New ASTRO President Calls Attention to In-Person Meetings, Remaining Challenges, and Ongoing Research in Radiation Oncology

Jeff M. Michalski, MD, MBA, FASTRO

Following the period of virtual medical meetings due to the COVID-19 pandemic, the field of radiation oncology is navigating the world of hybrid conferences to continue pushing the paradigm forward, said Jeff M. Michalski, MD, MBA, FASTRO, who added that in-person interactions allow for conversations regarding diagnostics, emerging therapies, treatment accessibility, and multidisciplinary care to occur organically.

“Radiation oncologists are uniquely positioned to make decisions about how patients should be treated, evaluated, and managed long-term,” said Michalski, who was voted president-elect of the American Society for Radiation Oncology (ASTRO) in July 2021. Michalski began his term in October 2021 during the 2021 ASTRO Annual Meeting, which was a hybrid conference.

“Over next few years, we will certainly face some challenges. I hope to impact and influence policy and research, as well as the education and training of radiation colleagues,” Michalski added.

In an interview with OncLive^®, Michalski, the Carlos A. Perez Distinguished Professor, vice chair and director of clinical programs, and chief of Genitourinary Service in the Department of Radiation Oncology at Washington University School of Medicine in St. Louis, discussed his presidential goals for ASTRO, the success of the hybrid 2021 ASTRO Annual Meeting, and remaining questions in radiation oncology that research efforts are poised to address.

OncLive^®: What was your first thought when you were notified that you were voted president-elect for ASTRO?

Michalski:I was excited to get the news. I’ve been involved in ASTRO the entirety of my career. One of my early mentors, James D. Cox, MD, FASTRO, was the president of ASTRO. He was the one who introduced me to radiation oncology. Then, when I came to do my training at Washington University in St. Louis, Carlos A. Pérez, MD, [of Siteman Cancer Center] was also one of my early leaders in the society.

For me to be at the level they were recognized for was an exciting opportunity for me and a real endorsement of my colleagues for my leadership. Over the next 4 years, I’m looking forward to making an impact and doing some good things for radiation oncology.

What are some of your short- and long-term goals for ASTRO?

Internationally, ASTRO has been the lead organization for radiation oncologists for several decades and certainly through my specialty. Maintaining that leadership role in cancer care, research, and education is going to be very important.

The ASTRO Annual Meeting is highly anticipated every year, and this year the meeting returned to an in-person format. Do you have any expectations for the 2022 meeting in San Antonio?

As we all know, COVID-19 has challenged in-person meetings. Last year, the ASTRO meeting had to be entirely virtual, which was successful from scientific and educational perspectives. However, many of the personal interactions that we rely upon—some of those hallway conversations where things get proposed—just didn’t happen. This year, quite surprisingly, we had an in-person meeting. It was remarkably successful. Although [attendance] was not where we had hoped it would be, it was certainly better than last year when we had no in-person attendees. In 2019, we had 11,000 attendees at the annual meeting compared with 5500 attendees this year at the in-person meeting at McCormick Place in Chicago, Illinois. That beat our expectations. We expected 40% to 45% [of the 2019 attendance], so to see 50% to 55% was great. There was also an online presence, which turned out nicely.

At the educational and scientific sessions, we seamlessly changed between in-person and virtual presenters. Questions and answers came from the audience in-person and online. Therefore, it worked. I was nervous, but it was great to see.

Next year’s meeting will be 100% in person. This year, some countries couldn’t send representatives to the United States to attend the meeting. Even within the United States, some institutions had restricted travel for business purposes. I’m hoping that there will be a strong in-person presence during the 2022 meeting in San Antonio.

For those who did attend in person, it was quite a relief. People loved to see one another. Of course, social distancing was practiced, everyone had to have been vaccinated, and wearing masks [was required] within the meeting venue. Despite those restrictions, the human interaction was alive, and people enjoyed see their colleagues that they missed last year.

On the exhibit hall, the interactions with the vendors were very positive. People were there for a purpose. The quality of the conversations, both in the exhibit hall and in the hallway, as I mentioned earlier, was positive and strong. In 2022, if we carry that emotion for seeking interpersonal interactions and the fondness of being at meetings in person, it will be a very good event for us.

