COMMENTARY

Virtual ASCO Levels the Playing Field for Oncologists Everywhere

Bishal Gyawali, MD, PhD

Disclosures

May 22, 2020

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I'll be honest: I don't feel as enthusiastic about the virtual version of the American Society of Clinical Oncology (ASCO) annual meeting taking place this year as I typically do for an ASCO meeting.

We are all drowning in information on the health and socioeconomic impacts of coronavirus. Yes, cancer does not wait for pandemics, and patients with cancer continue to need the best possible care. But the pandemic has affected so much of our lives—both personally and clinically—that this doesn't feel like a good time for a meeting.

The other reason I am not that interested is because the meeting is not in person. As I have talked about previously, the biggest attraction for me to the ASCO (or any other) meeting is seeing people and catching up with friends. The renewal of friendships that takes place during those five evenings in Chicago sustains me for a year. That's definitely not going to happen with a virtual meeting.

While it is true that I am not enthusiastic, I will of course be attending the virtual ASCO. I am an oncologist and I take care of patients with cancer, COVID-19 or not. As the pandemic drags on, it is obvious that we cannot wait until it passes to update ourselves on cancer research, education, and best practices. Thus, it's important that ASCO and other meetings go virtual, allowing us to stay updated on practice-changing cancer research.

Ultimately, I think this year's meeting will change all of our medical meetings in the future, perhaps for the better.

A Big Deal: Increased Global Access

The best thing about a meeting like ASCO going virtual is the increase in accessibility. For example, I had never attended an American Association for Cancer Research (AACR) meeting before because it was perceived as a meeting for basic science cancer researchers, which I am not (though this has been changing over the past couple of years as more clinical research is being presented at AACR). This year, I had the chance to attend the virtual meeting for free from the comfort of my home. I had a great experience. Now that I know what it's like, I may attend it in person next year.

The ASCO virtual meeting will also be free this year for members, which will almost certainly increase access and audience size. This is a very big deal—more than you may imagine. Let me explain.

Attending a typical ASCO meeting is astonishingly cost-prohibitive, especially for colleagues from low- and middle-income countries. Cancer care workers in these countries cannot simply afford to travel to and pay for a hotel for 5 nights in Chicago during the ASCO meeting. The hotel alone costs more than the airfare. Combined with the costs of food, meeting registration fees, local transportation, and the loss of income while away from clinical practice (never mind the additional burden of clinical task-shifting and coverage), attending ASCO creates a big hole in your pocket, especially when those pockets were relatively small to begin with.

There will always be a perceived difference between those who attended the ASCO meeting and those who did not. It's actually quite palpable in daily work conversations immediately post-ASCO: Hey, you went to ASCO; did you find anything interesting in prostate cancer? You attended that oral session on drug X, right? Quick, give me a grand rounds summarizing your key takeaways from ASCO. What was that guy's name who gave that talk at ASCO? And so on.

A virtual ASCO levels the playing field. Now everybody has the same access to the meeting. This is quite a big deal for colleagues who wouldn't have been able to attend it in person for whatever reason.

It is also an amazing opportunity for trainees. First, you can attend the meeting without having an abstract accepted and being at the mercy of your program director to support your participation. Being able to participate early in your training is in itself a huge deal. By participating virtually, you can peek into one of the biggest medical meetings in the world without being intimidated. I clearly remember the intimidation of attending the ASCO meeting for the first time—it was truly overwhelming. (In some ways, it is still overwhelming, all these years later.) If you are presenting an abstract for the first time, you can build a lot of confidence without having to face a sea of people in person. You can also ask questions of top experts, which you might not have the courage to do otherwise. Yes, you will miss out on making some friends, but for first-timers and trainees, the ups clearly outweigh the downs.

For my colleagues in the developing world, ASCO has typically been seen as a big, flashy meeting featuring mostly US-centric research without good takeaways for clinical practice in their resource-strapped home countries. Those who pay their own way often seem especially disappointed, feeling that the conference was not very high-value for their practice. Ironically, the plenary session—deemed most important of all by ASCO planners—is usually the one most avoided by colleagues from low- and middle-income countries; it's irrelevant to their local context.

That said, this year the plenary abstract on the role of local therapy in patients with metastatic breast cancer should be immediately practice-changing globally. Furthermore, because the virtual meeting is hassle free (no need to get a visa) and literally free for members, colleagues in these countries will probably find the 2020 meeting relatively high-value.

Yet, even for oncologists in high-income, first-world countries, a virtual meeting lowers barriers to access: Now everybody has the chance to attend and everybody can be updated equally.

There are upsides even for colleagues who would have otherwise attended in person. Take your pick: You can either watch whatever session you want in your pajamas on your sofa while drinking freshly made coffee; or hustle through the sprawling corridors of McCormick Place hauling a massive bag, pretending to look important (but really just be invisible among a crowd of 40,000), and then wait hours for an overpriced lunch.

A Trade-off

Like everything in oncology, ultimately it's a trade-off. Not being able to meet friends and colleagues, not being able to take in the inspirational grand atmosphere of our biggest meeting in oncology—these are significant downsides for me, especially because I have friends in many corners of the world who I'm not able to meet otherwise. I will also miss meeting colleagues and trainees in person who I've only known via social media.

I have also had the experience of giving talks virtually in recent weeks, and virtual is not the same—not even close! I miss the audience. I miss their nodding, their laughter, and the post-talk discussion. This in itself provides some value and acknowledgement for the work that we do. I put in hours to make a good slide and I have no idea how the audience received it. I deliver what I think (hope!) is a good joke within the context of the presentation and...silence! And let's be honest: Zoom happy hours aren't exactly happy; they feel more like sharing one's loneliness.

From the ASCO organizers' point of view, an in-person meeting with corporate sponsorships is much more lucrative than a free virtual meeting.

For all of these reasons, I don't think virtual meetings are going to replace in-person meetings anytime soon.

The Case for a Hybrid Approach

In the future, I think we will need both in-person and virtual meetings. When the pandemic has waned, I believe we should return with a new format for these meetings: The actual meeting happens in-person, as in previous years, but with the option for people around the world to participate live virtually at a nominal fee. There is no reason this can't happen. We should allow people to meet and network in person, as well as provide the opportunity to view important science regardless of whether one can afford to travel to Chicago.

Doing so may also have an impact on the content of the meeting. With the increasing participation of colleagues from around the world, more globally important research may take center stage, making ASCO a truly global oncology summit.

My hope is that we can meet in person for the 2021 ASCO annual meeting, not only to share our research but also to congratulate ourselves on getting through this pandemic, staying sane and safe, continuing to work for our patients, and sharing the amazing bond that keeps us all together through good and bad times. Consider this my invitation to a real happy hour in Chicago in 2021!

Bishal Gyawali, MD, PhD, has lived and worked as a physician in Nepal, Japan, the United States, and Canada. He is currently an assistant professor in the Department of Public Health Sciences, a scientist in the Division of Cancer Care and Epidemiology, and a clinical fellow in the Department of Medical Oncology at Queen's University in Kingston, Canada, and is also affiliated faculty at the Program on Regulation, Therapeutics, and Law in the Department of Medicine at Brigham and Women's Hospital in Boston. His clinical and research interests revolve around cancer policy, global oncology, evidence-based oncology, financial toxicities of cancer treatment, clinical trial methods, and supportive care.

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