2 minute read
By Shruti Sharma, DO
By Shruti Sharma, DO
The practice of community oncology has evolved significantly in the last ten years. The general focus of community oncology was primarily to bring accessibility of cancer care treatment to patients while academic oncology focused largely on specialty and sub-specialty oncology services, research and being the powerhouse for education and training programs. We largely associated clinical trial availability with academic oncology and looked to them for additional resources, including research laboratories, libraries and access to exclusive research databases.
It has been stimulating to see the evolution of community oncology to include procedures that were traditionally observed only at academic institutions. Many oncologists have started to develop “special focuses” instead of remaining as a general oncology physician. Furthermore, community hospitals have started investing in graduate medical education programs, which subsequently has allowed for the development of communitybased hematology and oncology fellowships. Lastly, clinical trials and research protocols have been investigated and implemented avidly in the community setting.
The mesh between community oncology and academic oncology has been beneficial to both parties. Some community hospitals have decided to establish an affiliation to an academic center. Other organizations have decided to remain independent but incorporate academic procedures within their structure. Is one structure better than the other? Not necessarily.
Establishing an affiliation to an academic center allows for increased access to numerous clinical trials and research already established by the academic institution, not necessarily available to independent standing community programs. Furthermore, the reputation obtained upon affiliation to an academic institution helps increase awareness of the community program itself. In addition, this relationship allows diversification of enrollment into various trials. Gender, age, race and socioeconomic status of individuals are all factors that need to be considered upon enrollment of clinical trials. Academic centers can also provide increased supportive services to patients more readily at their community site.
Independent organizations have also flawlessly implemented academic procedures and have continued to provide rich resources for patients. As we continue to learn from the research being conducted by these clinical trials, independent organizations have continued to encourage community oncologists to become private investigators and establish leadership roles to ensure that patient care is never compromised and remains inclusive. Some comprehensive cancer centers also consist of surgery and radiation services within the same organization, which allows for continuity of care and accessible communication among patient treatment teams. As research continues to produce results, the knowledge gained from these studies keeps academic oncologists, community oncologists and pharmaceutical companies busy, so we can continue to understand the mechanisms of malignant hematology and solid tumors and manufacture new drugs that can help combat these disease processes. With all this vast knowledge, is it better for patient care, then, to “subspecialize” in oncology or remain a generalist in the community going forward? Currently, some community practices encourage oncologists to pick a few focuses to mold their practice into, while many others still leave this decision up to the physician.
Conclusively, we have observed significant change in this last decade regarding the structure of academic oncology and community oncology. As the relationship between community and academic oncology continues to evolve, the goal of both, however, remains unified: to provide the best cancer care for our patients as close as possible to them.
Shruti Sharma, DO. She is a Medical Oncologist and Hematologist at Texas Oncology, San Antonio Medical Center and a member of Bexar County Medical Society.
