编者按：在2025年美国国立综合癌症网络（NCCN）年会落幕之际，《肿瘤瞭望》特别对话NCCN首席医疗官Wui-Jin Koh教授，解码肿瘤诊疗的未来趋势。从AI辅助医疗决策的应用前景到去中心化临床试验的普惠实践，从对抗医护人员职业倦怠的系统性挑战到癌症患者照护体系的生态重构，Wui-Jin Koh教授的见解不仅揭示了NCCN工作的未来方向，也为全球医疗界提供了宝贵的参考。现将采访内容整理如下，以飨读者。

 

Wui-Jin Koh教授：众所周知，AI在社会的许多领域，包括医学和肿瘤学中，正扮演着越来越重要的角色。但我认为，我们在使用AI时仍需保持谨慎态度。AI的应用场景需要更加明确的界定，NCCN将持续关注AI技术的发展及其在临床决策支持中的潜在价值。

 

就当前阶段而言，NCCN暂未将AI直接整合至指南制定流程中（例如通过AI生成指南建议），我们认为其成熟度尚未达到标准。但需要强调的是，AI在指南的特定环节已发挥作用。例如，AI辅助技术（如乳腺钼靶筛查或肺癌CT检查）的应用已较为成熟。以《前列腺癌指南》为例，我们纳入了基于AI的数字病理检测，用于指导患者是否接受激素治疗。

 

因此，尽管AI在局部环节的应用已获认可，但我们尚不主张让AI来告诉医生或患者整个治疗过程该怎么做。我认为随着时间的推移，我们会逐渐纳入更多关于AI的元素。未来一段时间内，NCCN将逐步扩大AI的应用范围。本次年会也特设专题讨论，聚焦AI的技术突破与临床前景，同时也深入探讨了其局限性以及需突破的瓶颈。

 

Dr.Wui-Jin Koh:Thank you for having me on this discussion.So，we understand the emerging role of AI in many parts of society，including medicine and oncology.I think we need to be a little bit careful when we use AI.To say broadly，what exactly that facet of AI，we’re continuing to monitor the emergence of AI and its potential role in decision support.

 

So at this point，NCCN，what we’re very interested in，it is not incorporating AI into how to create the guidelines，for example.We still believe that is not yet there，but we do recognize the role of AI in certain elements of the guidelines.For example，we know that AI is used in helping do screening，breast mammographies or lung cancer CTs.We know that’s well established.And if you look at our prostate cancer guidelines，we include an AI test，a digital pathology AI test to help patients decide whether or not to get hormonal therapy.So there are certain elements where AI is already incorporated.I don’t think we’re quite ready to say，let’s have AI tell the doctor what to do for the whole course of the patient.I think overtime，we will incorporate larger elements of AI.And at this conference，you know，we had a session that discussed the promises，the advances in AI，but also the things that we need to overcome in terms of its limitations.

Wui-Jin Koh教授：首先需要明确的是，NCCN在每项指南开篇都强调临床试验的重要性。我们明确指出：“我们认可临床试验的价值，并鼓励患者在条件允许时积极参与，同时所有试验设计都应致力于实现最大包容性和广泛代表性。”

 

关于如何覆盖资源匮乏群体，NCCN正在通过成员机构提供相应的支持，例如开展“去中心化的试验”，其核心在于：传统临床试验多在大型癌症中心开展，患者往往需要长途跋涉。因此，我们希望能够通过提供交通支持帮助患者前往大型癌症中心，或者让与临床试验相关的大部分医疗护理能够在患者居住地附近完成，患者无需为了抽血等检查频繁前往中心。我们还可以利用远程医疗提供支持。此外，我们也倡导为参与临床试验的患者提供经济支持，因为参与试验确实会带来额外的费用。此外，我们一直在推动有关政策，确保政府和保险公司能够承担与临床试验相关的常规医疗费用，以保证经济因素不会成为人们参与临床试验的障碍。

 

Dr.Wui-Jin Koh:So the first part is that we and NCCN at the beginning of every guideline states how important clinical trials is，right?And we state that it recognizes the importance of clinical trials and encourages participation when applicable and available，and trials should always be designed to maximize inclusiveness and broad representative participation.

