PREPARING FOR THE UNEXPECTED: WHAT YOU’RE NOT · 2017-09-26 · Scan with a QR code reader to...

Volume 7 • Issue 3, 09.15

My Path to Fellowship: Slightly Different From Most

Geriatric Oncology: Learning the Balancing Act of Treating the Older Cancer Patient

Apps for the Healthcare Professional

Bringing the Oncology Community Together

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WHAT YOU’RE NOTTOLD DURING ORIENTAT ION

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OncLive.com Oncology Fellows • 09.15 | 1

Interested in contributing to Oncology Fellows? If you’d like to submit an article for consideration in an upcoming issue, please e-mail Jeanne Linke at [email protected].

Table of Contents

2

Volume 7 • Issue 3, 09.15

Feature

Departments

President, Healthcare Specialty Group and Oncology Specialty Group Mike Hennessy, Jr

Editorial & ProductionSenior Vice President, Operations and Clinical AffairsJeff D. Prescott, PharmD, RPh

Senior Clinical Projects ManagerIda Delmendo

Project CoordinatorJen Douglass

Associate Editor Jeanne Linke

Senior DesignerMelissa Feinen

Sales & MarketingVice President, Integrated Special Projects Group David Lepping

Associate Publisher Erik Lohrmann

Director of SalesRobert Goldsmith

National Accounts ManagerAlbert Tierney

Digital Media AssociateKristin Lopez

National Accounts AssociateJames Maier

Sales & Marketing CoordinatorJessica Smith

Director, Strategic Alliance ProgramFrancine Durcan

National Accounts Manager, Strategic Alliance PartnershipHeather Shankman

Operations & FinanceGroup Director, Circulation and ProductionJohn Burke

Director of OperationsThomas J. Kanzler

ControllerJonathan Fisher, CPA

Assistant ControllerLeah Babitz, CPA

AccountantTejinder Gill

CorporateChairman and CEOMike Hennessy, Sr

Vice Chairman Jack Lepping

Chief Operating Officer and Chief Financial OfficerNeil Glasser, CPA/CFE

Executive Vice President and General ManagerJohn C. Maglione

Vice President, Digital Media Jung Kim

Chief Creative OfficerJeff Brown

Human Resources Director Shari Lundenberg

For more articles, go to www.OncLive.com/publications/ oncology-fellows

My Path to Fellowship: Slightly Different From MostStephen Williams, MD, discusses his unique path in medicine, and explains why he opted to leave private practice to pursue fellowship and an academic career.

Preparing for the Unexpected: What You’re Not Told During OrientationBased on personal experiences, Moshe Ornstein, MD, MA, shares advice to first-year fellows on how to manage their new roles and responsibilities.

6

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A Word From Your Fellows10 Geriatric Oncology: Learning the

Balancing Act of Treating the Older Cancer Patient

Shin Yin Lee, MD, explains that when healthcare professionals make treatment decisions for older patients with cancer, the challenge is in selecting the appropriate therapy for the appropriate patient.

Online Oncologist14 Mobile Medicine

Apps for the healthcare professional.

By the Numbers15 Concerns Regarding the Future

Oncology Workforce

Conference Center16 2015 Oncology & Hematology

Meetings

Scan with a QR code reader to visit OncLive.com, the online home of Oncoloy Fellows®.

FEATURE

2 | Oncology Fellows • 09.15 OncLive.com


Dear Incoming Oncology Fellow,

Congratulations! It took at least 4 years of college, 4 years of medical school, and 3 years of internal medicine residency to reach this point. But you’re finally here. There are no more agonizing personal statements to write, ERAS tokens to obtain, or “Why do you want to be an oncologist?” questions to answer. That’s the good news. As you begin your first year of oncology fellowship, I want to share with you a few things I’ve learned since standing in your shoes just 12 months ago.

Oncology Fellowship Is Not a Continuation of ResidencyDuring your first year of fellowship, you will confront challenges different from those encountered by your colleagues who have pursued specialty training in other fields such as cardiology, critical care, and gastroenterology. In most residency programs, the majority of inpatient rotations surround the traditional medical fields of general medicine, gastrointestinal medicine, intensive care, and cardiology. Inpatient oncol-ogy rotations are far less common, thus limiting your exposure to the acute medical complications faced by cancer patients. Moreover, even if you were to rotate on the inpatient oncology service, it would not be an accurate reflection of what you will ex-perience as an oncology fellow, because the majority of oncology care takes place in the outpatient setting.

