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Serving Interests in Hematologic Malignancies in the Journal of Clinical Oncology

Georgetown University, Washington, DC

Daniel Haller

University of Pennsylvania Cancer Center, Philadelphia, PA

Sandra J. Horning

Stanford University, Palo Alto, CA

From time to time, medical societies and their journals need to examine whether they are serving the needs of their members and subscribers. The mission of the American Society of Clinical Oncology (ASCO) is to support research, education, and clinical care for patients with all forms of malignant diseases. However, there has been an impression among some members with a particular interest in hematologic malignancies that ASCO and the Journal of Clinical Oncology (JCO) have not paid adequate attention to those diseases. The hematologic malignancies are not uncommon forms of cancer: for example, non-Hodgkin's lymphomas represent the fifth leading cause of cancer and cancer deaths in the United States. In fact, only two common cancer types are currently increasing in incidence in the United States: malignant melanoma and non-Hodgkin's lymphoma. When Hodgkin's lymphoma, acute and chronic leukemias, and multiple myeloma are combined, the hematologic malignancies are as common as colorectal cancer. Nevertheless, within the ASCO membership, there has been a perceived disproportionate attention to the solid tumors by those whose research and practice focuses primarily on hematologic malignancies (which we will refer to hereafter as leukemia, lymphoma, and myeloma [LLM]). Several years ago, ASCO established a task force to address this problem. In addition, spurring an examination of the dedication of ASCO to LLM were the limited number of sessions devoted to these disorders at the 2004 ASCO meeting, and the inadequate space provided for these sessions for the attendees.

In an attempt to improve not only the perception but the reality of the society's attention to LLM, ASCO organized a workshop in August 2004 to discuss ways in which the importance of these diseases to the society could be better articulated and further enhanced. Participants included North American and European investigators who have dedicated their careers to laboratory-based or clinical research in LLM.

The discussions focused on what ASCO members consider to be the two most important aspects of ASCO: the Annual Meeting and JCO. What became apparent was that there were numerous, serious misperceptions regarding JCO. The participants believed that there were few, if any, LLM articles in JCO, reflecting the perception that the society and JCO were relatively indifferent about this group of diseases. As a consequence of this impression, interesting clinical articles have all too frequently been submitted first to either the New England Journal of Medicine or to Blood, the journal of the American Society of Hematology (ASH). A number of explanations were offered for the choice of the latter journal. First, our European colleagues, in particular, did not want their high-quality LLM studies included with the solid tumor articles in JCO that were of less interest to them. Second, Blood contains much more in the way of laboratory-based and translational research, providing a potentially more comfortable environment for the relatively few clinical hematology articles it publishes. Third, many physicians who treat LLM are card-carrying hematologists, not medical oncologists (as is the case with one of the authors of this editorial comment). The fact that many important studies are presented at ASH, rather than ASCO, directly leads to their submission to Blood rather than JCO. The feeling was that the impact factor (the number that indicates how often articles from a particular journal are cited, which is important both for authors and advertisers), and the overall impact on the breadth of readership were higher for articles published in Blood. There was also the impression that the review system in JCO was inadequate, with long review times and slow publication. Finally, there was a sentiment that JCO was not interested in publishing LLM articles, especially those with a translational research component.

Those were the perceptions, but here is the current reality: during the last 2 years, the number of LLM articles submitted for publication in the JCO has steadily increased from 228 in 2002 to 280 in 2004, accompanied by an increase in the number accepted per year from 55 to 74, with a concomitant improvement in the quality of those articles. Indeed, there are more LLM articles received and reviewed by JCO than for any other disease or modality section. With 355 LLM articles available online, there were 239,563 accesses to full text HTML and 146,000 accesses to PDF files in 2004. There has also been a marked reduction in the time of the review process. In 2000, the time from manuscript submission to editorial decision was 9.3 weeks, which has incrementally decreased each year to 7 weeks in 2004. Similarly, the time from acceptance to publication decreased from 18.1 weeks in 2000 to 15 weeks in 2004. Thus, the overall time from submission to print publication improved by 2.5 months during that time period. This effect resulted in part from self-publication, which began in 2003. With the recent move to online submission and review, these times will certainly be reduced even further. Moreover, with our ability to publish online before print, the availability of manuscripts to the scientific community has been more rapid. As editors, we have become increasingly proactive in soliciting LLM manuscripts for publication in JCO; we approach the potential authors as early as the time the abstracts are accepted for presentation at the ASCO Annual Meeting.

Regarding the impact factor, during the last 2 years the impact factor of JCO articles has increased to 10.9, which is highly competitive with any subspecialty peer-reviewed journal in hematology-oncology. In addition, beginning in 2005, a new issue of JCO is devoted to molecular oncology alternating with a review topic each month that will provide a resource for the publication of LLM articles not previously thought to be appropriate for JCO. Finally, one of the special review editions of JCO to be published this year, coordinated by Bruce Cheson and edited by Sandra Horning, Ken Anderson, and Hartmut Doehner, will contain state-of-the-art reviews of the biology and therapy of the leukemias, lymphomas, and myeloma. Given that ASCO, reflected by enhancements in the Annual Meeting, shows greater attention to these diseases, we expect a larger number of excellent articles to be submitted to and published in JCO.

Clearly, ASCO and JCO have a long way to go before those members whose primary focus is in the research and treatment of the LLM believe that they and their field are adequately represented in the Annual Meeting and in the society's journal. But that process requires continued active participation by both ASCO and the membership. For those whose work focuses on LLM to feel well-represented by ASCO, in its Annual Meeting, and in its journal, they need to attend the Annual Meeting, to submit abstracts to the ASCO Annual Meeting and articles to JCO, and—most importantly—to continue to encourage our fellows and younger colleagues to do the same. Finally, to make sure that the membership, the society, and its journal continue to meet common goals in the dissemination of information and advancement of treatment of LLM, it will be important to have a continuous process of feedback and improvements. Working together, JCO will not only continue to be the premier journal for oncology as a whole, but for each of its constituencies, notably for those interested in hematologic malignancies.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

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