 

So the first thing we say is the clinical trials is an important part.We recognize that.I think in terms of including historically underserved population，we are supporting，and this is led by our member institutions，things such as decentralized trials.And what we mean by that is historically，trials are done in big cancer centers where patients have to travel a long way.So what we’re hoping to achieve is either to help provide transport if patients need to come to the big cancer centers or to allow a lot of the medical care associated with clinical trials to be done closer to a patient’s home.They don’t have to come in for blood test.We can use tele-medicine to help support，and we also advocate for financial support for patients who are in clinical trials because there’s an added cost.So we’ve been advocating policy to make sure that the government and insurance companies cover the routine medical cost associated with clinical trials so that everybody，that does not become a barrier to people being involved in clinical trials.

Wui-Jin Koh教授：临床医生的职业倦怠确实是一个重大问题，这一问题在新冠疫情期间尤为凸显，并持续至今。具体到肿瘤学领域，我们意识到许多肿瘤科医生年龄偏大，未来将有更多人退休。同时，随着人口老龄化，癌症患者数量将持续增加，而临床医生以及护理人员的数量却在减少，医疗资源将更加紧张。

 

因此，我们试图解决的问题是：首先，通过教育使医护人员意识到职业倦怠的普遍性，鼓励其正视而非羞于承认。过去人们可能会认为“倦怠是软弱的表现”，我们致力于消除这种偏见；其次，推动医疗机构为受倦怠困扰的医护人员提供帮助、教育及解决方案（例如精神和心理健康支持）。

 

此外，我们相信NCCN指南可通过优化诊疗流程间接缓解职业倦怠。在美国，大量倦怠源于“预先授权”流程——医生需反复与保险公司协商以获得治疗批准。我们正与多方合作推动“自动授权”机制：若患者符合NCCN指南推荐的治疗方案，则无需额外审批即可进行治疗。同时，我们致力于将指南整合至电子健康记录系统，使医生在接诊时能根据患者特征直接调取相关建议，提升信息获取与决策效率。

 

最后我想要强调的一点是，除支持医护人员外，我们也需要高度关注患者家属及照护者的支持体系建设，他们在患者的抗癌历程中至关重要，而这一群体常被忽视。因此，NCCN也在特别强调对癌症护理的支持。

 

Dr.Wui-Jin Koh:Clinician burnout is indeed a big issue，as you know.It was highlighted or brought into greater emphasis with the covid pandemic and it’s continued.

 

And specific to oncology，we realize that a lot of oncologists are already on the older side.There will be more retirements.And as the population gets older，there’ll be more people with cancer.So the workforce is being stretched by more cancer patients and less clinicians，not just doctors.In fact，we could argue that nursing is another big area.So the areas that we try to address is that we make people through the efforts of educators aware that burnout is something that is common，that people should not be ashamed，to recognize it.Because in the past，people would say，well，it’s a sign of weakness if we say this burnout.So we want people to recognize the symptoms of burnout.We want systems to provide help and education and options to address burnout，you know，mindfulness，mental health.

 

I think that one other thing that can help with burnout is that we believe that NCCN guidelines can help with making the right treatment the easier thing to get.What I mean by that is a lot of burnout，at least in the United States，has to do with pre-authorization.You know，if you want a treatment，can you get the insurance company to agree to it，to reimburse for it rather than have this constant fight?So if the guidelines continue to represent the standard of care，we’re working with many organizations to have what we call automatic authorization so that if a patient is determined to benefit from a treatment on the NCCN guidelines，then that would be approve without having to go through all of these battles，if you will，to get it approve.So that’s one way because insurance and pre-authorization is one of the big factors in burnout.And the other thing I should say is that we’re also working to get our guidelines into electronic health record systems，so that clinicians at the point of care have direct access even as the，you know，typing in the patient characteristic.So we wanna make the information easy to get and easy to effect.

 

And one other thing I should mention is that we also focus that when we deal with burnout，there’s so many aspects of it.And one of the aspects that we dealt with was we wanna support the patients，we wanna support the clinicians.But an important part is to support the patients’caregivers，their family members.Because that’s a really important part of the healthcare journey for patients.And we’re also made an emphasis on supporting that very important component within cancer care.

 

Wui-Jin Koh

●医学博士

●NCCN高级副总裁、首席医疗官