Your learning curve will be far steeper than those of your colleagues in other special-ties, who gained substantial exposure to the core medical issues in their fields during their residency. Whereas words like heart failure, chronic obstructive pulmonary dis-ease (COPD), diabetes, and hypertension roll seamlessly off the tongue of any resident, tongue twisters like blinatumomab and palbociclib do not. You’ll quickly learn that while residency may have prepared you for the acute management of a patient’s prer-enal kidney injury, it did not necessarily provide you with the foundation for facing the

Moshe Ornstein, MD, MA, is a hematology and oncology fellow at the Cleveland Clinic Taussig Cancer Institute in Cleveland, Ohio, where he also trained as an internal medicine resident. He completed graduate work in biotechnology at Columbia University, after which he attended medical school at SUNY Stony Brook. A devoted husband to his wife, Adina, and a father of 3, he is busy but is still making time to slowly learn how to use Twitter @MCOmd.

ABOUT THE AUTHOR

By Moshe Ornstein, MD


WHAT YOU’RE NOTTOLD DURING ORIENTAT ION

FELLOWSFIRST-YEAR

for

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PREPARING FOR THE UNEXPECTED:

FEATURE

day-to-day issues and challenges of cancer patients and their medical providers.

There’s another more subtle difference between the world of oncology and other medical fields. Think back (if you are brave enough) to your intensive care unit rotations, or time on the cardiology service. There was so much emphasis on preload, afterload, systemic vas-cular resistance, pressure, and flow. In other words, the emphasis was on physiology: “Why is the heart failing, why is there blood in the stool, and why are the urine casts granular?” In oncology, the focus is shifted to the pathology of disease: “What is the driver mutation of the cancer, what is the cellularity or dys-plasia in the bone marrow, and what is the primary origin of the patient’s cancer?”

However, more important than the fundamental difference between pathology and physiology is the critical distinction between taking care of a patient’s medical condition and taking care of the patient. In residency, you were trained to resolve a patient’s COPD exacerbation, diurese fluid-filled lungs, and control rapid atrial fibrillation. In simple terms, your job was to identify the problem, fix it, and move on. During on-cology fellowship, you will be expected to empathize with your patient’s struggle with cancer, understand how a mother’s chemotherapy schedule is interfering with her ability to care for her children, and recognize a patient’s right to choose between quantity and qual-ity of life. The objective is not necessarily to distin-guish which drug to use and when, but rather to also understand the emotional and psychological impact of the disease and its therapy.

One challenge during your first year of fellowship will be to balance your excitement regarding the med-ical aspects of treating the disease with the equally important patient interactions, communication, and relationships. And although you are correctly think-ing that this should be the case in all specialties, it is amplified in oncology, where the impact of disease is often more significant. Maintaining this balance is something that comes naturally to very few people. As you follow your attendings in clinic and in the hospi-tal, take note of their words, phrases, and mannerisms as they discuss diagnosis, treatment, disease progres-sion, and end-of-life issues with patients and their families. Almost anyone can follow an algorithm to

determine therapy, but only the well trained can in-corporate the psychosocial elements of cancer therapy into their oncologic treatment plan.

Research: A Few Dos and Don’ts for Your First YearMost oncology fellowship programs have high research expectations for their fellows. That’s hopefully not news to you. Each program has a different research structure. However, as a general rule, the first year of fellowship revolves around clinical duties, while the next 2 years are more research focused. Nonetheless, there will be pressure on you to identify a mentor, begin to design a research project, and even start to think about partici-pating in your institution’s clinical trials during your first year of fellowship. Dr Mireles-Cabodevila, director of the critical care fellowship program at the Cleveland Clinic, began his fellowship fascinated with the physi-ology of heart rate variability in the critically ill. For a variety of reasons, his fellowship research project failed, which prompted him to turn his experiences into the “Ten Commandments” of research during fellow-ship. I urge you to read these “Ten Commandments,” as they will certainly influence your approach to research during fellowship.1

His advice is practical and includes common sense recommendations such as recognizing that everything takes longer than expected, that you will need more help than you think, and that you need to set dead-lines. However, for those of you who won’t read the publication (even though it’s free!), I want to quote the take-home message from Commandment 8, entitled “You Can Always Say No:” 1

While it may be hard to say “no,” it is generally bet-ter than saying “I could not deliver.” As a venerated mentor once said, “If you don’t use certain ‘two- letter words’ enough (ie, “no”), you’ll end up using certain ‘four-letter words’ a lot more.”

In other words, if you’ve gotten as far as an oncology fellowship, chances are you are at least moderately in-terested in research. As an anxious, excited, and ea-ger-to-please first year fellow, you will meet many fac-ulty members who would be thrilled to serve as your mentor. For example, after your leukemia rotation, you may be offered the opportunity to write a review article, or when rotating through lung cancer clinic, you may be asked to help with a retrospective data



review based on your institution’s experience with a novel therapeutic. Learn to say “no.” Don’t agree to a project about which you are not excited. Remember that agreeing to a project and not seeing it to fruition is far worse than politely declining in the first place. Find the area of research that most excites you and the clinical questions that you want to answer. That is a guaranteed recipe for success.

