For example, the number of professional attendees, as a proportion and raw number, went up. The number of international attendees went up. And even beyond that, the number of non-member attendees—all those three categories went up.

So, while the total number of attendees was similar to what we would expect face-to-face, we reached, in a sense, deeper into our core and high-impact audience—the professional cancer care providers and researchers.

 

PG:

Attendance is usually about 40,000, if I’m correct.

CH:

It’s been around for 42,000. I’m only being careful about the numbers, because they’re still counting. But I believe that our final tally will show that we actually registered more people for this meeting than for any in our history. Total attendees—42,700; professional attendees—40,000.

 

PG:

There’s a kind of a culture around an ASCO meeting, because it has its own personality. Can you capture and create that virtually? How does that culture split differently between the scientific and education programs?

CH:

There are a couple of things to try to expand on. And I don’t want to skip answering the question, but forgive me if I lose my way.

If we start with the scientific content and we, of course, solicit those abstracts—they come in during the wintertime. They are viewed by the scientific program committee in the springtime. They are assembled into the program by peer review, and then they’re presented to the world, on this weekend every year. We felt that there was no real choice: the scientific content had to be shared on our usual schedule.

Most importantly, we have a moral and ethical responsibility to our patients to share this data on time, as promised. If the data and the results we’ve collected are truly important to the world, then, of course, we shouldn’t sit on them. We need to get them out, again, when they’re expected and in a timely, responsible manner.

In practical terms, this meant that you saw the abstracts posted on about the same day they would have been any other year. You saw the press program unfold the way it would have any other year. And you saw the availability of the abstracts in total, with the posters and the oral sessions, and all of that, pretty much right on schedule.

If anything, you got them a day or two earlier, because we released all of that on Friday morning, as opposed to releasing it Friday, Saturday, Sunday, Monday, Tuesday, as the speakers got up to speak.

In order to make sure we could do that in a way that would be technically feasible, that wouldn’t overstrain our resources, we made the decision to separate the science program and the education program. In fact, the education program is a separate committee from the scientific program.

The education committee meets earlier in the year, in the fall. They select the speakers and build the program, and so forth. During the annual meeting, we then present the education tracks and the scientific tracks over one long weekend.

But this year, we chose to separate them so that we could limit the technical burden of putting this all on at once. The education meeting is the weekend of Aug. 8, whereas all of the science program was presented this weekend.

In that regard, I hasten to add that the scientific program that you saw over the weekend contained 100% of the normal expected scientific program of any annual meeting. We did not drop any sessions. We recorded everything and put it all up.

Our goal, when we went into this, was that in the future when somebody looks back at ASCO20, they should not be able to tell that it was a different year from any other in terms of the science. There should not need to be any asterisk on the citations or discussions of it.

So, 100% of the science was put out just the way it should have been. While we bundled it into the usual oral sessions, clinical science symposia and posted discussions and posters, the only difference is that we made it all available Friday morning all at once.

Now, on the education side, we couldn’t aim for a hundred percent fidelity to the in-person program, because there are some educational sessions that are very high-touch, very hands-on and require a lot of engagement, that we’re not able yet to duplicate online.

The education meeting will contain about 75% of what would have been in the in-person meeting. And the approach we’ve taken looks high-tech, but if you think about it, it actually was a low-tech approach.

We decided that we really couldn’t count on successfully managing live presentations and transitions, both from live to tape or live-to-live. All of that required production capacity that would be extensive and risky under any circumstance. So, everything was pre-recorded.

In addition, we created a shared viewing experience with the opening ceremony on Saturday morning, and then the plenary session on Sunday afternoon.

 

PG:

The saddest part was not being able to just wander around McCormick Center.

CH:

You asked about the culture, and I’m looking at what people are saying on social media, and I’m thinking about it myself.

If we were robots, and our job was to vacuum up all of the information in the most efficient way possible, the virtual meeting gets us in that direction pretty successfully. But that is not, really, what makes the ASCO meeting useful to the world.

What makes it useful to the world is you bump into people, you sit down, and over a cup of coffee, you talk about some ideas you have. Out of those happenstance and planned meetings, new collaborations are born.

They lead to grants and research projects, and, ultimately, they lead to the generation of the very content that brings somebody to ASCO anyway. Most importantly, they lead to breakthroughs for patients of ASCO. How do you recapture all of that in a virtual format?

We even offered online networking, but sometimes it helps to just bump into somebody that you just hadn’t thought about for two years, and have a discussion.

Maybe this is ultimately why, like in the prior pandemics that have racked the world over the eons, humans still come back to the same behaviors they enjoy. And this is why I would expect that we will get back to face-to-face meetings when it is safe.

 

AC:

Definitely. Can we talk about the economics of the meeting for a minute? Does ASCO make more money throughout all of this, or less money? What happens to the exhibit hall, for instance?

CH:

The exhibit hall was duplicated to a degree online—you could click on the exhibit hall, go into it, and wander in and out of booths.

The exhibitors varied in technical sophistication, including some with a virtual 3D experience, and many offered the opportunity to make appointments and talk one to one. We know that they got a good bit of use, plus they’re going to stay up for several months now.

