Dr. Jack West Part 1: Why Time-Pressured Community Oncologists Aren’t Applying Precision Medicine
In this first episode with Dr. Jack West, Associate Clinical Professor at the City of Hope, we discuss the state of precision oncology today. In particular, Dr. West talks about the challenges providers face when it comes to performing the right molecular tests to appropriately prescribe targeted therapies.
Listen to the full episode above and download the full PDF transcript here.
Dr. West is clear that the medical community is at a challenging crossroads, because the amount of information that molecular oncology continues to introduce makes it increasingly difficult for general oncologists—as well as labs and payers—to keep up. He references a recent article he wrote for Medscape, “How Could We Fail So Miserably?” Real-World Evidence Offers Sobering Reality. In his article, Dr. West points out the appalling fact that, based on a recent report by Foundation Medicine and Flatiron Health, only 64.3% of patients with an EGFR mutation (405 of 630 patients) and only 70.1% of patients with an ALK rearrangement (75 of 107 patients) received the appropriate targeted therapy at any time for their advanced NSCLC.
Why is this happening?
Dr. West believes a commonly overlooked factor is the constant time-pressure community oncologists face. Molecular testing can take up to 3 to 4 weeks, which can seem daunting compared to a one-off ad hoc test for EGFR mutation or ALK rearrangement, which they may get back in a matter of days. He believes specialists and academic oncologists can more easily—and with more certainty—convince patients that it's okay to wait a couple of weeks for the data to ensure they are prescribing the most appropriate treatment and not just the most rapid treatment.
Dr. West attributes this difference in approaches to a divide in the knowledge level of academic physicians versus community physicians. He suggests that bridging that gap will be necessary to maintain or improve the quality of care as precision medicine grows.
This is just the tip of the iceberg in terms of how much we learned from our discussion with Dr. West, which is why we continued our conversation in Part 2 of this podcast. (As many of you may already know Dr. West is a believer in the power of media. He is a speaker, writer and has his own podcast to help advance the precision oncology industry.)
We hope you take the time to listen to both episodes for more insight into how the medical community, as well as other stakeholders in precision medicine, might work more collaboratively to ensure the appropriate use of NGS testing and that treatment decisions are based on the outcomes of those tests.
Listen to Part 1 above. And be sure to subscribe to receive notice when Part 2 is live.
Download the full transcript of the episode here (pdf).
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About Our Guest
Dr. Jack West, City of Hope
Associate Clinical Professor, Medical Oncology
Executive Director, Employer Services
Dr. West is an Associate Clinical Professor in Medical Oncology, a specialist in thoracic oncology, and serves as Executive Director of Employer Services at City of Hope. He was previously Medical Director of the Thoracic Oncology Program at the Swedish Cancer Institute in Seattle.
Dr. West received an MPhil in Experimental Biology from Cambridge University on a Fulbright Scholarship and a medical degree (magna cum laude) from Harvard Medical School, where Dr. West also conducted research as a Howard Hughes Medical Student Fellow. His postdoctoral training included an internship and residency in internal medicine at the Harvard-affiliated Brigham and Women’s Hospital Boston, MA, followed by a fellowship in medical oncology at the Fred Hutchinson Cancer Research Center/University of Washington in Seattle, WA.
In late, 2002, he moved to Swedish Cancer Institute in Seattle, where he served for over 16 years as Medical Director of the Thoracic Oncology Program, overseeing a broad array of clinical care and research responsibilities. In March, 2019, he moved to the Los Angeles area to dedicate his focus on innovative approaches to delivering sub-specialist expertise across a broader geography, using tools such as remote case reviews and telemedicine consultations.
He has authored dozens of papers and chairs several CME programs and symposia internationally on thoracic oncology, novel educational approaches, and social media in cancer care.
In addition to these activities, he is the Founder & President of Global Resource for Advancing Cancer Education (GRACE); Web Editor for JAMA Oncology; regular correspondent for Medscape; and contributing author and section editor in Lung Cancer for UpToDate.
Connect with Dr. West:
On Twitter: @JackWestMD