You’re No Longer “Just a Trainee”You are entering your final stage of formal medical training. Whereas in residency you were merely one of 20, 30, or 40 residents training in internal medicine, you are now part of a select and small group of indi-viduals. Most programs enlist only 4 to 8 hematology/oncology fellows per year. This has critical ramifica-tions for your current training and future career.

At this stage, your co-fellows and faculty are not merely fleeting figures in your academic and clinic training. Rather, they are potential future coworkers and employers, as well as individuals whom you may encounter time and again throughout the course of your career. Fellowship is unlike residency in that you are not constantly moving from one department to another; rather, you are developing sustained long-term relationships with faculty, advanced practitio-ners, and nursing staff.

In many ways, your fellowship is a 3- or 4-year interview. Your faculty are assessing whether you’re someone they would want as a future colleague and whether they would recommend you as a potential colleague to their contacts at other institutions. This is not meant to imply that you are expected to know all there is to know about oncology during your first few months of training. However, it does place a greater emphasis on the basics: be respectful to ev-eryone, be kind, be willing to help out a colleague in need, be honest. Nurture the relationships you build during these critical years, as they will serve as the foundation for your future.

TimeI saved the most important topic for last. As much as we yearn for more, there are still only 24 hours in a day. During the recent oncology fellowship gradua-tion at Cleveland Clinic, Dr Matt Kalaycio, chairman

of the hematology/oncology department, reminded the fellows of this fact. He explained that throughout a career in oncology, we will be asked and often re-quired to give away our most precious asset—time—in response to demands from many sources, including patients and their families, research, and clinical duties. Especially during fellowship, as you aim to impress, it will quickly become easy for you to com-mit all of your time to others. He therefore asked the graduating fellows to consider the following: “I hope you will give yourselves the gift of time.”

Over the next 3 years, you will have many obli-gations, and it will not be difficult for you to allow your fellowship to take control of your life. Despite a plethora of data documenting the issue of burnout in oncology, there is surprisingly little mention of work-life balance during training. Whether your time away from work involves your family, exercise, religion, leisure reading, or some combination thereof, be sure you do yourself the service of ensuring an appropri-ate balance between your work and “life.” Physician, heal thyself—you and your patients will be grateful.

Some Parting WordsIt’s been a long road and you’re nearing the end. Some of you have always dreamed of being an oncologist, and some of you have made that decision only within the last few years. Regardless of the timing of your decision, you have invested a tremendous amount of time, energy, and money in getting to where you are today. I urge you to take pride in your work. Be proud of your commitment to spend your days taking care of cancer patients. Feel fortunate to be a part of such an exciting and rapidly evolving medical field. Most importantly, remember, even in the darkest of days, to have fun. You owe yourself at least that much.

Good luck and enjoy the journey,Moshe

REFERENCE

1. Mireles-Cabodevila E, Stoller JK. Research during fellow-ship: ten commandments. Chest. 2009;135(5):1395-1399.


FEATURE

By Stephen Williams, MD

My Path to Fellowship: Slightly Different From Most


modating my wife’s desire to move closer to family. However, some programs not located in close proximity to family also interested me. While ponder-ing this dilemma of whether to pursue my academic interests or satisfy family obligations, an opportunity emerged to enter community practice in Southern California. I interviewed with the practice and after considering the balance between work and family interests, I decided to pursue community practice.

Community practice offered the clinical appeal of managing my own patients and encountering diverse types of clinical urology cases. During my time in practice, I treated a variety of urologic con-ditions, from stone management to female urology; however, I enjoyed urologic oncology cases the most. From the initial diagnosis, to treatment, to patient follow-ups, I found great joy in managing prostate, blad-der, kidney, and testicular cancers. I also kept track of my patient outcomes and quickly realized there was a void in practice that I wanted to address.

I approached the ad-ministration at St. Joseph Hospital to ask if I could become involved with com-mittees and organizations to help improve the qual-ity of care provided to our patients. I found this op-portunity satisfying, as it allowed me to embrace not just my own practice, but also practices in other dis-ciplines in and around the community. After work-ing on several fund-raising events, I was elected to the Foundation Board of Directors at St. Joseph, and received the hospital’s support in hosting a Los Angeles-based radio show, “The Men’s Health Hour.” A weekly, hour-long talk show, it featured discus-sions on relevant men’s health topics ranging from urinary disorders related to benign prostatic hyper-trophy to prostate cancer.


Stephen Williams, MD, is a urologic oncology fellow in the Department of Urology at The University of Texas MD Anderson Cancer Center in Houston, Texas.

ABOUT THE AUTHOR

From the onset of our medical training, and con-tinuing into residency, we are exposed to academic medicine. Seldom do we have any interaction or experience with private practice. After residency, many of us choose to enter a fellowship program for additional specialized training. Others, includ-ing myself, decide to enter private practice. Many fellows are disgruntled, as they believe their col-leagues who opted for private practice are making a substantially greater income and “getting on with their lives.”

