Healthcare Unfiltered
Healthcare Unfiltered is an honest, raw, timely podcast tackling any and all topics in healthcare that affect stakeholders. Dr. Chadi Nabhan uses his dynamic conversational skills to challenge his guests to address controversial and important topics. He also brings on world renowned experts to discuss clinical advances in medicine.
Healthcare Unfiltered
Episode 280 - Cooperative Group Trials: Now and Tomorrow With Sue Yom
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Chadi sits down with sit down with Sue S. Yom, MD, PhD, FASTRO—radiation oncologist at UCSF, Editor-in-Chief of the International Journal of Radiation Oncology Biology Physics, and leader within NRG Oncology—to explore the critical role of cooperative groups in advancing cancer research. She unpacks their history, the benefits and challenges of large-scale collaboration, and how federal funding and partnerships with industry shape the design and execution of clinical trials. Dr. Yom also shares insights from her editorial perspective and highlights what’s ahead in radiation oncology, including the growing role of biomarkers, personalized treatment strategies, and smarter sequencing of therapies.
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Healthcare Unfiltered, and it's your host, Shadi Naban. Thank you folks for tuning in on this special episode of Healthcare Unfiltered, where I have a phenomenal leader and top-notch radiation oncologist, Dr. Sue Yom, from the University of California in San Francisco, who is the editor-in-chief of the Red Journal, the most prestigious journal in radiation oncology in the world, and who is also the um, again, leading the NRG part of the leading the uh NRG uh cooperative group. Sue has done phenomenal work over the years as a leader, a mentor, a teacher, uh, and a researcher. And uh she is generous with her time that she is coming on Healthcare Unfiltered to talk about her career path, but also about cooperative groups. Uh, folks who are listening to this show, they probably know a lot about cooperative groups, but we're gonna this we're gonna go into the details, the history of cooperative groups, the pluses, the minuses, the negatives, the positives, and so on. So everybody who is listening or viewing knows about cooperative groups and understands what we mean about these and uh and also about the funding pertaining to cooperative groups, and also we're gonna talk about her role as editor-in-chief of the Red Journal. So, really appreciate the time that Sue has provided me and sitting down, and we taped actually this episode before the end of 2025. It is airing in 2026 as we all have gotten younger. Yes, we are getting younger, I believe. So, uh thank you so uh thank you folks for tuning in. And of course, I'm gonna plug in my third book coming out this year on artificial intelligence and cancer care. We go over everything pertaining to AI and cancer care, how AI is really helping shape help helping to shape the way we deliver cancer care uh to every patient uh in the country and in the world. Uh, my other two books, one came out in 2023, Toxic Exposure, and the other one, The Cancer Journey in 2024. Check them out, they're available everywhere in the US and Europe, and soon enough they will be in print in Polish, in Lithuanian, and in Portuguese. Without further ado, Dr. Su Yom on Healthcare Unfiltered. Always fun to have a first timer on my Healthcare Unfiltered podcast, Dr. Su Yom. Welcome to the show.
SPEAKER_00Oh my goodness. Hey Chaudi, it's so nice to see you.
SPEAKER_03And apparently you're a fellow podcaster. Tell me about your podcast first before we make an intro. What's your podcast about?
SPEAKER_02Oh, I love my podcast. We we do a monthly podcast, which is centered around one of the journal articles that we publish in the Red Journal. So it comes out about once a month. We publish 14 issues a year, so 14 times. But it's been great. I I had a hard time at first because I just wasn't sure about the format and how it would work out. But we do a long form podcast, kind of similar to you, where I interview people and we sort of turned it into a little bit of a talk show with a few people, and they come and talk about one to three articles, depending on the focus. And I often bring in someone who wrote an editorial and one of the editors to give the journal perspective, and it's just amazing, so wide-ranging. Everyone finishes taping that thing, and we all say we all learn so much from each other and how fun it was. And it's a beautiful thing in my life, honestly.
SPEAKER_03And we can find it everywhere.
SPEAKER_02Oh, yeah. It's I mean, okay, yeah, yeah.
SPEAKER_03What is it?
SPEAKER_02It's the one thing about the journal that comes with no charge.
SPEAKER_03What what is it called? So I have people hopefully can check it out.
SPEAKER_02It's on Apple and Spotify and BuzzSprout, and you can also download it from our website, redjournal.org. Um, but on those on those commercial channels, it's called Astro Journals.
SPEAKER_03So it's called the Astro Journals Podcast?
SPEAKER_02Mm-hmm. Just Astro Journals.
SPEAKER_03So, Sue, is my only chance of coming to your podcast I have to publish in the Red Journal? That's my only chance, huh? I gotta I gotta start sending papers there.
SPEAKER_02You could be an editor at the Red Journal. That would also work.
SPEAKER_03It would be an honor. So tell us a bit about you uh for folks who are meeting you for the first time.