I think that the ultimate impact and success of it is still to be determined, but it certainly got used, and it did help.

Economically, we’re not yet ready to talk about. It’s no secret, of course, that like for many professional societies, along with publishing and membership dues, an annual meeting is an important source of revenue—and ours was profoundly compromised this year.

Going virtual, compared to in-person, represented a huge financial hit. We have insurance, for the loss, but the size of our claim will have to be determined by how big a loss we end up with.

So, to answer your question, in isolation, the meeting may be able to break even, or even better this year. But it will not offer the positive margin that a traditional meeting would have offered, at least not this year.

 

PG:

Even with insurance potential?

CH:

Well, the insurance can’t turn us to the profitable side; right?

It’ll mitigate the loss. And we have to, for lots of reasons, take every step we can to mitigate the loss, because our responsibility in this context is to minimize the financial damage in every way we can. So, how big an insurance claim we might end up with will, in part, depend upon what our ultimate losses are, and what steps we took to make sure that we minimize those losses.

The other point is that the meeting isn’t done until August, because we have to still do the education part of it.

 

AC:

ASCO has done quite a bit with COVID, obviously. Could you summarize this for us?

CH:

Well, actually I think you’ve covered a bit of it as well. For COVID-19, there really are several threads to the ASCO response.

In the face of the emerging pandemic and crisis in March, our members turned to us for support. What do we do about this disease, medically and scientifically, as well as practically? What do we do about our practices, and how do we stay viable?

And, of course, patients turn to us, a need we try to meet through Cancer.Net.They ask, what does this mean for me and my care, and so forth? And then, ASCO asks what can we learn from this, and how do we get ourselves organized to do that?

So, to go back through all this, we immediately started to get questions from our members, which we assembled into 30 to 40 pages of FAQs that we posted online. We sourced the highest quality answers we could find.

In many cases, there were no answers. But at least knowing that they weren’t missing anything can be reassurance to clinicians that they are not missing something. We posted all that and updated it regularly. More recently we then upgraded that content and released it as a guide for practices now managing during the pandemic itself.

We also put on webinars with up to a thousand participants, in collaboration with the Oncology Nursing Society. It is important to note that and with support from the Infectious Disease Society of America helped us tremendously with the resources for all of this.

We put on these webinars to learn what front line docs were using as solutions and to share resources we had assembled. They are archived, so people can go back and view them now. We hadparticipants globally and speakers from the front lines in Milan and elsewhere.

For patients, with the National Coalition for Cancer Survivorship, we created online resources at Cancer.Net. And we had a version of our Q&A for them and an ongoing updated blog from Merry-Jennifer Markham.

And then, we took a breath and asked what can we do to actually learn from this and help the community be prepared for whatever comes next? The result was the ASCO registry, that you have covered already with Rich Schilsky (The Cancer Letter, April 17, 2020)

Through this, we’re going to try to learn not just what happens individually to patients who have COVID-19 and cancer, but we also want to document, quantify the impact on practices as a whole. That registry is now open and running, and there are practices submitting data right now.

Finally, we stood up two task forces. They just are starting work right now.

We announced this at a press conference in April—they’re operating under the perhaps uncreative name Road to Recovery, which everybody’s using, but the truth is, they’re not about a road to recovery—they’re about a road to a better new normal.

And what I mean by that is in the research domain and in the clinical care domain, there are all manners of rapidly implemented compromises, changes, upgrades made in order to make it safer and easier for patients to get care and to participate in research as COVID-19 emerged. A simple example would be allowing a laboratory to do a blood test on a study patient, even though the lab wasn’t a previously certified one, things like that.

So, the question I think we have to ask ourselves is how many of those urgent compromises are better for patients all the time, and should be maintained?

I’m asking, not how do we turn back the clock to where we were, but, in fact—how do we not turn back the clock to the burdensome and unproductive things we did before? How do we preserve the upgrades? Telemedicine is another great example. If it was good enough in March and April, why isn’t it good enough forever?

These two task forces will generate two reports to the ASCO Board. And they’re going to do it on a short timeline—we’re talking weeks to months now.

Our goal is to provoke, a little bit, introspection and make sure that we don’t allow some of our inefficiencies that are not patient friendly and patient-centric to creep back into our work. There are economic implications of all this, but that just means we have to rethink some of our models—what we pay for and so forth.

 

PG:

What do you think needs to happen on the economic side?

CH:

I’ll pick some simple examples. It’s obvious that a telemedicine visit for 20 minutes should be reimbursed at the same level as any other 20-minute time block that a doc spends.

 

PG:

Oh, that is an easy one.

CH:

But it’s an example, there are a many others.

I’ll give you another simple one: If in the end, you could suspend enforcement of some of the HIPAA rules to allow people to use FaceTime or other audio, visual communication tools—why isn’t that good enough forever? Why only in the midst of a pandemic?

 

PG:

Can you project the impact of COVID on the practice of cancer medicine? Who’s hit hardest? Is it geographic, is it by type of healthcare delivery? How does it work?