My path is unique. I decided to pursue private practice upon graduation from residency. However, after a couple of years of practice, I realized that I missed research and teaching and returned to aca-demic medicine by entering a fellowship program.

I completed my training in urology in the Har-vard Program in Urology at Brigham and Women’s

Hospital in Boston, Massachusetts. Additionally, I accumulated over 60 publication credits,

which included numerous presentations primarily dedicated to urologic oncol-

ogy and supported my interest in pursuing fellowship after

residency. Many of these presentations were deliv-

ered during national and sectional American

Urological Associa-tion (AUA) annual

meetings. I also inter-

viewed with fellowship

programs in urologic on-cology, with

the inten-tion of accom-


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Despite the amazing opportunities I was offered and the wonderful relationships I developed while in private practice, I greatly missed the investiga-tive research and teaching components of academic medicine. While clinical practice was intriguing, it often left me wondering what more I could do to improve medicine. One evening, while I was review-ing my billing (which should be the highlight of the day and why we put forth all of our hard work), I remember saying to myself, “I would rather be writing a manuscript or contemplating my next re-search project.” In that instant, I realized that I did not want to continue my career in private medical practice. Rather, I decided, I wanted to get back into academic medicine.

I was torn between continuing at my current prac-tice or pursuing my academic interests. During my time in Boston and thereafter, I had stayed in contact

with colleagues who respected my intention to pursue oppor-tunities outside of academia. These colleagues recognized my work ethic and were aware of my contributions to a variety of publications. Naturally, this made it easy for one of them to call my bluff when a fellow-ship opportunity at a leading urologic oncology program

opened up. After some serious thought and discussion with my fam-

ily and previous mentors (including the chairman from my residency), I decided to leave community practice and enter fellow-ship at The University of Texas MD Ander-

son Cancer Center in Houston. Fellowship has been a wonderful ex-perience thus far, especially in light

of being in practice for some time, as my time in practice allowed

me to identify areas that I want to improve clinical-

ly. I have engaged in several clinical

and molec-

ular epidemiology-related research projects that are satisfying my research appetite, and I’ve since had the opportunity to present at the Society of Urologic Oncology, Genitourinary Cancers-American Society of Clinical Oncology (ASCO), and AUA meetings.

I’ve received several awards, including the ASCO Merit Award and the Comparative Effectiveness Re-search on Cancer in Texas research scholar award. The second award led to a current research grant that supports my population-based comparative ef-fectiveness research in prostate cancer. I have also extended my prior epidemiology research in pros-tate cancer into molecular epidemiology in bladder cancer, as MD Anderson has a wealth of resources dedicated to this field of research. Recently, I real-ized how my prior and current work has contributed to the field of urologic oncology and health policy decision making. I have been invited to speak at the Institute of Medicine in Washington, DC, to discuss my prior comparative effectiveness research in prostate cancer, which specifically evaluated the ap-propriate utilization of treatments. I see this as one of my greatest accomplishments, and I see it as a tremendous opportunity to support my current re-search and to help direct health policy decisions in order to optimize cancer care and decrease costs to our healthcare system. As I look back, I’m thankful that I decided to head back into academic medicine, and more importantly, I thank my amazing wife and family for allowing me to pursue my dreams.

There is no magic door to walk through at the end of our training (whether that be residency or fellowship) that leads to the perfect job. We are hu-man. The decision to pursue a career in academic medicine or private practice is complex and is based on numerous factors of varying importance. My only advice to fellows and young physicians is to never have regrets and to always pursue your dreams. Both you and your family have worked very hard to make your pursuit of a career in medicine possible. Pursuing your dreams is beneficial to both you and your patients.

FEATURE


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A WORD FROM YOUR FELLOWS



“I am a veteran and a fighter—I will do anything so that the cancer doesn’t come back,” my patient said to me as I sat with him and his daughter in clinic to discuss his treatment options.

The resected tumor was a locally advanced squamous cell carcinoma of the lung with high-risk features, indicating a high likelihood of disease recurrence. Most guidelines would recommend adjuvant chemotherapy; in fact, his daughter did her own research on the Internet and came to the same conclusion.

As I shifted my focus from the tumor back to my pa-tient, the benefits of treating him with chemotherapy became less clear. Although he was recovering well from surgery, he was a frail male octogenarian with multiple medical problems who required assistance with some of his activities of daily living and all of his instrumental activities of daily living.

I asked myself, “Are the expected benefits from ad-juvant chemotherapy going to outweigh the risks in a patient with limited life expectancy and decreased toler-ance of stress? Is a good Eastern Cooperative Oncology Group (ECOG) performance status enough to pronounce him fit for chemotherapy?”