SPEAKER_02I'm a radiation oncologist. Mostly I work on head neck cancer and lung cancer, but it's sort of spun out into skin cancer. That's really my professional identity. And then my whole life has been very formulated by someone that was quite important to me in my life, Dr. Jim Cox, who was the department chair at MD Anderson when I was there as a resident. And he literally imprinted upon me, I was like a little duckling, and he imprinted upon me that I must love the same three things that he loves, which were the cooperative groups, the Red Journal, and the Radium Society. And I'm sure out of those three, everyone will go and now have to Google the Radio Society. But those three, those three things were things that Jim really loved. And I just think about that all the time. And, you know, later in your life, you sort of realize, wow, you know, that was that was important. That was a formative time. And he really showed me these things and taught me these things. And those are three things that have been constants through my whole career.
SPEAKER_03You know, isn't that amazing how a lot of our careers are shaped by mentors and people that we meet early on as we start our medical journey.
SPEAKER_02You don't even realize. I I didn't even realize until it all sort of came to roost, and I realized how much time I spend on these particular things. Not that there are not other things in my life, and of course, other things have arisen out of those things that are now distinct in their own. But but fundamentally, yes, someone entering your life when you're young and just showing you things and teaching you things and making you love those things, it's so important.
SPEAKER_03Yeah. And um, you know, I I know that you pass it on forward uh to other people who are looking up to you as mentees. And and a lot of times when we look back and see people who have helped us, we we try to help others who seek our guidance. So I I know that.
SPEAKER_02I think if you genuinely love something, it's not hard to show other people that that thing.
SPEAKER_00Yeah.
SPEAKER_02And if you genuinely love it, you will show them all the good things that you love about it. And and that is really the definition of inspiration.
SPEAKER_03And you're currently at UCSF. Is that the uh only job you got after MD Anderson?
SPEAKER_02Or have you that is my only job? I'm a very, very loyal person. So I I have had one paying job my whole life.
SPEAKER_03Yeah, listen, if you ever leave, doesn't mean you're not loyal, it just means you're you know you're spreading your wings. It's okay.
SPEAKER_00Yeah.
SPEAKER_03So uh what's your day looks like at UCSF? You I know you wear a lot of hats, and I want to talk about all of these hats, but in a sense, how what is it that you actually do? You do clinical care, you told us about this. What else? What other hats do you wear?
SPEAKER_02Well, I, you know, as I said, I do a lot of work on the cooperative grades because I'm the contact principal investigator for our institution for energy oncology. And then I have some funded grant work, so I have to spend some time on that, and then running a lot of clinical trials. And then I have a role in the department as a strategy chair, which is a very interesting role that not many places have, but it's becoming more popular, where I essentially serve as advisor to the chair about overall research and other strategies related to that within the department.
SPEAKER_03Amazing. So, Sue, um, radiation oncology, like anything in oncology, has evolved over the past 20 years, 20 plus years with so many things. I mean, um as you look backwards and then but more importantly, forward, what is exciting you a lot about what's coming down the pike for radiation oncology? Uh, in medical oncology, we're all excited about, you know, from immunotherapy, target therapy, and things of that nature, although who knows what's coming next? What's happening in the world of radiation oncology as we look forward?
SPEAKER_02Yeah, um I think you would get different answers from different people. If if you asked 10 or 20 radiation oncologists around the country, you would probably get slightly different refracted through their lens types of answers. But from my perspective, there's a few things, and you know, this is just very much based on sort of, you know, my own cauldron of personal experiences. But one is that I think we are getting to an era where we can actually use biomarkers in radiation oncology. And in other specialties, you know, particularly in medical oncology, I think the use of biomarkers came on so early, especially with the rise in targeted therapy and then personalized medicine and all of that. But in radiation oncology, as usual, you know, it's a conservative sort of field. And I don't mean conservative in any political sense, but just that we move slower. A lot of our treatments are curative intent, and so there's just a slower progression. And then, you know, of course, we're first line as opposed to last line therapy most of the time, or at least half the time. So um, predictive biomarkers have come slowly to radiation oncology, but I do think we're getting to a point where we can actually start to talk about personalization of therapy. And for us, that has, you know, for our field, it has very specific connotations in terms of how we sequence and what kinds of technologies we can bring to bear. So, in addition to actually using biological biomarkers or imaging biomarkers, which I think are starting to actually change treatment and personalized treatment, we have this ability to translate that into the technology realm, which I think is more unique to us. How we sequence the technologies, what kind of novel technologies we bring into that mix. I'll just throw a few out there. I I think lattice is really interesting and unexplored. It's kind of a um uh a very specific form of delivering, if you want to call it, uneven doses of radiation, particle therapies. And by particle therapies, I don't mean just proton. I'm talking about the whole range of physics, uh, which is, you know, particle physics is a whole distinct separate field that is much deeper and much more historically broad than proton. And then radiopharmaceutical therapy. And when I say bring in these new technologies, what I mean by that is in addition to biomarkers, we have the ability now to maybe start to even layer another larger complexity, which is biomarkers that lead to combinations of therapies. And that's complex. Um, because when you start to talk about combinations of different radiation therapies, you can start to really develop a lot of new combinations, almost like we're combining different drugs, if if you really want to make that comparison. And then the third layer of complexity is that, you know, with biomarkers, or perhaps just from our greater understanding of disease and our treatment efficacy in general, intensification versus deintensification is a way that you see it playing out in the literature a lot. I think we have the ability to do adaptive therapies. And when I say adaptive therapy, I don't just mean using MRI on the table to change your contours. I'm talking about adaptation as a global dynamic concept throughout a patient's treatment course, maybe even over the course of their lifetime. And so the problem is, of course, that this is so many different things. And so we have to be very strategic as a field and I think more unified as we test these questions. And this is where my bias comes in at the cooperative group level, because we don't have, you know, the luxury of having so, so many patients, you know, the the way that the our our two companion fields do. You know, radiation oncology is kind of a smaller specialty. We only have 5,000 radiation oncologists in the United States. So we, you know, and and not and maybe 60% of those are academics. So we have to kind of be a little bit careful about how we test these questions, not not wasting our precious resources, which are in short supply all over. But you can see just from that short list, which is, you know, just the things I can think of off the top of my head, that's a lot of different hypotheses to test.
