Hello from the seventh annual World Conference on Interventional Oncology! We've just wrapped up our first day at WCIO, the international and multidisciplinary meeting for image-guided cancer therapies.
Perhaps not surprising given the current tenor of the health care industry, this year's meeting is highly focused on demonstrating comparative effectiveness as well as cost effectiveness of interventional oncology techniques. Given the wide range of oncologic treatment options and the growing arsenal of interventional modalities, there is keen interest in identifying comparative effectiveness research (CER) to guide treatment decision-making and define care pathways. Furthermore, as health care providers, policymakers, and industry stakeholders prepare for the implementation of national health care reform legislation calling for a greater focus on CER and evidence-based medicine, there is tangible interest in these areas highlighted in this year's WCIO presentations and clinical sessions.
CER in the interventional oncology (IO) space has a two-fold value proposition: to raise the profile of interventional treatment modalities among other medical oncology, radiation therapy and surgical treatment options--typically utilized as an adjuvant, second, or third-line therapy--and also to aid in clinicians' treatment selection among different interventional approaches. Many of the clinical abstracts presented at this year's WCIO meeting are focused on the use of interventional techniques for either therapeutic and/or palliative use, with the intent of demonstrating comparative effectiveness of these modalities. Additionally, there is also a significant focus on quality of life outcomes associated with IO techniques, such as decreased pain and extended months of life, as there is a lot of interest in palliative applications and use among salvage patient populations who may be ineligible for other treatment options.
Beyond the focus on comparative effectiveness research, multidisciplinary care is another major theme of this year's conference. Though "ownership" of interventional procedures is typically shared by interventional radiologists and surgeons, cooperation with and buy in from medical oncologists, radiation oncologists and other specialists, is critical to sustaining a robust interventional oncology program. Multidisciplinary tumor boards, which are increasing in number in line with larger trends in cancer care, can function as a critical pipeline for identifying patients who are eligible for interventional treatments and generating IO volumes. As researchers are exploring expanded applications for interventional modalities to complement medical, radiation and surgical treatments, convening a group of multidisciplinary stakeholders in tumor boards may help broaden the IO referral base by engaging a range of clinicians in the consideration of interventional treatment options. IO platform vendors are also quick to point out that interventional modalities need not necessarily displace other service lines' books of business, but that they can complement other courses of therapy.
We'll continue to live blog from the conference, so stay tuned. Tomorrow, we'll cover some of the most compelling new research in interventional oncology applications.
To continue with the previous posts following the WCIO conference, Zach Binney has weighed in below to discuss the strategies for building an effective interventional oncology (IO) program:
Building an interventional oncology program requires broad interdisciplinary cooperation
Many conversations at the conference revolved around how to best structure an interventional oncology program. Most IO procedures are shared by interventional radiologists and surgeons. In the ablation space, in particular, most open surgical procedures are handled by surgeons, while percutaneous procedures remain primarily the domain of interventional radiologists. Laparoscopic procedures may be done by either group.
Cooperation with other specialists is also critical to driving the creation and growth of an IO program. Medical oncologists coordinate the treatment of many cancer patients, and as such they -- along with surgeons -- serve as "gatekeepers" to the interventional radiologists, who report typically seeing patients only after a surgical consultation. To drive volumes, radiologists stress, both surgeons and medical oncologists must be willing to refer patients for consults with interventional radiologists.
The increasing prominence of multi-disciplinary tumor boards will likely help drive the integration necessary to strengthen IO as, potentially, a fourth leg of the chemo-surgery-radiation cancer care stool. However, this is contingent on interventional radiologists being willing to attend and actively participate in multi-disciplinary care conferences, physicians noted.
Even absent broad-based cooperative initiatives, however, programs can flourish on personal relationships. Dr. James Urbanic, a radiation oncologist at Wake Forest University Baptist Medical Center (WFUBMC), presented on how he and a radiologist colleague have collaborated on a number of cases requiring an IO and RT perspective. They regularly discuss whether RFA or radiation makes the most sense for any given patient based on the tumor's location, patient's treatment history, and other factors. They have even split patients in the past: one female patient with two lung tumors received SBRT for one and had the other ablated.
Dr. Urbanic described ideas for several clinical trials with his colleague and other physicians across WFUBMC, which he hopes will be vehicles for further collaboration.
For the third post of the series following the World Conference on Interventional Oncology, my colleague Zach Binney has provided a synopsis of the discussions and debates surrounding the relative roles of the wide array of interventional oncology (IO) therapies:
Physician preference likely to dominate modality choice for foreseeable future
One of the dominant themes of the conference was how to sort out for which patients each modality in the increasingly-crowded interventional oncology landscape is appropriate. Under the specter of healthcare reform and a broad comparative effectiveness research (CER) push, several presenters mused about the possibility of randomized controlled trials (RCTs) to help sort out the roles of individual therapies.
However, the consensus appeared to be that while in an ideal world each modality would be subjected to a rigorous series of RCTs, in reality this is not likely to happen due to a combination of factors. One is the relatively low incidence of liver cancer -- a primary site for many of these therapies -- in relation to the number of modalities that need to be tested. Combined with a general unwillingness on the part of these patients and their physicians -- the vast majority are under the auspices of medical oncologists and surgeons, not interventional radiologists -- to participate in such trials, the prospect of large-scale RCTs to sort out the issue remains weak.
Realistically, administrators should expect interventional oncology to continue to be driven by individual physician preferences for specific treatment modalities.
Many physicians at the conference expressed a strong degree of comfort with more clinically tenured modalities, such as RFA and cryoablation. In the ablation space, clinicians generally indicated an interest in continuing to use RFA for cases where it is known to be highly effective, particularly liver and lung lesions < 3 cm in diameter. Microwave ablation and other emerging modalities, meanwhile, may have a larger role to play in areas where RFA or other incumbent modalities fall short, such as larger tumors and those near blood vessels that siphon heat away before tumor cells can be killed.