This type of scenario is becoming increasingly more common in the United States. A demographic shift known as the “silver tsunami” makes it likely that the number of older patients with cancer will increase.1 Age itself is a known risk factor for developing cancer: it has been reported that a majority of cancer diagnoses and deaths occur in patients older than 65 years.2 By 2030, it is predicted that 70% of cancer diagnoses will be made in adults in this age group.3

When making treatment decisions for older cancer patients, the challenge is in selecting the appropriate therapy for the appropriate patient. Age alone should not

be used to preclude a patient from receiving the best available treatment. For this reason, the field of geriatric oncology was born.

The specific needs of older cancer patients are different from those of younger adults. Older patients are more likely to have signifi-cant comorbidities, disabilities, and geriatric

syndromes. Physiological changes also occur with age, such as decreased creatinine clearance, impaired gas exchange, and decreased cardiac output.2 Unfortunately, there is a lack of high-quality evidence to help guide cli-nicians in selecting treatment, as the majority of cancer treatment clinical trials have excluded older patients.4

Most oncologists use scor-ing systems such as the ECOG and Karnofsky score to determine performance status.5 Compared with these scoring systems, the Comprehensive Geriatric As-sessment (CGA) is more sen-sitive in detecting functional impairments in older adults and can help with clinical risk stratification and indi-vidualized treatment plan-ning. The CGA evaluates key domains that are predictive of morbidity and mortality risk in older adults. These

By Shin Yin Lee, MD

Shin Yin Lee, MD, is a geriatrics and hematology/oncology fellow at Boston Medical Center in Boston, Massachusetts.

ABOUT THE AUTHOR

Geriatric Oncology: Learning the Balancing Act

of Treating the Older Cancer Patient

FELLOWSALL

for

SUGGESTED READING


A WORD FROM YOUR FELLOWS

domains include functional status, comorbid medical conditions, cognition, psychological state, current medi-cations, social support, and nutritional status.6

The American Society of Clinical Oncology (ASCO) is recognizing the increasing importance of geriatric oncol-ogy and is playing a large role in promoting this field. There have been many presentations and educational sessions surrounding the field of geriatrics during recent ASCO annual meetings. Additionally, more funding has been provided to promote research and career develop-ment. Geriatric oncology is now being recognized in ma-jor journals such as the Journal of Clinical Oncology.2,3

A cooperative group, the Cancer and Aging Research Group, has made many important contributions to the field, including the development of a tool to help gauge the likelihood of chemotherapy toxicity in older adults.7 Outside of the United States, the International Society of Geriatric Oncology has established task forces to help in making treatment recommendations. The society now has a peer-reviewed journal called the Journal of Geriat-ric Oncology.8 The National Comprehensive Cancer Net-work also has specific guidelines that pertain to older patients with cancer.9

Most hematology and oncology fellowship program directors agree that geriatric oncology should be in-corporated into fellowship curriculums. However, only one-third of hematology and oncology programs formally cover topics related to geriatric oncology as part of their

curriculum.10 Therefore, it is clear that although an un-derstanding of the needs of geriatric patients is vital to successfully treating cancer in adults, many hematology and oncology trainees will complete fellowship without any formal exposure to geriatrics.

How can fellowship programs be structured to provide greater exposure to and knowledge of geriatric oncol-ogy? Didactics aside, programs can subscribe fellows to ASCO’s Education Essentials for Oncology Fellows, which includes general modules on geriatric oncology and disease-specific modules.11 Some medical centers have a geriatric oncology clinic where fellows can do a rotation. Unfortunately, this is not yet commonplace. A required rotation in geriatrics could be beneficial, par-ticularly for the purpose of allowing fellows to practice doing a CGA.

Interdisciplinary collaboration between geriatrics and oncology, in tumor board for example, can foster more discussion and participation between the specialties. Because geriatricians have recognized the shortage of practitioners in the field, they have collaborated with physicians in other specialties and developed strate-gies to educate trainees and inspire them to specialize in geriatrics. The Chief Resident Immersion Training (CRIT) in the Care of Older Adults program, developed at Boston University/Boston Medical Center, has been

successful in promoting collaboration among disciplines in the management of medically complex older patients. In fact, an opportunity to participate in CRIT as an internal medicine resident helped de-velop my interest in geriatrics. This pro-gram, which focuses on case-based learn-ing of geriatric principles and leadership, has been conducted in more than a dozen institutions nationwide.12

In order to foster the creation of new leaders in the field, in 2006 the ASCO-Hartford Foundation provided funding for the development of 10 geriatric oncology training programs.13 Being a fellow at one of these programs provided me with a unique training experience. Aside from addressing the clinical requirements for board eligibility in medical oncology, approximately 1 year of the fellowship

When making treatment decisions for older cancer patients, the challenge is in selecting the appropriate therapy for the appropriate patient. Age alone should not be used to preclude a patient from receiving the best available treatment.