SPEAKER_03That is, I I like the I'm I'm really very intrigued by the first one. I mean, they're all important, but the biomarker-driven radiotherapy delivery intrigues me as a non-radiation oncologist because we we know, I mean, we know in medical oncology and in radiation oncology, probably we over-treat people to save the fume. I mean, we like you know, the decision on the dosing of radiotherapy or chemotherapy is a bit, you know, arbitrary. I mean, you know, so so I love the idea, for example, if we're using biomarker to say, you know what, in your situation, I can completely not give radiotherapy, or I can lower the dose by 10 grades, and that could really lower toxicity and so on. I love the idea of starting to be smarter in delivering our our novel therapies.
SPEAKER_02Yes, and you know, it's the difference between how we determine the dosages historically, which I think was very appropriate and valid for the time.
SPEAKER_00For the time.
SPEAKER_02And what you know, what they would try to do is say, what dosage do we do so that we cure 90% of the population, right? But the really interesting question that you're bringing up, Chaudi, is can I sit down with a patient and be able to say, what dosage do I use to have a 90% chance of curing you? That's a different question, right? Very different. And so um, to test that, we need to be able to specify these populations better. And it also requires skills and patient counseling that, you know, I think maybe are a little bit underdeveloped throughout medicine. Uh, but you know, if you think about it, I mean, one of the things I say a lot when I go around and give lectures and stuff is that you know, cancer therapy is very inefficient. Um, I was really impressed by this analysis I read. I can't even remember why I read it, but you know, if you use a drug for diabetes or, you know, you use a drug for depression or you know, many other things in in medicine, you know, you know, you you did a lot of medicine. Um those things are gonna work. They have to work pretty well. Like you kind of expect, like, oh, okay, I give this person jardine, it's gonna work. Uh you know, cancer therapy, it's kind of terrible. It's it's it is the most prone to inefficient and ineffective therapy. And and so the answer to that is biomarker-driven treatment. And I'm just gonna be clear here, by biomarkers, I mean not just things like CT DNA or you know, um DNA profiling, genomic profiling, um, or um, you know, uh certain kinds of immunistic chemistry. I'm talking about, you know, also imaging, because for us, imaging and radiomics and AI are also very important biomarkers. Although, again, you know, you just try to not let your mind go ranging too far because then you can't come up with a hypothesis.
SPEAKER_03It's everything. It's everything together.
SPEAKER_02It's very overwhelming, yeah.
SPEAKER_03I um, you know, I shared with you earlier that I have a book coming out next year on AI and cancer care. As part of the research I was doing, I came across actually in radiation oncology a lot of uh folks in radiation, radiation oncology that are doing these um digital twins on the patient level where you really have all of this information you mentioned, right? The genomics, but you integrate that into um you know clin, you know, uh CT scans or MRIs and so on. And there was a I'm I can't really cite this because I don't remember um which one, but uh there was uh um some investigators looked at delivering different types of radiotherapy for GBM. I mean, it's a terrible disease as well and we probably over-treat and so on. And the idea was that you could lower radiotherapy and doesn't really affect prognosis and so on. So hopefully we move towards a smarter way of this. And I think um AI may help with that. I mean, I don't know. I mean, I don't know how whether you think AI can look at all of this data collectively. Like in my mind, I'm thinking you put all of this information about Mr. Nabhan as a patient, and then the machine comes out and says, you know what, you should give him 25 gray, and that's it. I don't know. Maybe that's in the future.
