Disruption – usually challenging, often upsetting, sometimes beneficial

Last month I attended a series of meetings at the National Cancer Institute (NCI) in Washington DC.   As was the case many times this winter, weather created havoc with air travel.   This disruption caused me considerable anxiety as I rode to the airport after my last meeting.  I wondered if my flights would be delayed or cancelled.  As it turned out, I scrambled and got on a flight as soon as I arrived at the airport.  This flight was scheduled to leave earlier in the day but was delayed because of weather.  So …  I left Washington for home earlier than planned.  In this case, the disruption in air traffic worked in my favor.

Disruption of a different sort influenced my meetings in Washington where a common theme was the impact of disruptive technology on cancer research.  Disruptive technology refers to the new ways of doing things that disrupts or overturns standard methods or practices.  For example, information technology and the incredible improvement in our ability to understand cancer at the molecular level (that I have discussed in prior blogs) are having a major impact on cancer research. These disruptive technologies make planning for the future both exciting and challenging.

My first NCI meeting was a retreat where the Cancer Center Directors met with NCI leadership to discuss a broad range of cancer research efforts.  We considered approaches to sharing massive amounts of cancer genetic information that cancer centers across the country are generating on individual patients.  Our goal is to share this information so we can accelerate the speed of cancer research while also protecting the privacy and rights of individual patients.   Some of the concepts on the table are based on new disruptive technologies that were not even conceivable just a few years ago.

At the second meeting, I was part of a working group charged with providing advice related to prioritizing extremely large  clinical research trials designed to determine which type of “adjuvant therapy” (therapy given to reduce the chance of a cancer coming back) is best for patients with a given type of cancer. These trials are very expensive to run because they require a large number of patients and careful follow-up for many years until we know which treatment is best.  Cancer research is moving so quickly that it is possible the treatments we would like to compare in such trials today will be considered obsolete by the time the trials are completed.  Do we invest in a trial to figure out which of our current approaches to treatment works  best with the understanding that the value of the trial could be disrupted by new more effective treatments, or do we invest in research designed to create those better treatments for the future?  The potential for disruption makes this a very difficult decision.

The third and final meeting was the 22nd meeting of the NCI “Clinical and Translational Advisory Committee Meeting” where we provided advice to the NCI on a broad range of issues related to clinical trials. This committee reviews how clinical cancer research is done across the country, including research at academic cancer centers such as Holden and research taking place in the offices of private practice oncologists.  Rapid changes in health care are disrupting the traditional approach to clinical cancer research.  At the meeting, we discussed ways to assure the disruption caused by these changes is managed so it has a positive impact on our ability to conduct innovative clinical cancer research.

It was a productive two days, and we made considerable progress in determining the best way to try and take advantage of disruption.

There are some circumstances where disruption has no upside.  Underlying all of our discussions was the incredibly disruptive effect of the cuts in funding to cancer research support by the federal government.

And, those of you who are “road warriors” and travel frequently know that the disruptive effect of weather on travel is very rarely constructive.  Indeed, I only shared part of my travel story with you.   Although I was able to get from Washington, DC to Chicago earlier than planned, my earlier flight from Chicago back home to Iowa was cancelled.   In the theme of making the best out of a disrupted situation, at least it gave me time to work on my blog.