An over 5000 in-person attendance is impressive after the long period of virtual meetings.

It was remarkable. I heard people say that they felt safer at the meeting than they did in most places they traveled. Obviously, people had to get there by trains and air travel, and many went to restaurants, but the meeting venue itself was very safe.

What are some misconceptions about radiation oncology that you would like to dispel?

Radiation oncology is often perceived as a technical and capital-intensive specialty. The treatments we give often require significant physical space and treatment courses are often delivered daily over a period of weeks or months. When people think about radiation oncology, they often think about the technical aspects of care.

However, what is most important [to underscore] is that radiation oncologists spend a lot of interpersonal time with their patients. The initial consultation can sometimes stretch more than an hour. Once the plan of treatment is decided upon, the physician and patient interact every week, sometimes multiple times during the week of treatment to review the treatment goals and toxicities of therapy. We get to know our patients very well. That is something that is misunderstood about radiation oncology. We spend a lot of time one-on-one with our patients and develop close relationships with them.

Likewise, we are often working in a multidisciplinary environment with medical oncologists, surgeons, diagnostic radiologists, and pathologists. We have very strong rapports and relationships with those members of our cancer care team.

What is one thing that most people don’t know about you, but should?

I have spent my career as a clinical trialist and have led various types of clinical studies from phase 1 and 2 trials all the way through to randomized studies. I’ve had experiences in adult oncology and run large clinical trials in prostate cancer that have contributed important results to how we manage those patients.

However, I also ran a large clinical study in patients with medulloblastoma, a malignancy of childhood [cancer]. I’ve had dual career interests in pediatric and genitourinary oncology.

It’s been a challenge to balance those [trials], particularly as the trials came to maturity. People are sometimes surprised when I talk about this rare brain tumor, and likewise, another audience would be surprised to hear me talk about prostate cancer. It’s been an interesting and fun time for me to get to know a diverse group of physicians and investigators.

What research has the potential to significantly affect the field of radiation oncology?

ASTRO and radiation oncologists should be excited about the burgeoning field of theranostics, which combines diagnostic imaging with therapeutic systemic radiation therapy. Recent studies [of theranostics] have shown positive outcomes in metastatic cancers of neuroendocrine origin and, most recently, in metastatic prostate cancer. That is going to be an exciting area of our specialty. Until now, it’s been an area that has been underrepresented among our specialty.

We will need to train more radiation oncologists on how to administer these radioactive drugs. [Theranostics] should also be perceived as a partnership with the 2 disciplines of nuclear medicine and radiation oncology. Nuclear medicine positions are vital to the Theranostics approach, in terms of interpretation of imaging, patient selection, and treatment delivery. Radiation oncologists are equally important in the evaluation, decision making, treatment delivery, and follow-up of those patients.

This represents a big opportunity for radiation oncologists and nuclear medicinists to work with medical oncologists who may see these patients with metastatic disease. [Together] they can offer a powerful treatment that appears to improve patient outcome and survival. That’s an exciting area and a lot of new theranostic products are likely to come to the market very soon.

With the therapeutic success observed in radiation oncology, what questions still need to be addressed regarding treatment accessibility in this field?

Radiation oncology will be facing several challenges in the years to come. One of them is advocating for patient access to our life-saving treatments. We are finding that our specialty is undergoing a revamp of how [patients] might be reimbursed. There is something called the Radiation Oncology Alternative Payment Model that is being tested throughout the United States. I fear that it might limit patient access to important therapies we provide as radiation oncologists. That’s going to be something we have to focus on.

Another thing is that many of our practices have become burdened with trying to get their treatments and diagnostic tests approved by insurance companies. We are seeing an increased number of denials and requirements for preauthorization for different diagnostic tests and treatments. I want to make sure that we can more seamlessly provide care to the patients who need it without interference or interruption by those who are expected to pay for it.

Finally, like many medical specialties, radiation oncology suffers from a lack of diversity in its workforce. We need to work hard to make sure medical students and residents in our specialty are representative of the communities we serve. That’s an important priority for myself, my medical school, my specialty, and certainly, for ASTRO.