SPEAKER_02No, I I I yeah, yeah, totally. I think, I mean, essentially what you're doing is you're creating very complex models, right? It's not really any different than before. Um, you know, digital twins is just a way to put all your retrospective data into this phantom thing and have it walk around and act like you know it's going to have an experiment done on it. But the um Chatty, I'm just curious. So in your book, how do you get around the problem that bothers me, which is that we we do use a lot of AI in radiation oncology. That's probably something I should have mentioned. But you asked what's exciting to me. AI doesn't excite me. It doesn't excite me that much. It feels like another tool. Yeah. Um, but you know, there are obviously like very mixed things about AI, right? So to me, it feels just like we're up-leveling. It doesn't feel like it's gonna like change our fundamental ways that we think about cancer, but it will up-level, it's a great tool. I do believe that um it probably will change sort of the way people interact between you know, colleagues and in the clinic and things like that, and certainly education. But anyway, my point being how do you get around the thing that bothers me, which is that I don't, I'm not convinced we've seen people talk about generative AI. I'm I'm not convinced we've seen generative AI. What I think I've seen is that AI is like this brilliant student that compiles all these things together. But AI cannot, at least I have not seen evidence that it goes past what has been imagined already.
SPEAKER_03Yeah, I mean, look, generative AI is three years old. I mean, it really came came in when Chat GPT came on on board in November 2022. So about three years old. It is in its infancy, if you think about it, it is evolving very rapidly, and I think we're trying just to understand. I think the the difference when I look at uh generative AI, it's it it provides a rational explanation to really what is what what what you're seeking. So it it it thinks like a human and the machine because it's trying to give you this rational thing, and the way it does that is by having so much information that you actually and capabilities that humans cannot have, and take all of this information and then spits out new uh you know information that it wasn't available before based on the information that I mean in the past it was always the machine.
SPEAKER_02Well, I don't think it's new information, that's that's the thing, right? It spits out it only it only has the information that it had.
SPEAKER_03No, the conclusion.
SPEAKER_02But I agree with you. I agree with you. Yes, you get to a place that you might not have gotten to because you were you had the capability to put all these things together.
SPEAKER_00Absolutely.
SPEAKER_02But I I still do believe there will be a place for truly breakthrough human imagination, which will which will create, you know, which has always created new um new conceptual things for us, right? But AI will help us, no doubt.
SPEAKER_03But generative AI should is not to replace humans. I mean, I I you know I that is that is for sure. There's a lot of hallucinations, a lot of issues and shortcuts.
SPEAKER_01Oh, yeah, yeah, yeah. The QI's no way. That's the other thing. Yeah, you gotta keep that thing on a leash.
SPEAKER_03I want to go back a little bit to what you mentioned because I want to dig a little bit deeper into cooperative group trials and the kind because I think a lot of my listeners and viewers probably don't, they may not really understand maybe a little bit of the infrastructure and a bit of the complexity of how the cooperative group trials are conducted, but more importantly, the opportunities that come with it. Um, so let's try to dig down a little bit deeper into that because you're heavily involved with it uh in it. Um, what are these cooperative groups and what do we mean by cooperative group trials? How are these different than whatever other type of studies that we usually do or or see out there?
SPEAKER_02Well, as you see from my comments on AI, I'm very old-fashioned. Uh so you're not alone, you're not alone.
SPEAKER_03A lot of people are skeptical, but you'll come around, you'll come around.
SPEAKER_02I mean, I use I use it all the time myself, but I mean we use it every day, contrary.
SPEAKER_03Oh, just using perplexity right now before we went on calling.
SPEAKER_02The um, I mean, we can talk about it more just in the editorial space where I think we should be using more. But the um, you know, if you go back to let's just go back to the origins, Chaudi, because you know, I'm getting old to the point where we start talking about the pictures on the cave walls and things like that, right? And everybody's eyes start rolling in the back of their head. The cooperative groups fundamentally the reason I love them so much is it's a throwback to a community model. It's a space where what I Is so amazing. You have these investigators. I mean, you know, top KOLs, okay. Um, and they come together, and the the ability to genuinely collaborate between people like that across institutions, thinking about the good of the community and what, for example, in my experience, we need in head and neck cancer as a nation, as a world community, that's a beautiful thing. And there's there's not really a space like that, right? Okay, you have meetings and stuff like that, but everybody knows what going to a meeting is like. It's not the same thing. This is shared purpose, and you know, the thing that kind of creates that special space is that it's federally funded, so it is a counterpoint to when you have pharmaceutical companies involved that have a very specific corporate need that is different, that that changes the uh goal. The purpose in cooperative group is really just about community and sustaining the community. And and there's a certain beautiful thing about that because the questions arise from that foundation. And then the other thing, of course, that you bring up is um, you know, the funding thing. This very much depends on the goodwill of cancer centers and investigators. We do get support from the NCI, and you know, I do think it would be nice if the NCI prioritized more that cancer centers would um make a bigger emphasis on federally funded trials, because I I do think that the you know the level of strain and and um budget consciousness out there is is really becoming a challenge. But this space really, I mean, in my opinion, it just has to continue to exist. Otherwise, we have no counterpoint to uh using trials to promote uh commercial interest. And there are questions that are very unique in the rare disease space, um, in the um sequencing space, in the de-escalation space, in the subset personalization space that corporate interests do not align with and that they're fundamental to practice. And so I I do really believe in that space and and I love the energy. I also love seeing people from you know these incredible institutions all around the country come together and really plot and plan on how to build the next generation. You know, young investigators don't have always the opportunity to, you know, to run some worldwide commercial trial, but they but they could actually have an opportunity similar to that in the cooperative groups. And so that's a that for me is a really beautiful thing too, and access to federal funding.
