How Oncologists Stay Current in Today's Medical Landscape

Clifford A. Hudis, MD, FACP

Just a few years ago, Clifford A. Hudis, MD, FACP, chief of the breast cancer medicine service at Memorial Sloan Kettering Cancer Center and a professor of medicine at Weill Cornell Medical College, both in New York City, gave a presentation at the 2009 American Society of Clinical Oncology (ASCO) meeting about how oncologists could stay up to date on the explosion of medical information and knowledge available. At the time, Hudis was a member of ASCO’s board of directors; he subsequently became ASCO president in 2013-14. In the webinar, he advocated establishing RSS feeds so that users could receive stories, abstracts, and research directly to one’s email inbox, and he urged attendees to “figure out an efficient way to get what you want. It’s easy to set up in a world where we are inundated with information.”

In 2014, the amount of medical and other information has only increased, and mobile devices such as smartphones and tablets make it even easier to access that data. “Today is not any different than before, but there are more channels of information, more sources,” said Hudis, now immediate past president of ASCO, in a recent phone interview. “Because of electronic publication, the medical information comes at us faster. The doctor has to be even more skilled to determine what is important and what is important in the context of clinical care.”

Understanding that context is crucial for helping cancer patients receive the best medical care available, while following what have become standards of that cancer care. Staying current involves paying attention to evolving guidelines, written using transparent rules, and knowing what the erudite cancer organizations are saying, said Hudis. Such standards “allow for an informed starting point. They are treatment guidelines but allow doctors to use their skills to know where to deviate” from the standards when necessary.

Mobile Devices Emerge

Everyone has the same 24 hours in a day to get things done. Once the day has been portioned off into time for sleep, personal care, family time and work, which can include patient care, administrative tasks, research, and more, how does staying current fit into the mix?

Digital mobility makes it easier.

“We do not just rely on our desktop computers anymore,” said Rogerio Lilenbaum, the chief medical officer for Smilow Cancer Hospital at Yale New Haven and a practicing thoracic oncologist. “It’s incredibly easy to access this information from anywhere on a mobile. It’s more—I don’t want to say it’s passive, because it does take active management to filter what is important to you. But it’s not how it used to be. When was the last time a physician walked into a library, for God’s sake? It just doesn’t happen anymore.”

Historically, physicians depended on textbooks and journal articles to learn about emerging data, and attended annual meetings from ASCO, and other professional associations such as the American Society of Hematology and the American Society for Radiation Oncology, said Lilenbaum, who has been practicing medicine for about two decades. Continuing medical education courses and other events helped disseminate new information about the field. But since around 1998 or 2000, Lilenbaum said, the Internet has transformed everything. “People still care about journal articles, but access them online instead of in print,” he said. “People still go to ASCO, but the meetings have a different value. They’re more about networking and getting to know other people and institutions, rather than about obtaining information. And textbooks, I think, have lost a lot of their applicability except as a source for a subject review.”

Instead, Lilenbaum and others rely on daily email roundups from organizations like ASCO, journal abstracts sent electronically, and access other updates from online resources such as Medscape. Searching PubMed, a database of more than 24 million biomedical citations from medical journals, books, and other resources, for clinical updates on specialized topics is another way to stay informed, said Amer Zeidan, MBBS, MHS, an assistant professor of medicine in the section of hematology in the department of internal medicine at Yale University in New Haven, Connecticut, who specializes in myelodysplastic syndromes. “I go to PubMed regularly and look up any recent papers in my area to make sure I stay updated,” he said. “Trying to keep up with recent review articles is a wonderful way to summarize the new knowledge in the last couple of years.”

Zeidan says he multitasks by reading his mobile phone or from print medical journals or printouts while exercising on an elliptical machine. “If I have some free time, instead of sitting at home, I try to do that at the gym, and this way, I kill two birds with one stone, as they say.” Last year, he wrote an article for OncLive.com (Oncology Business Management’s host website) about “How Do I Keep Up With the Literature?” while he was an oncology fellow at Johns Hopkins University. Since that piece published in January, 2013, he says he relies much more on his phone to read, particularly while traveling, than he did while on a laptop as a fellow.

Both Zeidan and Lilenbaum advocate blocking out a specific time each day or week to catch up on reading, perhaps 30-60 minutes a day or one to two hours each week. “Close the door, and go through journals and abstract information that is important to your clinical practice,” said Lilenbaum. “It may be different for people in training, who need to devote more time to acquiring clinical information, or for those in practice for a long time. I think it’s good for absorbing information,” he said. For general oncologists, rather than specialists, Zeidan suggested reading about different topics each day, such as spending one day on breast cancer, one day on lung cancer, and so on. “This way, they can get up to date” on a variety of cancer topics necessary for a general oncologist to know.

What’s Next?

Expected to update in 2015 after launching as a prototype in 2013, ASCO’s CancerLinQ will be what Hudis believes will be “the way doctors will keep up in the future.” Built as a database of how millions of cancer patients have been treated in the past, CancerLinQ is an electronic system that will allow oncologists to see the collective information of how other cancer patients have been treated, and how that knowledge can be applied to a physician’s current mix of patients, using what ASCO describes as “real-time quality feedback to providers, personalized insights, and uncovering patterns that that can improve care.”

“CancerLinQ will aggregate care and decisions and outcomes for those patients getting care,” said Hudis. “It seems like a foreign concept, but it will be a lot like the rest of our lives. When you type into a Google search box, you don’t even type in the search term—Google already knows what you are searching for and populates the search terms, because Google learned the likely search terms that people are searching for. Why isn’t medicine doing the same kind of thing? I think this application will help doctors keep up and will help them understand and provide us with a more nuanced way of practicing medicine.”

Such data won’t provide all answers right away, but it will be a start, providing alerts for potential drug interactions for example. Hudis believes that after using such a system, physicians will say, “I can’t believe we didn’t already do this.”

Medical professionals, as a whole, have other areas of intense focus, and haven’t been on the cutting edge of technology, said Hudis. “Doctors have been relatively closed about new technology, and while I love this stuff, we were often dragging doctors along into the modern era. Earlier ASCO sessions would help people get on to WiFi, or how to use their personal digital assistants, like Palm Pilots. Technology is expensive, time-consuming, there were always accuracy and legal issues. For good reason, medicine has been relatively slow to the tech world.”

But consider the alternative, he said. “If you are a patient today, if you have open heart surgery at one New York City institution, and you cross the street to get cancer care at another New York City institution, how do you transfer the information? Right now, the electronic health records systems don’t talk to each other, so you have to copy the information and walk it across the street. People are worried about security, but how secure is the binder of paper crossing the street?”

With technological advances, such data are simply packaged differently, and in many cases, the basics of medicine and patient care remain the same: “Physicians need to read, and need to be critical thinkers,” said Hudis. “The fundamentals will never change. An abstract on a smart phone is the same as an abstract in a print issue of a 1987 New England Journal of Medicine. The tools we have now can be used to make all of us more efficient and help us be smarter, which helps us give better care to our patients."