When the American Society of Clinical Oncology inaugurates its 2011-2012 President during the Annual Meeting, Michael P. Link, MD, will become the first pediatric oncologist to assume ASCO's top leadership post.
Although other pediatric oncologists have unsuccessfully sought the ASCO presidency in the past, this year was a shoo-in for a member of what ASCO refers to as a "minority" cancer specialty, since Dr. Link's "opponent" in the race, Gregory H. Reaman, MD, is also a pediatric oncologist.
Dr. Link is the Lydia J. Lee Professor of Pediatric Hematology/Oncology at Stanford University School of Medicine. His research interests include the biology and management of non-Hodgkin's lymphoma and Hodgkin's disease in children, and the treatment of sarcomas of bone and soft tissue.
He recently stepped down as chief of the division and director of the Bass Center for Cancer and Blood Diseases at the Lucille Salter Packer Children's Hospital at Stanford, in part to fulfill his upcoming ASCO responsibilities.
OT spoke with Dr. Link in March shortly after he had resigned after 10 years as an associate editor with the Journal of Clinical Oncology, a position that he said was very important to him, but which he could not continue in, since to avoid potential conflicts regarding oversight, ASCO has a new policy that prohibits members of the Board of Directors from serving as journal editors.
"The ASCO presidency is a fairly big job with a lot going on. Perhaps there was a time in the past when it was more ceremonial, but the job has evolved, and one has to devote full attention to it," he said, adding that he still intends to spend some time in the clinic because he considers it important to continue practicing and seeing patients while serving his term.
Dr. Link joined ASCO in 1982, three years after joining the faculty at Stanford, and had been involved in numerous ASCO leadership positions over the years, including as a member of the Board of Directors and its Executive Committee; chair of the Membership Committee; chair of the Cancer Research Committee; and as a member of the Cancer.Net Advisory Board, the Public Issues Committee, and the Strategic Planning Committee.
He first served on the Board from 1999 to 2002, when the society was developing its strategic plans for the future, a perspective he said is invaluable now, especially after seeing so many societal aspirations he had remembered being discussed coming to fruition.
'The Voice of[horizontal ellipsis]'
"It's almost de rigueur to have been on the Board [before becoming president], and I served at two time points. It was wonderful to have been part of initiating the transformation. We worked out a mission statement for ASCO and what we hoped to achieve, and we were able to realize so many of the goals of the strategic plan including becoming the authoritative voice of oncology, the voice of patients, the voice of policy, and the voice of quality with QOPI (Quality Oncology Practice Initiative)."
He said the days of incoming ASCO presidents setting forth a specific initiative during their year in office were also over.
"It's understood we can't bounce from theme to theme every year-what is brought by each president is a new perspective about things that need retooling or aren't being addressed."
If ASCO has had one ongoing theme, it has been its quality initiative, which he said is being escalated to a very serious endeavor that will soon be rolled out as something that can be measured in a patient care report card through QOPI.
'Tackle-able' Problems
"We've been struggling with what practice standards we are going to adopt. There are some guidelines that are meticulous in their levels of evidence, but for the majority of things we do not have that level of evidence."
Dr. Link said that in the past the guidelines committee had "tackled problems that were tackle-able," and the first question the society must now tackle is to determine the relatively limited number of areas that are ready for full-fledged guidelines.
He said in order to establish the highest-quality care it would be necessary for oncologists to run the best practices with patients receiving the best, state-of-the-art care.
"ASCO will wrestle with the way to set benchmarks that practices can achieve to score and see how they are doing, and we need to decide how to impose those benchmarks. QOPI is the vehicle, and now we have to put some fuel in it."
Pediatric Oncologists Taking the Lead
Survivorship is another area of key interest to Dr. Link, who as a pediatric oncologist said he had been especially attentive to the "price of the cure," most notably the late effects and side effects of cancer.
During this past year as president-elect he seemed especially proud of having helped create ASCO's cancer survivorship committee dealing with the long-term survival issues of pediatric patients.
He said that previously survivorship had been part of the prevention committee and did not address the full spectrum of issues faced by many cancer survivors, an area where pediatric oncologists had taken the lead.
He mentioned acute lymphocytic leukemia (ALL) as the poster child for discovering that what was once considered a single disease could actually be multiple different diseases on a molecular level-i.e., was actually a predecessor to targeted therapy.
Pediatric oncologists were also early adapters of multidisciplinary care teams.
"We were collaborators, since it takes a village to take care of children, with surgeons, oncologists, pathologists, and radiotherapists all working together on the problem, and we also very quickly understood biology and the importance of tissue banks. It also became clear that if you wanted to do clinical research, you couldn't do it yourself, since no institution had sufficient numbers of patients for trials. We pooled resources[horizontal ellipsis]and necessity became the mother of invention."
He acknowledged that the success of pediatric clinical trials also involved some luck because of the patients' responsiveness to chemotherapy and radiation, resulting in marked improvements in outcomes.
Dr. Link recently finished terms as a member of both the FDA's Oncologic Drugs Advisory Committee and the NCI's Board of Scientific Advisors.
He's a member of the Scientific Advisory Board of St. Jude Children's Research Hospital, and an associate chair of the Children's Oncology Group, and has received numerous honors and awards including ASCO's Statesman Award, the Brent Ely Visiting Professorship in Pediatric Oncology at the University of Colorado Center and Children's Hospital, Denver; and being asked to deliver the Pediatric Center Research Foundation Memorial Lectureship.
Global Outlook
Now in preparation for the wide range of more global issues he'll face as ASCO president, he's paying more attention to areas such as Medicare that were of limited professional focus in pediatrics, but which affect many oncology practices and are also of growing personal interest to a man approaching the age for enrollment.
"It's especially important today that oncologists and especially generalists understand the biology of cancer and its translation into clinical practice, because if they don't understand the science they won't be able to practice," he said, also emphasizing ASCO's role as an international society and the need to think about delivery problems when therapies become to expensive to export.
Hooked on Pediatrics
Dr. Link became hooked on pediatrics after rotating in that specialty, and later as a pediatric house officer and intern who was very interested in immunology, he became fascinated by bone marrow transplantation as an intervention for cancer.
"My first oncology rotation was with mentors who were terribly charismatic. I loved science and the intensity of care made possible by treating children and having a relationship with their families. Babies are wonderful, and if you don't fall in love with a four-year-old [patient] then you don't have a soul.
"One of my patients I took care of 15 years ago is now a nurse practitioner in my clinic, and a number of my patients have gone into medicine, with one, a surgeon, actually calling me up [after all these years] to run a case by me," he said with considerable pride.
Stanford, Columbia, Children's Hospital in Boston and Dana-Farber
The youngest of three children, Dr. Link was born in suburban Cleveland and attended medical school at Stanford after graduating from Columbia College in New York.
He completed his residency and fellowship at Children's Hospital in Boston and Dana-Farber Cancer Institute before returning to Stanford in 1979-a decision, he said, that was considered "idiotic" at the time by those who had trained him in Boston.
He said he always knew he wanted to be a doctor, and his older brother David-currently a pediatric nephrologist who is chief of pediatrics at Cambridge City Hospital, a Harvard teaching hospital-started his fellowship at Boston Children's when Michael was a resident there.