SPEAKER_03How many cooperative groups are we talking about? Like why do we have so many?
SPEAKER_02Well, the NCI actually uh, you know, believe it or not, uh, you know, over a decade ago consolidated them to make fewer. So there's actually only five now. There used to be a few dozen, but the NCI actually did go in, and because there were too much too much competition, I wasn't around at that time, of course, but I think it was too much competition and too much overlap and inefficiencies, they did actually consolidate. So there's not really that many. Um, now people call themselves Cooperative Group, but they're not federally funded, right? The the the the ones that are federally funded are actually only uh uh five plus uh and then you know Canada is in there as well. So which which what are they by courtesy is one ecog Akron, Energy Oncology, which is you know the NSABP, G O G and RTOG, um, the Alliance, uh COG, and uh which one did I forget?
SPEAKER_03SWAG and SWAG. Okay, so these are the five car these are federally funded. Now what does that mean? That means that the NCI Ah I see.
SPEAKER_02Yes, yes, yes. Thank you for asking that because I actually have to explain this to young people all the time because it's very opaque. Nobody will just write this down. Maybe you could go ask uh Chat GPT, it would be the only person who would tell you.
SPEAKER_01I'm asking you.
SPEAKER_02They would be the only person, that's the only place you get any clear answer. Um, so so each cooperative group uh uh applies for a core grant. Same as the cancer centers. Maybe people don't realize this, but the federally designated cancer centers apply for a core grant, which is often called the CCSG. So the next time you know your department chair or someone in the cancer center is bemoaning about having to do all the work on the CCSG, now you know what they're actually saying. You don't have to just nod and the cancer center core grant. Cancer Center Support Grant. But the cooperative groups apply for a cooperative group support grant. It's a core grant that funds the administration and headquarters of each cooperative group. And you have to, of course, be able to show all the same things, like you know, you you met your goals from the last cycles, you know, um, and then you um uh six years ago, and you also you know made some innovations and you made some scientific impact and stuff like that. So, you know, to be frank, not to be scary to people, you know, any cooperative group could be defunded at any time. They do operate on these grant cycles and they have to be successful, and they do have set, you know, goals, scientific goals that they are expected to achieve. That core grant funds the headquarters and the basic administration, but then you you need the grant for the actual work, the trial. So, and each trial concept needs to be reviewed in some way, so you can either um submit it through a couple of smaller mechanisms, but if you have a big randomized phase two or three, you're most likely going to have to go through what's called the steering committee. So NCI developed this review process, and you can be appointed to be on a steering committee. It's comprised of a number of different sort of set positions, you know, like you have to have a spore representative, you have to have, you know, some statistics, you have to have different kinds of, you know, um representatives from each of the groups. And so it's kind of designed to be like a swath, uh, you know, through let's say the um sarcoma committee or the GI committee or the head neck committee or the lung committee or whatever, uh brain committee, or sorry, brain community. So, you know, they they pick these people, put them on the steering, and then you bring the trial concept and they approve or disapprove that. And then that becomes a separate grant that is awarded to the group.
SPEAKER_03Okay, so uh then the NCI could award you another grant for the specific study. So where does it yes? Where where is the uh collaboration then with pharma and industry? Because doesn't also industry fund some of these cooperative group trials?
SPEAKER_02Um yeah, so they they can support uh the cooperative group trials in a couple ways. So there is a drug distribution program run by uh the NCI. I won't go into all the names and confusing things of what how the contracts are done, but essentially the NCI has uh a bank uh where they can hold, label, and distribute drug. And they set up a contract with the pharmaceutical companies. If the pharmaceutical companies want their drugs to be available for these federally funded investigations, they put their drug in the bank and then they draw up a contract to support uh the the uh and help to um distribute those drugs to the sites. And that can be done, you know, on a more limited basis or even internationally. So that that is called a um create a contract. But anyway, long story short, basically they can support it with drug through that mechanism. And the other way is that the companies sometimes, if they have interest perhaps in registration, or they have interest in some very specific companion biomarker or exploratory biomarker they're trying to develop further that they're interested in, or imaging or quality of life instrument they want to develop, then they will contract separately with the group and support the additional work of the group uh to bring that concept forward. Now, that that biomarker or instrument or imaging study still has to be uh reviewed by the NCI as appropriate to include in the trial scientifically, but the company can can also independently support the work that's going into that, especially if it's a registrational intent. Then obviously there's so much more administrative work and data quality and and um reporting that's required, but that has to be funded through a separate uh sort of, I guess you call it private contract. But um, and then the other thing is that the NCI will sometimes, for biomarkers that are not of interest to uh uh corporate concerns, they also have an internal program where they can fund um kind of on a smaller scale biomarker research that can go as a companion to that that trial or quality of life research that can go as companion to that trial.
