Professor Eva Segelov chats to Professor Nathan Cherny, who leads the Multidisciplinary Cancer Pain and Palliative Medicine Service at Shaare Zedek Medical Center, in Jerusalem, Israel and is the mastermind behind the ESMO Magnitude of Clinical Benefit Scale.
In this personal and moving interview, Nathan addresses flaws in clinical trial design, the politics of drug costs and disparities of outcomes. Nathan also reflects on his medical school days at Monash where he discovered he had testicular cancer. He discusses his experiences as a young physician in the USA, his work in Jerusalem integrating oncology with palliative care and treating patients in the West Bank.
At the end, money doesn’t buy happiness or health. The issues that people were confronting – the existential issues and the spiritual issues at the end of life – were similar amongst the super wealthy and the super poor.
References and further reading:
Cherny NI, et al. Words matter: distinguishing “personalized medicine” and “biologically personalized therapeutics”. J Natl Cancer Inst. 2014 Oct 7;106(12):dju321. doi: 10.1093/jnci/dju321. PMID: 25293984; PMCID: PMC4568994. Access online here.
Cherny NI, et al. Improving the methodologic and ethical validity of best supportive care studies in oncology: lessons from a systematic review. J Clin Oncol. 2009 Nov 10;27(32):5476-86. doi: 10.1200/JCO.2009.21.9592. Epub 2009 Jun 29. PMID: 19564538. Access online here.
Gyawali B, et al. Biases in study design, implementation, and data analysis that distort the appraisal of clinical benefit and ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) scoring. ESMO Open. 2021 Jun;6(3):100117. doi: 10.1016/j.esmoop.2021.100117. Epub 2021 Apr 20. PMID: 33887690; PMCID: PMC8086024. Access online here.
Cherny NI. Commentary: sedation in response to refractory existential distress: walking the fine line. J Pain Symptom Manage. 1998 Dec;16(6):404-6. doi: 10.1016/s0885-3924(98)00114-6. PMID: 9879166. Access online here.
Cherny NI, et al; Board of the European Association for Palliative Care. European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care. Palliat Med. 2009 Oct;23(7):581-93. doi: 10.1177/0269216309107024. PMID: 19858355. Access online here.
Cherny NI, ey al. Palliative care: needs of advanced breast cancer patients. Breast Cancer (Dove Med Press). 2018 Dec 3;10:231-243. doi: 10.2147/BCTT.S160462. PMID: 30584354; PMCID: PMC6284851. Access online here.
Cleary J, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Latin America and the Caribbean: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013 Dec;24 Suppl 11:xi41-50. doi: 10.1093/annonc/mdt502. PMID: 24285228. Access online here.
Cleary J, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in India: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013 Dec;24 Suppl 11:xi33-40. doi: 10.1093/annonc/mdt501. PMID: 24285227. Access online here.
Cleary J, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013 Dec;24 Suppl 11:xi14-23. doi: 10.1093/annonc/mdt499. PMID: 24285225. Access online here.
Cherny NI, et al. The Global Opioid Policy Initiative (GOPI) project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Caribbean, and the Middle East: introduction and methodology. Ann Oncol. 2013 Dec;24 Suppl 11:xi7-13. doi: 10.1093/annonc/mdt498. PMID: 24436961. Access online here.
Cleary J,et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013 Dec;24 Suppl 11:xi51-9. doi: 10.1093/annonc/mdt503. PMID: 24285230. Access online here.
Cherny NI, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative. Ann Oncol. 2010 Mar;21(3):615-626. doi: 10.1093/annonc/mdp581. PMID: 20176694. Access online here.
Cleary J, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Asia: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013 Dec;24 Suppl 11:xi24-32. doi: 10.1093/annonc/mdt500. PMID: 24285226. Access online here.
Cleary J, et al. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol. 2013 Dec;24 Suppl 11:xi51-9. doi: 10.1093/annonc/mdt503. PMID: 24285230. Access online here.
Cherny NI; Palliative Care Working Group of the European Society for Medical Oncology. Factors influencing the attitudes and behaviors of oncologists regarding the truthful disclosure of information to patients with advanced and incurable cancer. Psychooncology. 2011 Dec;20(12):1269-84. doi: 10.1002/pon.1853. Epub 2010 Sep 28. PMID: 20878723. Access online here.
Cherny NI. Controversies in oncologist-patient communication: a nuanced approach to autonomy, culture, and paternalism. Oncology (Williston Park). 2012 Jan;26(1):37-43, 46. PMID: 22393795. Access online here.
Cherny NI, et al. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Ann Oncol. 2015 Aug;26(8):1547-73. doi: 10.1093/annonc/mdv249. Epub 2015 May 30. Erratum in: Ann Oncol. 2017 Nov 1;28(11):2901-2905. PMID: 26026162. Access online here.
Kiesewetter B, et al. EHA evaluation of the ESMO-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS v1.1) for haematological malignancies. ESMO Open. 2020 Jan;5(1):e000611. doi: 10.1136/esmoopen-2019-000611. PMID: 31958292; PMCID: PMC7003483. Access online here.
Dafni U, et al. Detailed statistical assessment of the characteristics of the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS) threshold rules. ESMO Open. 2017 Oct 9;2(4):e000216. doi: 10.1136/esmoopen-2017-000216. PMID: 29067214; PMCID: PMC5640101. Access online here.
Cherny NI, et al. Comparative Assessment of Clinical Benefit Using the ESMO-Magnitude of Clinical Benefit Scale Version 1.1 and the ASCO Value Framework Net Health Benefit Score. J Clin Oncol. 2019 Feb 1;37(4):336-349. doi: 10.1200/JCO.18.00729. Epub 2018 Dec 17. PMID: 30707056. Access online here.