For updates on cancer research and to access educational materials

for patients, visit curetoday.com

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program is dedicated to core clinical geriatrics train-ing; this includes rotations in the geriatrics inpatient service, nursing home care, rehabilitation medicine, the Alzheimer’s unit, palliative care, and an outpatient continuity clinic. In addition, fellows gain experience in performing outpatient comprehensive geriatric as-sessments of older adults who have been referred to the clinic for evaluation.

The integration of didactic, research, and clinical experiences in both geriatrics and oncology can lead to board eligibility in both specialties after 3 years. Some fellows have participated in an additional year of train-ing in order to become board eligible for hematology. The most distinctive feature of my training at Boston University/Boston Medical Center is that I have the op-portunity to practice in different models of care and to treat a remarkably diverse patient population. At Boston Medical Center, we care for a large, underserved, and international migrant population. Additionally, we care for veterans at the Boston Veterans Affairs Healthcare System. We also care for patients in a unique way at a Program of All-inclusive Care of the Elderly (PACE) site. (PACE is a capitated payment model focused on multidis-ciplinary team-based care.)

Whether it be to identify a seemingly frail older pa-tient with metastatic colon cancer who would tolerate and benefit from standard treatment, or to prevent a frail older lung cancer patient from experiencing severe side effects due to adjuvant chemotherapy, oncologists are having to make difficult decisions with increasing frequency. Integrating geriatric oncology principles into fellowship training is one of the many efforts under way that can improve the field of geriatric oncology so as to improve patients’ quality of life, increase survival, and decrease treatment toxicity in our older cancer patients. As a saying in oncology goes, “If you are not a pediatric oncologist, you are a geriatric oncologist.”

REFERENCES

1. Guardian News and Media Limited. Martin Amis in new row over ‘euthanasia booths.’ The Guardian website. http://www.theguardian.com/books/2010/jan/24/martin-amis-euthanasia-booths-alzheimers. Accessed August 4, 2015.

2. Pal SK, Hurria A. Impact of age, sex, and comorbidity on cancer therapy and disease progression. J Clin Oncol. 2010;28(26):4086-4093. doi:10.1200/JCO.2009.27.0579.

3. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27(17):2758-2765. doi:10.1200/JCO.2008.20.8983.

4. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in can-cer-treatment trials. N Engl J Med. 1999;341(27):2061-2067.

5. Owusu C, Koroukian SM, Schluchter M, Bakaki P, Berger NA. Screening older cancer patients for a Comprehensive Geriatric Assessment: a comparison of three instruments. J Geriatr Oncol. 2011;2(2):121-129.

6. Comprehensive geriatric assessment. Tufts OpenCourseWare website. http://ocw.tufts.edu/data/42/499797.pdf. Accessed August 4, 2015.

7. Geriatric assessment tools. Cancer & Aging Research Group website. http://www.mycarg.org/SelectQuestionnaire. Accessed August 4, 2015.

8. SIOG - International Society of Geriatric Oncology website. http://www.siog.org. Accessed August 4, 2015.

9. NCCN clinical practice guidelines in oncology (NCCN guide-lines): older adult oncology: version 2.2015. National Comprehen-sive Cancer Network website. http://www.nccn.org/profession-als/physician_gls/f_guidelines.asp#senior. Accessed August 4, 2015.

10. Naeim A, Hurria A, Rao A, et al. The need for an aging and cancer curriculum for hematology/oncology trainees. J Geriatr Oncol. 2010;1:109-113.

11. American Society of Clinical Oncology (ASCO). Education Essentials for Oncology Fellows (EEOF). ASCO University web-site. http://university.asco.org/education-essentials-oncology-fellows-eeof. Accessed August 4, 2015.

12. Chief Resident Immersion Training in the Care of Older Adults (CRIT). ADGAP - Association of Directors of Geriatric Academic Programs website. http://adgap.americangeriatrics.org/adgap-programs/crit. Accessed August 4, 2015.

13. Medicine grants: a commitment to geriatric oncology. The John A. Hartford Foundation website. http://www.jhartfound.org/grants-strategy/a-commitment-to-geriatric-oncology-asco-foundation. Accessed August 4, 2015.