SPEAKER_03That's amazing. So just for the NRG, um uh because it has like the NSABP, the RTOG, and the G OG, but let's say, again, let's say you have a trial, uh just specifically radiotherapy trial. Like it doesn't really have it's basically the endpoints radiotherapy, whatever it is, it has to go through the NRG, right? Although there's like no, like even, you know, I mean, like any type of a radiotherapy study cooperative group goes through the NRG, correct?
SPEAKER_02No, no, no, not necessarily. Um, no, no, no. I mean, I think all the cooperative groups could could choose to run a radiation trial. I see now, um, you know, NRG has perhaps like one of the most developed radiation therapy QA procedures because we are actually housed within the American College of Radiology and work pretty collaboratively with them. And so for that reason, we have the ability to store radiologic images, you know, to do RTQA at a pretty high level. Um, and we have sort of, you know, just a lot of scoring mechanisms and and and um, you know, ways to evaluate contouring and stuff. So so I would say, you know, maybe the energy has the most developed and focused interests, but certainly the other cooperative groups could run radiation trials. You know, radiation trials aren't always the most um sought after because they they often don't entail the ability to engage additional contracts. So, you know, in some ways it's a it's a mission of love and it's a a throwback to the history of the RTOG that there are so many radiation trials and energy. Um and then the other, you know, I mean, of course, like you know, ECOG is associated with Akron, right? So they they have very high imaging capability as well. And SWAG certainly does run radiation trials. So there, you know, COG runs tons of radiation trials.
SPEAKER_03And for those who are listening and don't know, when when you hear the term intergroup trials, what did that mean?
SPEAKER_02Oh, I love that question. That's actually one of the first questions I asked for any resident on my service. What is the intergroup? And nobody ever knows. There you go.
SPEAKER_03Now they have to listen to my show so they could know.
SPEAKER_02They're all gonna listen to your show. Uh yeah, yeah. I mean, it's so obvious once you explain to people, and that's like, oh, why don't we just explain these things to people? Intergroup means between groups. So in the old days when we had all these groups just running around and it was confusing, they would call it intergroup if two or three of the groups got together and did a trial together. Okay. Now, intergroup, the term went away. So you'll see intergroup historically in some of the old trials, like the names of them are intergroup, blah, blah, blah, blah. That means two or three groups collaborated and put their accrual there. But nowadays, when they reorganized, um the uh NCI created what's called uh the NCT NCTN. Okay, the NCTN is a network, um National Cooperative Trials Network. And the NCTN network means that all five of the cooperative groups uh and CCTG, you can enroll in any other group's trials. So if you open a trial, if if you're a primarily a SWOG site, but you open an NRG trial, you can choose to enroll as a as NRG or you can choose to enroll as a SWOG site either way. And if you're a SWAG site, you'll probably enroll as a SWAG site. And they created that network on purpose to reduce the competition and the friction between the groups with people just sort of being allied only to their group. And so there isn't really no intergroup anymore, it's just the NCTN trial in the network. And and so when one group opens the trial, it's like the whole network opened the trial.
SPEAKER_03So if I were your resident and you quiz me and then you explain this to me, I will say, well, why not all studies be NCTN or intergroup? Like why in the world would we not do every single trial as a collaboration between all of these groups? It would be faster enrollment, probably lower cost, and so on. Why not every study is as such? It is, it is so I understood I understood from you that usually most studies are done separately, like SWAGDA study, eCOG does study.
SPEAKER_02Well, yes, yes, yes, yes. So so the grant, the grant that the NCI gave for the study, right? Because we went to steering, we got our grant. I see, and then the grant was awarded to NRG Oncology, which means that the data, uh, the database and the data, as well as the administrative responsibilities, you know, for tracking the enrollment and accrual and checking eligibility and then doing the QA and the follow-up surveillance data collection and you know, any instruments and stuff like that, all goes to, you know, the group that got the grant. So that's the holder of the trial and the grant and the data. But any group can enroll in that. But you can see that, you know, because the cooperative groups are so community-based, I'll be honest, like, you know, people still feel very attached to the cooperative group because a lot of this is really just personal connection, you know, like like if if someone in Energy opens a study and it's a young investigator I know from um, you know, a nice center that you know really wants to break out and and and they they've put all their resources into making this person, you know, a star. And and I feel very motivated to support that person. I'm gonna say, okay, you know what? I'm gonna push to open this cooperative group trial at my institution to support her because I met her at the energy meeting, and she's like a wonderful person and she's really smart, you know. So, so it's like that. And a lot of that drives the cooperative group because we're no, you know, nobody ever makes money on research.