Cherny NI, et al. Attitudes of medical oncologists toward palliative care for patients with advanced and incurable cancer: report on a survery by the European Society of Medical Oncology Taskforce on Palliative and Supportive Care. Cancer. 2003 Dec 1;98(11):2502-10. doi: 10.1002/cncr.11815. PMID: 14635087. Access online here.
ESMO: A Guide for Patients with Advanced Cancer (pdf).
Hui D, et al. Indicators of integration at ESMO Designated Centres of Integrated Oncology and Palliative Care. ESMO Open. 2018 Jul 11;3(5):e000372. doi: 10.1136/esmoopen-2018-000372. PMID: 30018816; PMCID: PMC6045723. Access online here.
Caraceni A, et al. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012 Feb;13(2):e58-68. doi: 10.1016/S1470-2045(12)70040-2. PMID: 22300860. Access online here.
Cherny NJ, Cet al. Opioid pharmacotherapy in the management of cancer pain: a survey of strategies used by pain physicians for the selection of analgesic drugs and routes of administration. Cancer. 1995 Oct 1;76(7):1283-93. doi: 10.1002/1097-0142(19951001)76:7<1283::aid-cncr2820760728>3.0.co;2-0. PMID: 8630910. Access online here.
Cherny NI. The management of cancer pain. CA Cancer J Clin. 2000 Mar-Apr;50(2):70-116; quiz 117-20. doi: 10.3322/canjclin.50.2.70. PMID: 10870487. Access online here.
Cherny NI. How to deal with difficult pain problems. Ann Oncol. 2005;16 Suppl 2:ii79-87. doi: 10.1093/annonc/mdi705. PMID: 15958481. Access online here.
Cherny NI, et al. Cancer pain management. Current strategy. Cancer. 1993 Dec 1;72(11 Suppl):3393-415. doi: 10.1002/1097-0142(19931201)72:11+<3393::aid-cncr2820721606>3.0.co;2-o. PMID: 7902204. Access online here.
de Vries EGE, et al. When is off-label off-road? Ann Oncol. 2019 Oct 1;30(10):1536-1538. doi: 10.1093/annonc/mdz445. Erratum in: Ann Oncol. 2019 Dec 1;30(12):2018. PMID: 31688929; PMCID: PMC6857611. Access online here.
Cherny NI, et al. The global imperative to make cancer medications affordable. Lancet Oncol. 2020 May;21(5):609-610. doi: 10.1016/S1470-2045(20)30165-0. PMID: 32359485. Access online here.
Cherny NI, et al. ESMO International Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in countries outside of Europe. Ann Oncol. 2017 Nov 1;28(11):2633-2647. doi: 10.1093/annonc/mdx521. PMID: 28950323; PMCID: PMC5834140. Access online here.
Cherny N, et al. Corrigendum to “ESMO European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in Europe”: Ann Oncol 2016; 27 (8): 1423-1443. Ann Oncol. 2020 Nov;31(11):1589. doi: 10.1016/j.annonc.2020.09.002. Epub 2020 Sep 18. Erratum for: Ann Oncol. 2016 Aug;27(8):1423-43. PMID: 32958358. Access online here.
Cherny NI. ESMO gave me a chance to help make a difference: a personal reflection on the occasion of receiving the 2015 ESMO Award. ESMO Open. 2016 May 25;1(3):e000061. doi: 10.1136/esmoopen-2016-000061. PMID: 27843614; PMCID: PMC5070249. Access online here.
This Week’s Team:
Professor Eva Segelov
Eva Segelov
Professor Eva Segelov is a Medical Oncologist and is Director of Oncology at Monash University and Monash Health, Melbourne, Victoria, previously Senior Medical Oncologist at St Vincent’s Hospital, St Vincent’s Private Hospital and St Vincent’s Clinic and Associate Professor of Medicine, University of New South Wales.
Eva has an interest in academic clinical trials in GI and breast cancer and has been a member of the AGITG since 2003. She has clinical trials expertise, links with national and international trials groups, and extensive experience with adult medical education. Connect with Eva on Twitter here: @profevasegelov
Nathan Cherny:
Nathan Cherny is married (to Nancy) with four children (Gil, Eitan, Noa and Calanit). He lives in Maccabim, central Israel. He was born in Melbourne, Australia, and studied medicine at Monash University Medical School.
In 1994 Dr Cherny joined with Prof Raphael Catane to establish the Oncology and Palliative Medicine Unit at the Shaare Zedek Hospital in Jerusalem. The model and standards for integrated oncology and palliative care developed by Prof Cherny and Prof Catane have since served as the basis for the designation criteria for the ESMO Designated Center program in Integrated Oncology and Palliative Care. He continues to head the Multidisciplinary Cancer Pain and Palliative Medicine Service at Shaare Zedek Medical Center, and, in addition, he maintains an active practice in general oncology. He runs a mentorship program for Palestinian oncologists from the West Bank and for the Al-sadeel Palliative Care Society in Bethlehem.
In 1999 he helped established the European Society of Medical Oncology Palliative Care Working Group. He is the current chair of the ESMO magnitude of clinical benefit scale working group. In 2019 he was awarded Member of the Order of Australia. Connect with Nathan on Twitter here: @ChernyNathan
Rachael Babin
Rachael Babin is Editor-in-Chief of The Oncology Newsletter, Publisher of Oncology News Host of The Oncology Podcast and Producer of The Oncology Journal Club. For regular oncology updates for healthcare professionals, please subscribe to The Oncology Newsletter.
With thanks to Eva Segelov, Nathan Cherny and Graham Knowles.
Connect with us on Twitter @OncologyNewsAus
