Editor’s Note
	The Real World

It's time for a confession. During medical school at the University of Pennsylvania, I always sat in the seat closest to the door of the lecture hall. After a few minutes of hearing a professorial incantation, I would decide whether it was worth listening or if I could learn more by reading textbooks and my colleagues' notes. More often than not, I was out the door.

My impatience with esoteric presentations that have minimal practical implications has continued, although the fast pace of ASCO and other scientific meetings prevents me from "giving the hook" to many speakers. My history of intolerance to boring educational formats led me to develop a CME group 20 years ago that constantly experiments with programs focusing on daily medical practice. The case discussions in this monograph typify the dilemmas faced by patients and physicians every day.

We held three working group meetings this year to identify the "real-world" issues in the care of women with breast cancer. One unusual facet of this initiative was that prior to the meetings, each participant submitted four breast cancer case writeups from their respective practices.

These cases focused on one challenging treatment decision that the physician and patient faced, and our group carefully analyzed these to identify themes we could potentially address in our educational programs.

It was interesting that when we transposed a case from the typical nondescript "a 44-year-old female with a 2.2-cm, Grade II, ER/PR-positive, HER2-positive infiltrating ductal carcinoma and three positive nodes" to "a 44-year-old nurse with high-risk breast cancer who is a single mother of three children under the age of 10," the nature of the discussion at the meeting shifted as it related to the perspectives of patients and physicians about emerging clinical research data and participation in clinical trials.

This monograph consists of edited discussions from a number of the more than 500 de-identified cases submitted, including comments from the faculty members who participated in these meetings. Our goal is to provide a snapshot of the myriad of complex biopsychosocial issues that oncologists and surgeons face when recommending therapy for patients with breast cancer in the adjuvant or metastatic setting.

Although this is the era of "evidence-based medicine," these cases include many "anecdote-based" management practices. Our purpose is not to endorse these approaches, but rather to acknowledge that clinicians often rely upon experience and intuition in making decisions when the research data are sparse or nonexistent.

Our CME group recently renamed ourselves, "Research To Practice," because the clinicians on our content development staff, including myself, wish to take a scientific approach to educating physicians about the potential clinical implications of emerging research data and ongoing clinical trials.

This includes a realistic assessment of the education needs of our audience, and we evaluate this using a somewhat complex and integrated model. First, we review the data published in journals and presented in meetings. We also follow the evolution of ongoing clinical trials and meet regularly with key investigators to learn of their "take" on emerging data.

We have also approached patients for input, and this year we held three "Breast Cancer Patients' Perspectives" meetings where more than 1,200 survivors utilized handheld keypads and portable computers to provide their input on controversial treatment decisions.

The three community physician working group meetings profiled in this monograph directly fit into this paradigm of CME needs assessment, in that we turned to these oncologists and surgeons to find out the issues they face in daily practice and how emerging research data and ongoing clinical trials are relevant.

We hope this discussion provides useful insight into some of the real-world challenges in translating oncology research into practice and that it will be an educational resource that helps us develop programs that prevent our physician audience from "bolting for the door."

-Neil Love, MD

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