SPEAKER_03I was gonna tell you, one of the common things, and maybe you can clarify this when people think of cooperative group trials, a lot of cancer centers and and they will say that this is like you said, the cooperative group trials don't really make the cancer center money because they're they're for whatever reason, either the funding is less than pharma-sponsored trials, or maybe the operational costs are higher, or a combination of thereof. So despite that, like you said, you sometimes still say, I'm gonna open these trials at my institution. Do you get any pushback? Because there are other people at the cancer centers who are not physicians, who are administrators, and frankly, they are looking at the PL, they are looking at all of this and say, look, Dr. Yom, I mean, this is this trial is gonna run us in the negative and we can't open it. And to be honest, Sue, I mean, we're in an era where you know dollars do talk and people have to do a lot of these things. So, do you get any pushback? How do you go around the pushback? What is the status of centers trying to open these uh studies despite the fact they're not really uh financially lucrative?
SPEAKER_02Yeah, I mean, that's part of what's you know, part of the mission-driven aspect of this. So, so one thing is that the NCI does require you to have some cooperative group trials. If you have a lot of cooperative group trials, they will, at least in the past, we don't know, things are changing a lot, but at least in the past, that has been a positive thing. And they can even reward you with certain special grants and things like that, support grants. So it is a good thing to go into your CCSG renewal with a lot of cooperative group enrollment and at least a minimum of such. Okay. Cooperative group is priority two, from what I understand. But um, you know, we don't have to talk about all the priority, but it's it's not priority four, it's priority two when they look at your trial portfolio. So that's number one is you have to to to get that status of a nationally recognized NCI designated cancer center or comprehensive cancer center. But the second thing is that if you want your young investigators to become prominent, one way is to teach them to work with industry. Another way is to teach them to work with cooperative group. And I have to be honest, I think a lot of people out there, you know, maybe would like to have their young investigators not thrown into the maw of industry as soon as, you know, while they're still babies. I mean, there is something really supportive and sort of beautiful about the way that cooperative group comes together to support young investigators in a very pure way and really teaching them principles that are a little bit different. And, you know, I'll just say as a um, you know, as a more established investigator, I think that influence is actually really, really important when you're young in your career to see that and to sort of develop your internal compass before you start getting a little bit too swayed by all the glitz and glamour, which which I was when I was, you know, earlier in my career. But thankfully I had such a strong base in the cooperative groups. I I sort of had a um an idea of of when things were, you know, crossing a line that I was uncomfortable with, right? And and I and I think that's really important for you to learn. So the other thing is like you can, you know, you can make your young investigator very well known in the cooperative groups very quickly because the the level of KOLs who are participating in the cooperative groups is is so impressive. Um, it's prestigious NCI funding. Cancer centers don't want to give that up. There will always be very impressive people in the cooperative groups. And as a young investigator, you come in with a lot of enthusiasm. You can meet a lot of people really quickly. And and you know, this is this is a big basis of how I developed uh my own career just meeting people there. Yeah and you know, uh it's it's a different it's a different environment because it's not competitive in the same way that you know when you're in those little booths meeting with companies in the basement of some conference.
SPEAKER_03I I still think you have you have to do both. I mean, I think you have to do both. I mean, some of the like I don't think they're mutually exclusive. No, I mean they're not at all.
SPEAKER_02No, no, no. I mean, and and like I said, you know, we have a lot of collaborative relationships, but I I I think they I think they do come from different shared purposes, right? With with when I work with companies, you know, I I am very conscious of the idea that they're thinking about, you know, how they're gonna get their FDA approval, how they're gonna get this drug to be accepted by the community, you know, what the risks are to their drug in that study, right? And they will avoid certain certain kinds of questions as a result for strategy purposes, whereas in the cooperative groups, it really is about what does the community need to see? What what do we need to treat our patient tomorrow in the clinic? That's just very different.
SPEAKER_03Yeah. So um maybe in the last segment, uh, before we part ways, is uh just uh I am curious about your role as editor-in-chief of the Red Journal. Um uh tell us a bit about maybe the history of it and and and and what what what does your day look like as an editor-in-chief? Like what is what are your responsibilities uh as editor-in-chief in the Red Journal?
SPEAKER_02Um I mean the the core responsibility is managing the flow of papers. So I get about uh I guess you could average it out and say 10 papers a day, but there's actually a lot more editorial and solicited content above that. Um and sort of just making sure that those papers are evaluated properly and make it through the system, that's you know, uh relatively prompt decisions. That's the main core responsibility, but there's a lot that goes into that because every paper has a story. Um there's a lot of correspondence uh with different teams. Uh we now have a lot of you know different kinds of expectations around um ethics and management and promotion of the journal. And so, you know, there is a kind of um corollary like public, public-facing presentation aspect to this too, because I'm considered to be um one of the um sort of parallel uh um officers within Astro in this role. All the editors are considered to be not on the board but parallel in a certain way to the board with the same expectations for COI and and uh conduct. And so, you know, that that and then and then we do um quite a bit of work on the production side, actually, like making the book, which is the Fun part. It's kind of like making your like high school yearbook every month. Um, like putting, you know, because we're still a print journal. We're still we're still pretty uh traditional in some ways. So we actually put together a book, and um The Reginald in particular has a um very artistic side to it. So I do a lot of work with cover art. We recently added poetry. Oh nice. And so so doing that is just like a really, you know, it we try to make it actually a beautiful book.
