SY2-4 - Training Oncologists in Cross-Specialty Medical Oncology

Abstract

ABSTRACT In the past, cancer chemotherapy was administered by physicians in organ-specific specialties in Japan. For example, patients with lung cancer were treated by chest physicians, and chemotherapy for patients with gastrointestinal (GI) cancers was administered by gastroenterologists and sometimes even by surgeons. However, this method of treatment of oncology patients produced large numbers of ‘cancer refugees’, and patients with metastasis from other organs were inadequately treated. Furthermore, the recent development of molecular target drugs has made anti-cancer drug therapy complicated and highly specialized, and it is now difficult to engage in chemotherapy as an endoscopist or surgeon. An era has come in which medical oncologists who are trained specifically to administer chemotherapy should provide anticancer drug therapy. Cancer chemotherapy should not be given in an organ-specific medical specialty system. Physicians who are able to treat only lung cancer should be called thoracic oncologists, not medical oncologists. Doctors who treat GI cancers but who cannot treat breast or other cancers are GI oncologists, not medical oncologists. Medical oncologists should be able to treat all cancers and have experience in the treatment of hematological malignancies. In 2013, hematological training will be required for all candidates for the examination for Board-Certified Medical Oncologists of the Japanese Society of Medical Oncology (JSMO). A training program in medical graduate schools, ‘GAN-PRO’, has been implemented for 5 years in Japan to educate medical oncologists who can manage various cancers. The JSMO certifies that kind of oncologists as Board-Certified Medical Oncologists. It is best to train oncologists to manage all types of cancers in one department of a medical school, which may be difficult in some medical schools because cancer patients have been treated in organ-specific medical specialties. Currently, we are in a transition phase from an organ-specific specialty to a general medical oncology system. For this purpose, basically two types of training systems are currently implemented in medical schools. In one system, trainees rotate through departments of a hospital, spending several months in each department. In this case, the policy for treatment may not be identical in all departments. In the other system, trainees can receive all their training in one department. Obviously the latter is a better system. In the Section of Medical Oncology/Hematology at Kobe University, the faculty comprises oncologists who cover all solid tumors and hematologists. They can train graduate students in treating all cancers including hematological malignancies. So far trainees of this system have passed the test for Board-Certified Medical Oncologists with high scores. A training system which enables trainees to experience treatment of all cancers should be implemented in all institutions in the near future.