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Essential Anatomy 5 features full, 3-dimensional skeleton models that can be rotated by fingertip at any angle. This full-featured anatomical reference app includes male and female models, 11 systems, and a total of 8200 anatomical structures. Users can view bones in isolation, listen to audio pronunciations of bone names, annotate and share media, and take quizzes. Essential Anatomy 5 is considered the “gold standard in medical reference applications.”http://bit.ly/1HLnFrX

Lab Values ProPRICE: $2.99PLATFORMS: iPhone, iPad, and iPod touch

Lab Values Pro features 3 medical reference apps in one, providing access to reference values for hundreds of lab tests, descriptions of thousands of medical abbreviations, and origin/etymology/definition information for over 400 prefixes and suffixes. Users can create new lab values, edit existing ones, and even create their own categories for lab tests. For quick retrieval of data, the app also includes “recently viewed” and “favorites” features.http://apple.co/1VWX4B5

RadOnc ResourcePRICE: Free on Google Play; $4.99 on iTunesPLATFORMS: Android, iPhone, iPad, and iPod touch

RadOnc Resource is designed to assist radiation oncologists in the clinic and during radiation treatment planning. The app, which has also been recommended as a useful tool for residents, includes comprehensive information about cancer staging, oncology ICD-9 codes, dose-volume histogram normal tissue constraints, and commonly prescribed medications. Contouring atlases and useful clinical calculators (eg, glioblastoma multiforme recursive partitioning analysis) are also accessible through RadOnc Resource. http://apple.co/1JHHNPN or http://bit.ly/1JHI0CJ

MeVis Lung-RADSPRICE: FreePLATFORMS: Android, iPhone, iPad, and iPod touch

The MeVis Lung-RADS app assists healthcare professionals such as radiologists, oncologists, pulmonologists, referring physicians, and medical students in developing and practicing routine use of the Lung-RADS reporting scheme. Its Lung CT Screening Reporting and Data System (ACR Lung-RADS, Version 1.0) can help structure and standardize lung cancer screening computed tomography interpretation and reporting of assessment categories for the entire lung care team. Additionally, the app features a step-by-step tool for reviewing assessment categories and a quiz mode that challenges healthcare professionals to assign the correct Lung-RADS category to nodule findings. http://bit.ly/1HlIS9H

Sensitivity and SpecificityPRICE: Free on Google Play; $0.99 on iTunesPLATFORMS: Android, iPhone, iPad, and iPod touch

This app provides users with a resource for reviewing the sensitivity and specificity of hundreds of medical tests; this information can facilitate evidence-based decision making and save time and money by helping to eliminate unnecessary testing. By providing access to data from recent, high-quality, peer-reviewed publications, this app can help healthcare professionals select appropriate tests for hundreds of conditions and interpret the results. This resource has been suggested as a great learning tool for medical students. http://bit.ly/1Ir99rd

ONLINEONCOLOGIST®

MOBILE MEDICINE: APPS FOR THE HEALTHCARE PROFESSIONAL


To access interactive learning modules, visit onclive.com/

interactive-tools

ON THE WEB

Oncology Fellows • 09.15 | 15

An aging population and improvements in cancer care are expected to lead to greater demand for a trained oncology workforce. How-ever, there is major concern that there will be a growing demand for cancer care coupled with a shortage in oncology professionals with the skills required to treat patients.1

By 2025, the number of new cancer diagnoses is projected to rise by 42% while the number of hematologists and oncologists is expected to rise by only 28% during the same time period.2 A sug-gested reason for the projected shortage in future oncology/hema-tology professionals is less interest in the specialty among medical residents. Intensive training and a lengthy time commitment may influence this lack of interest because additional training delays physicians from earning a professional-level salary (vs the salary of a fellow in training).1 Even with the demanding training require-ments, oncologists still fall in the middle of the field (ranked 11 of 26 specialties) in terms of salary earned per year ($302,000) com-pared with healthcare professionals in other specialties.3

According to the American Society of Clinical Oncology (ASCO), the shortage in the recruitment of oncology professionals is par-ticularly concerning because oncologists 64 years and older cur-rently outnumber oncologists 40 years and younger (20% vs 15%, respectively). This additional factor is likely to impact the delivery of oncology care into the future as the older generation of practicing oncologists begins to retire.1,2

Another consideration is the geographic distribution of cancer care professionals. Cancer affects patients nationwide who need to live in close proximity to their healthcare professionals to receive quality care. However, it has been noted that oncologists are spread

Concerns Regarding the Future Oncology Workforce

BY THE NUMBERS

FELLOWSALL

for

SUGGESTED READING

By 2025, the number of new cancer diagnoses is projected to rise by 42% while the number of hema-tologists and oncologists is expected to rise by only 28% during the same time period.2

…oncologists still fall in the middle of the field (ranked 11 of 26 specialties) in terms of salary earned per year ($302,000) compared with healthcare professionals in other specialties.3

…oncologists 64 years and older currently outnumber oncologists 40 years and younger (20% vs 15%, respectively).

thin in more rural areas of the United States. Currently, almost 97% of physicians who specialize in medical oncology practice in urban areas compared with the 3% who practice in rural areas.2,4

Thus, several factors collectively contribute to the predicted shortage of oncology healthcare workers. In a recent call to action, ASCO recognized that these factors, along with others, are likely to affect cancer care in the future. As a result, the organization has made recommendations that it feels are critical to addressing key issues, including improving patient access to care across the na-tion. ASCO has also recommended researching strategies to help increase the size of the oncology workforce to address the demand for oncology care well into the future.2

REFERENCES

1. Stern V. Does oncology have a recruitment problem? Med-scape website. www.medscape.com/viewarticle/836555. Pub-lished December 16, 2014. Accessed August 19, 2015.

