The addition of algenpantucel-L to standard adjuvant therapy for resected pancreatic cancer may improve survival. A multi-institutional, phase 3 study is ongoing (ClinicalTrials.gov identifier, NCT01072981).

A MESSAGE FROM ASCO'S PRESIDENT As this report demonstrates—and as history shows—investment in clinical cancer research pays off. Since 1990, cancer mortality rates have declined by 15%. Today, two thirds of patients survive at least 5 years after diagnosis, compared with just half of patients 40 years ago. Patient quality of life has improved dramatically. In addition, thanks to basic research advances, we are entering an era of personalized cancer medicine, in which treatment is tailored to the unique genetics of the individual. Clinical cancer research is finally receiving an urgently needed boost in investment. For the first time in 5 years, federal funding for research has increased. The economic stimulus package infused billions into short-term biomedical research projects, and President Obama has pledged to invest in “a cure for cancer in our time.” However, despite this progress, cancer remains the number-two killer of Americans. Incidence is projected to nearly double by 2020 as the population grows and ages. Scientifically, cancer is highly complex; it is not one disease, but many, and is increasingly defined by thousands of genetic variations, epigenetic changes, post-transcriptional modifications, and combinations of these mechanisms, rather than by site of origin. Unraveling these complexities begins to explain why some cancers are especially resistant to treatment, a fact we have known for some time. Other cancers are fatal because they are typically diagnosed late in the course of disease, when treatment is less effective. To achieve new breakthroughs, the scale of the national response must match the scale of the problem. Years of flat federal research funding have resulted in abandoned or stalled clinical research projects, a deteriorating research infrastructure, and the loss of talented physicians to other fields. In this report, the American Society of Clinical Oncology (ASCO) commends the recent increases in funding and calls on Congress to make a multiyear commitment to sustained increases in clinical cancer research at the National Institutes of Health and National Cancer Institute. Major advances in cancer treatment cannot be expected to emerge without consistent and predictable investment at the federal level. Although a robust clinical research enterprise is essential to improving patient care, advances mean little if they do not reach people in need. For people with cancer, lack of health insurance can be the difference between life and death. It is estimated that 32% of patients with cancer in the United States are uninsured at some point during their treatment, and more than a quarter opt not to seek treatment as a result. We must end the inequality in health care access. ASCO believes that health care reform must ensure that everyone diagnosed with cancer has the coverage necessary to receive high-quality treatment. To that end, we have made access to cancer care a top priority in our advocacy agenda. I believe the advances described in this report should give all of us cause for hope. Although there is a long road ahead, by investing in a robust national clinical research program and by improving access to high-quality care, we can give every patient the best chance of survival. Douglas Blayney, MD President American Society of Clinical Oncology

A MESSAGE FROM ASCO'S PRESIDENT Like many health professionals who care for people with cancer, I entered the field because of specific patients who touched my heart. They still do. In an effort to weave together my personal view of what the American Society of Clinical Oncology (ASCO) stands for and the purpose the organization serves, my presidential theme this year is “Patients. Pathways. Progress.” Patients come first. Caring for patients is the most important, rewarding aspect of being an oncology professional. At its best, the relationship between doctor and patient is compassionate and honest—and a relationship of mutual respect. Many professional organizations have an interest in cancer, but no other society is so focused on the entire spectrum of cancer care, education, and research. Nor is any other society as particularly interested in bringing new treatments to our patients through clinical trials as ASCO is. Clinical trials are the crux for improving treatments for people with cancer and are critical for continued progress against the disease. “Pathways” has several meanings. Some pathways are molecular—like the cancer cell's machinery of destruction, which we have only begun to understand in recent years. But there are other equally important pathways, including the pathways new therapies follow as they move from bench to bedside and the pathways patients follow during the course of their diseases. Improved understanding of these pathways will lead to new approaches in cancer care, allowing doctors to provide targeted therapies that deliver improved, personalized treatment. The best pathway for patients to gain access to new therapies is through clinical trials. Trials conducted by the National Cancer Institute's Cooperative Group Program, a nationwide network of cancer centers and physicians, represent the United States' most important pathway for accelerating progress against cancer. This year, the Institute of Medicine released a report on major challenges facing the Cooperative Group Program. Chief among them is the fact that funding for the program has been nearly flat since 2002. ASCO has called for a doubling of funding for cooperative group research within five years and supports the full implementation of the Institute of Medicine recommendations to revitalize the program. ASCO harnesses the expertise and resources of its 28,000 members to bring all of these pathways together for the greater good of patients. Progress against cancer is being made every day—measurable both in our improved understanding of the disease and in our ability to treat it. A report issued in December 2009 by the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society, and the North American Association of Central Cancer Registries found that rates of new diagnoses and rates of death resulting from all cancers combined have declined significantly in recent years for men and women overall and for most racial and ethnic populations in the United States. The pace of progress can be and needs to be hastened. Much remains to be done. Sustained national investment in cancer research is needed to bring better, more effective, less toxic treatments to people living with cancer. Pathways to progress continue in the clinic as doctors strive to find the right treatments for the right patients, to understand what represents the right treatments, and to partner with patients and caregivers for access to those treatments. This report demonstrates that significant progress is being made on the front lines of clinical cancer research. But although our nation's investment in this research is paying off, we must never forget the magnitude of what lies ahead. Cancer remains the number two killer of Americans. Future progress depends on continued commitment, from both ASCO and the larger medical community. George W. Sledge Jr, MD President American Society of Clinical Oncology

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Outpatient ACP is feasible early in the care of patients with stage IV cancer through systematic improvement in workflow and motivated providers. Education and infrastructure were pivotal to routine development of advance care plans.