1. Eastman, Peggy

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Facing serious demographic challenges, cancer center directors tackled oncology workforce issues at the recent annual meeting of the Association of American Cancer Institutes (AACI) in Washington, D.C.

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The anticipated influx of older cancer patients, growth in the number of older cancer survivors, and an aging and decreasing physician-scientist research pool of talent could create marked problems in cancer care, warned speakers. These workforce issues are especially critical since they come at a time of unprecedented scientific advances in oncology such as CAR T-cell therapy, they noted.


The AACI held its first CAR-T symposium at this year's annual meeting. The symposium featured a keynote talk by a CAR-T recipient, cancer survivor, and patient advocate Sydney Joorabchi, and covered the nuts and bolts of establishing and administering a CAR-T program.


Training the next generation of scientists is especially critical now because opportunities in the cancer field are "truly spectacular," said Eric Fearon, MD, PhD, Professor in the Departments of Human Genetics, Internal Medicine, and Pathology, as well as Director of the Rogel Cancer Center at the University of Michigan. "This is a great time to bring new colleagues into the cancer workforce." Fearon moderated a session on training the cancer center workforce for 2030.


Today is an especially exciting time for cancer research because advances in treatments based on cancer biology can have a major impact on patients, agreed Elizabeth R. Lawlor, MD, PhD, the Russell G. Adderley Professor of Pediatric Oncology in the Department of Pediatrics and Communicable Diseases at the University of Michigan. But, she said, by 2030 every baby boomer will be 65 or older, creating a major stress on the oncology workforce since cancers disproportionately affect older people. In addition to patients in active treatment, the number of cancer survivors-about 16.9 million today-is expected to swell to as many as 22 million, she said, and the needs of a growing number of survivors will also have to be met.


Unfortunately, these demographic changes loom at a time when there are fewer and fewer physician-scientists-those whose clinical research moves the field forward-in the workforce today, said Lawlor; that number is only about 1.5 percent. Lawlor described physician-scientists as "a leaky and aging workforce," adding there is a pressing need to "increase the physician-scientist pipeline and reduce attrition." She noted that today there are increased financial, time, and publication expectations and pressures on young physicians which may dissuade them from undertaking a career in cancer research. It can take up to 5 years to get a publication in a major journal, she noted.


"We need to act now and stop this leaky pipeline," said Lawlor. She made the following recommendations to increase the number of physician-scientists in the oncology workforce.


* Facilitate better and early promotion of the value of biomedical research to the general public.


* Expose students in middle school and high school to science and engage their interest.


* Increase the diversity of physician-scientists in the workplace.


* Emphasize opportunities for international physician-scientists to remain in the U.S.


* Enhance research opportunities for non-MD/PhD students.


* Establish grant programs to enhance the retention of physician-scientist trainees.



Agreeing on the need to address looming oncology workforce challenges was Brenda Nevidjon, MSN, RN, FAAN, who is CEO of the Oncology Nursing Society (ONS). Today there are some 3 million registered nurses, and it is anticipated that there will be 3.9 million by 2030. Slightly less than 3 percent identify themselves specifically as oncology nurses, she said. "We are an aging workforce," said Nevidjon, noting that the average age of nurses entering the workforce today is 30, and the average age of nurses in practice is 50. "Expansion in nursing enrollment is needed."


She said that nurses today, especially nurse practitioners, are being called on to fill gaps in primary care, which siphons off those who might specialize in oncology; there are fewer nursing schools offering oncology concentrations; there are nursing faculty shortages and the faculty is aging, with most members in the mid-fifties or older; there are fewer nurses entering PhD programs; and the pipeline of nurse researchers "is weakening."


Nevidjon said that in the near future there will be a "survivorship tsunami" of cancer patients, and therefore a pressing need for team-based care-including nurses-to address their needs. "We don't have the workforce to care for this," she said.


To increase the workforce of oncology nurses, Nevidjon said that nurses and trainees need to be made aware of the opportunities and choices within oncology. They "need to understand that cancer is not all about death and pain." She recommended that nurses sit on organizational boards and participate in decision-making meetings. She noted that nurses who specialize in oncology can choose roles in an infusion center, a radiology department, chemotherapy treatment, clinical trials, and patient navigation. Nevidjon said ONS recommends course bundles on oncology for new nurses and information on collaborating with other organizations. Looking to the future, Nevidjon said ONS sees roles for nurses as health coaches for cancer patients, health literacy guides, oncology treatment advisors, survivorship support specialists, and virtual care delivery guides.


Mindful of the need for more oncology scientists and physician-scientists, the National Cancer Institute (NCI) offers a wide array of opportunities to support their training, said Sergey Radaev, PhD, a scientific review officer in NCI's Cancer Training Branch. Radaev reviewed the NCI training grants available, which range from pre-doc to post-doc to early career fellowships to mid-career development awards. He noted that about one-fourth of all NCI grants are training grants, and NCI has a number of training awards specifically aimed at promoting workforce diversity.


At the AACI's 11th annual Clinical Research Innovation conference, which preceded the AACI annual meeting in Washington, several presentations focused specifically on increasing the pool of cancer researchers. A study from a committee at the Huntsman Cancer Institute at the University of Utah, called "How to Be a Principal Investigator: A Practical Training Program for Investigators," emphasized core competencies, including the roles and responsibilities of the investigator and research staff; federal and international regulations; institutional processes and regulations; informed consent; adverse event assessment; and source documentation.


Another presentation, "Educating the Next Generation of Clinical Researchers," from the University of Florida Health Cancer Center, described how the center's Clinical Research Office (CRO) implemented a clinical research internship for recent college graduates who are preparing for future careers in health care or continued education in health sciences. The first group of interns went on to work within the adult Solid Tumor and Hematologic Malignancies Divisions in the CRO.


In other news from the meeting, AACI President Roy A. Jensen, MD, Director of the University of Kansas Cancer Center, announced the establishment of a curated online collection of cancer advocacy resources, called the AACI Public Policy Resource Library. The new library will enable cancer centers and partners in the cancer advocacy community to share resources to foster collaboration, promote cancer prevention, and enhance the development of sound public health policy at the state and local level. The new online library will provide a platform to share carefully vetted information on topics including legislation and state funding programs for cancer research. Jensen said he sees the new online library as a "one-stop shop" of information, a tool to leverage cancer centers' collective ability to generate good public policy and "push for legislation that leads to a healthier society."


In the coming months, volunteer curators-subject matter experts from AACI cancer centers-will add material to the resource library on the elimination of cancers caused by HPV and measures to curb the use of tobacco products and e-cigarettes. According to the recent third annual National Cancer Opinion Survey from ASCO, only one in four Americans incorporate cancer prevention into their daily lives, despite evidence showing that up to half of all cancers are preventable. The online survey, done by The Harris Poll, showed that nearly one in four young people ages 18-38 believe e-cigarettes are harmless and not addictive, and three in 10 think flavored e-cigarettes are less harmful to health than non-flavored ones.


The AACI presented its Distinguished Scientist Award to Douglas R. Lowy, MD, NCI Acting Director, for his long-term cancer research which has led to the development of HPV vaccines for clinical use. As previously reported in Oncology Times, Lowy has stressed that as the nation approaches the 50th anniversary of the National Cancer Act, the U.S. commitment to strong, robust federal funding of research must be sustained to maintain momentum in the fight against cancer. "If discouraged researchers leave the field, we will squander the tremendous momentum and innovation alive in the research community today," he noted. "There is no pause button for cancer research."


Peggy Eastman is a contributing writer.