2. American Society of Clinical Oncology. The state of cancer care in America, 2014: a report by the American Society of Clini-cal Oncology. J Oncol Pract. 2014;10(2):119-142. doi: 10.1200/JOP.2014.001386.

3. Peckham C. Medscape oncologist compensation report 2015. Medscape website. www.medscape.com/features/slideshow/compensation/2015/oncology#page=1. Published April 21, 2015. Accessed August 19, 2015.

4. Kirkwood MK, Bruinooge SS, Goldstein MA, Bajorin DF, Kosty MP. Enhancing the American Society of Clinical Oncology work-force information system with geographic distribution of oncolo-gists and comparison of data sources for the number of practic-ing oncologists. J Oncol Pract. 2014;10(1):32-38. doi: 10.1200/JOP.2013.001311.

Currently, almost 97% of physicians who specialize in medical oncology practice in urban areas compared with the 3% who practice in rural areas.2,4

CONFERENCE CENTER


2015 Oncology & Hematology Meetings

September 25-264th International Conference on Immunotherapy in Pediatric Oncology (CIPO 2015)Seattle, WAhttp://bit.ly/1GKuwFq

September 25-27Breast Cancer SymposiumSan Francisco, CAhttp://bit.ly/1vWxEUp

October 9-10Palliative Care in Oncology SymposiumBoston, MAhttp://bit.ly/1OBFjmq

October 16-17NCCN 10th Annual Congress: Hematologic MalignanciesSan Francisco, CAhttp://bit.ly/1aV2Z6h

October 18-21ASTRO’s 57th Annual MeetingSan Antonio, TXhttp://bit.ly/1b3aKHX

October 22-24Lymphoma & Myeloma 2015: An International Congress on Hematologic MalignanciesNew York, NYhttp://bit.ly/1P4FdTA

November 4-633rd Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for TomorrowNew York, NYhttp://bit.ly/1hwkBcn

November 5-713th Annual School of Breast OncologyAtlanta, GAhttp://bit.ly/1PjggV9

November 6-8ESMO Summit Americas: Oncology Updates - From Evidence to PracticeMiami Beach, FLhttp://bit.ly/1mP5k6O

November 14-1612th International Conference of the Society for Integrative OncologyBoston, MAhttp://bit.ly/1L4wUcy

December 5-857th ASH Annual Meeting & ExpositionOrlando, FLhttp://bit.ly/1ssrOdd

For coverage from the latest oncology/hematology conferences, visit onclive

.com/conference-coverage

For information on upcoming CME

accredited conferences, visit gotoper.com

ON THE WEB ON THE WEB

We welcome submissions to Oncology Fellows, a publication that speaks directly to the issues that matter most to hematology/oncology fellows at all stages of training. Oncology Fellows aims to provide timely and practical information that is geared toward fellows from a professional and lifestyle standpoint—from opportunities that await them after the conclusion of their fellowship training, to information on what their colleagues and peers are doing and thinking right now.

Oncology Fellows features articles written by practicing physicians, clinical instructors, researchers, and current fellows who share their knowledge, advice, and insights on a range of issues.

We invite current fellows and oncology professionals to submit articles on a variety of topics, including, but not limited to:

• Lifestyle and general interest articles pertaining to fellows at all stages of training.

• A Word From Your Fellows: articles written by current fellows describing their thoughts and opinions on various topics.

• Transitions: articles written by oncology professionals that provide career-related insight and advice to fellows on life post training.

• A Day in the Life: articles describing a typical workday for a fellow or an oncology professional post training.

The list above is not comprehensive, and suggestions for future topics are welcome. Please note that we have the ability to edit and proofread submitted articles, and all manuscripts will be sent to the author for final approval prior to publication.

If you are interested in contributing an article to Oncology Fellows, or would like more information, please e-mail Jeanne Linke at [email protected].

CALL for PAPERS

With CancerCare, the difference comes from: • Professional oncology social workers• Free counseling • Education and practical help• Up-to-date information • CancerCare for Kids®

For needs that go beyond medical care, refer your patients and their loved ones to CancerCare.

CancerCare’s free services help people cope with the emotional and practical concerns arising from a cancer diagnosis and are integral to the standard of care for all cancer patients, as recommended by the Institute of Medicine.

makes all the difference

®

1-800-813-HOPE (4673)

www.cancercare.org

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