Prescribing Patterns of Surgical Oncologists: Are We Surgeons, Oncologists, or Both?

Abstract

Although surgical treatment is the centerpiece of our specialty, what differentiates surgical oncology from other areas in surgery is the oncology experience and expertise needed in dealing with all aspects of cancer management in a multidisciplinary fashion. ... The salient feature of differentiation is that surgical oncology is both a technical and cognitive specialty involving a chronic disease process. What is a surgical oncologist? Ann Surg Oncol 1993; 1:4 Despite our stated purpose of surgical oncology as a specialty, it would probably not surprise the readers of the Annals that there is still a fairly widespread perception among medical oncologists and members of the pharmaceutical companies that ‘‘surgeons spend their time in the operating room and have a relatively minor role in prescribing oncology and supportive drugs.’’ Recently, I talked with a senior marketing executive of a major pharmaceutical company who stated that their company would not advertise in our journal, exhibit at our meeting, or fund SSO educational grants or sponsorships. This was because of their perception that surgeons—including surgical oncologists—neither prescribe their drug products nor influence their use in surgical patients. Perhaps less well understood by both the medical oncology community and the pharmaceutical leadership is that many, if not the majority, of cancer patients look to the surgeon who made the diagnosis and initiated the primary treatment for advice about systemic therapy. Furthermore, surgical oncologists have led the way in defining predictors of survival outcomes for the majority of cancers, thereby identifying those at greatest risk of occult distant metastases, and hence are knowledgeable as to which of their surgical patients might benefit from systemic therapy. While we may know this perception is untrue at an individual level, there is nothing better than having good data to break such molds of misperception. That is why I was pleased with the enormous response from our SSO members to a survey conducted by the Annals of Surgical Oncology Editors and Springer Verlag Publishers. One component of this survey was to tabulate prescribing practice patterns of 532 surgical oncologists. This is more than onethird of the active membership and makes the survey results very creditable and representative. (The entire TABLE 1. On average, how many drug orders (inpatient or outpatient) do you or a trainee under your supervision prescribe each week? (520 responses)