SPEAKER_03What's the acceptance rate of the journal for original contributions?
SPEAKER_02Uh it's something around 15% for original scientific research. Um, but like I said, we have a lot of solicited content, and then it might actually be lower in some sections. In some sections, it's really low, like as low as like even 8%. It kind of depends because we also run a lot of special issues. We have the ability to still make a really beautiful special issue book on certain topics that we want to focus on, um, which is kind of rare these days, but we really work on that. And so for special issues, the um the acceptance rate is a little bit higher because we're really going for a theme and there's a lot more solicited content.
SPEAKER_03Do you have difficulty finding peer reviewers?
SPEAKER_02We are super fortunate. This this journal is so historically important um to our community, to the worldwide radiation community. We just actually celebrated our 50th anniversary. Um the journal was founded in 1975, October 1975. And so the the alliance to the journal is very high. So our our our peer reviewer acceptance rate has always been around 50%, kind of no matter what, through thick and thin. We actually tried to add in a whole incentives program and rewards program, and I was not sure how that was gonna go. And I was surprised to see that people really loved it and were very happy, and we got lots of nice letters, but it did not change the rate. So that that tells me that people are reviewing for us for a different reason, right? There is a um a love for the journal and a feeling of community, and so I do really actually try to lean into that. I'm very conscious of that. That that our our journal has a particular status of this kind that is it's very it's very precious. It may not last forever, but oh it's gonna last forever.
SPEAKER_03What do you mean? It's gonna last forever.
SPEAKER_02Well, it will evolve.
SPEAKER_03Yeah, it will always last forever.
SPEAKER_02It will evolve. All all all creatures evolve.
SPEAKER_03With you at the helm, it will continue to last. It's gonna evolve to the better. That's what we leave listeners with.
SPEAKER_02Yes, yes. Well, we we make small adjustments all the time, but it is a challenging time for all journals, especially print subscription journals from specialty medical and scientific societies. It is a very challenging time.
SPEAKER_03I will wait uh for my invite in the mail to talk about AI in the root journal. I don't think that's gonna be coming anytime soon. Sue, this was really amazing. Thank you so much for spending some time with me. Any parting thoughts you want to leave our listeners and viewers with?
SPEAKER_02Well, you uh you asked me where we were gonna go get coffee.
SPEAKER_03Yes, yes. Well, I'm hoping to uh well, you don't come to our meetings, Ash and Astow and Esmo and so on. So I'll have to come to yours at Astro, that's for sure.
SPEAKER_02Yeah, if you come, well, if you come to Astro, we'll be in Boston this year.
SPEAKER_03Boston is my favorite town.
SPEAKER_02I'm sure they have lots of good coffee, but I'm I'm not a very particular coffee drinker. I actually just like Vietnamese coffee. So, you know, because any coffee, I'll just tell the the listeners this is a little tip. Even if you have very bad coffee, if you put a little condensed milk in it, it will be good coffee.
SPEAKER_03Yeah, I'm like, you know, I live on the edge. I drink exotic Starbucks coffee, you know, the five coffee that they have, you know. I mean, sometimes Dunkin' Donuts. When is Astro, by the way? I think uh if it's in Boston, I'll definitely come in.
SPEAKER_02Oh, I don't know the exact day, but it's always sometime in like October, November.
SPEAKER_03Yeah, yeah, yeah.
SPEAKER_02I can't remember right now. They're gonna they're gonna be mad that I didn't tell you the date.
SPEAKER_03It's probably gonna conflict with uh Esmo. I mean, there are so many scientific meetings out there, let me tell you. I mean, there's so many, it's crazy. I think we can have a meeting every single week. So, but I look forward to uh to seeing you very soon. Uh, Dr. Sui Oms, thank you so much for coming on Healthcare Unfiltered. Thanks, folks, for listening. I appreciate you tuning in. Thank you for your support. Don't forget to rate the show. Um, again, review it. Uh, let me know what you think. You can also check out my other show, Healthcare Unfiltered Express, which really reviews a lot of clinical data that is that just cannot wait from week in and week out. So we actually air Healthcare Unfiltered Express, which you can find it everywhere on Apple, Spotify, Amazon, YouTube, and so on. Folks, before I let you go, I'm gonna leave you with a saying by Epictus. We have two ears and one mouth so that we can listen twice as much. Until next time. Take care.