CH:

I think it’s the same story we hear all the time, which is that the part of practice that’s under the most constant pressure, historically, over the past years, is probably the group that’s going to have the greatest change from this as well.

So, the small rural practices and the under-resourced urban practices, for example. Ultimately, the consolidation trends that we’ve been seeing will only be accelerated by this. And that has a lot of implications obviously.

We are getting some data, and I think we’ve shared this with you. If not, I think Rich (Dr. Schilsky) will in a week or so. But both from our PracticeNET resources and from CancerLinQ, we are generating and sharing observations about trends in the care delivery that I think are noteworthy.

 

PG:

Wouldn’t the science of COVID-19 be applicable to cancer? It feels like it would be.

CH:

It’s so great that you asked that, because one of the things that I could never have predicted, was that the overlap would be seen in Dr. David Fajgenbaum’s talk as he gave our opening speech. Did you watch his talk or have you read his book Chasing My Cure? When you get a chance, you should watch the opening ceremony. You can also listen to his interview on NPR Fresh Air from about two weeks ago.

Here’s the issue: He describes his personal quest to understand and impact Castleman disease, which is what he had as a young physician. He describes the cytokine storm that can be part of a Castleman Disease crisis, is similar to that seen with COVID-19.

Then, in recent weeks, he converted part of his lab efforts to address this part of COVID-19 and has published already on that.

So, it’s a remarkable question you ask, because it turns out that our opening ceremony speaker used his own disease and his own scientific quest in exactly that way. He pivoted from his disease to COVID-19, because of the commonalities they shared.

 

AC:

You mentioned this briefly earlier, but where do you think these meetings are headed in the future? Do you think it’ll be more of a blend between virtual and in person?

CH:

It’s interesting. I think quietly we’ve already had that plan, and I alluded to this when we first started to speak.

We were able to launch our virtual meeting, in part, because so much of the technology infrastructure was already there. In the past, we hold the meeting and then we would make the resources from the meeting available on the back end. And you could go back and watch the lecture with slides and so forth.

When you think about it, the virtual meeting just changes the order of all that. There are a few other small changes, like having everybody record at home in advance, but the concept isn’t that different from a technology perspective.

When I look at what we saw and are still seeing on social media—the fact that people really, I think, appreciate the opportunity to start and then stop, and to take notes and think, to sit at home in their pajamas and watch—getting the content out virtually clearly is useful and increases its reach and impact as well as even the engagement.

But what everybody else also laments is the loss of the serendipity, the happenstance of the meetings that take place at ASCO—and, also the planned meetings, with the opportunity to go to arranged events and brainstorm or participate in collaborative discussions and so forth.

Your question really hinges on how we upgrade what we’ve done in the past to maintain the great strength of the virtual meeting, and also  how we facilitate the great strengths of the in-person meeting.

I know that is where the ASCO staff will be focusing in the weeks ahead. I think we’re going to need a system that is flexible for the next couple of years while we get through the pandemic. And we are really dependent on either herd immunity, which seems to be far off, or an effective broadly distributed vaccine, which is also somewhat far off at the moment, before we could really count on a big in-person meeting, without risk, I think.

Our vision is that we will for sure end up with a more flexible approach to meetings that allows us to fine-tune them, depending on conditions. I think people want to get together, but I don’t think we’re going to give up some of the clear benefits of the virtual format either.

 

PG:

You also conduct a whole lot of meetings. Are they also going virtual now?

CH:

The way we’re approaching the general question of business travel, headquarters, operations, and meetings altogether is on a quarter-by-quarter basis right now.

At the moment, we’ve already announced that we’re remaining on in our current remote working mode with no business travel and no face-to-face meetings through September 30th—so through the second and third quarters. We will make a decision on the fourth quarter in the coming weeks, the summer. And then after that, we have to decide on the first quarter of 2021.

There are a lot of variables that go into these decisions, but the number one thing first and foremost is the safety of our membership and the attendees and the patients, they go on to care for, and our staff. And as long as that’s in jeopardy, we’re going to be choosing this conservative course, I think.

 

PG:

You couldn’t possibly predict whether there will be an ASCO annual meeting in Chicago next year.

CH:

There will be an annual meeting next year. In order to answer that question specifically—virtual or in-person—I would have to be making a bet on vaccination, public health and public policy.

For example, if you go back to March, when we made the decision to cancel the meeting, it turned out that just a week later, the Army Corps of Engineers took over McCormick Place. They were going to put a field hospital in there, and they did. I submit to you humbly that we are downstream of those big variables and forces, and what we need is to have an organization and approach that’s flexible enough to cope.

When you ask—are we going to have a face-to-face meeting in Chicago in a very concrete way—I hear the question as, will the vaccine be available at the CVS on your corner?

 

AC:

Is there anything else we forgot to mention?

CH:

I don’t think so. The one thing I would say about all this for us is that all of this underscores the urgency of our ongoing digital transformation. This is where a tremendous amount of ASCO operational attention is focused now.

We’ve got to serve our members where they are. And that requires us to go, even more rapidly, deeper into the digital transformation already underway at ASCO.

 

PG:

Thank you very much.

AC:

Thank you.

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