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“…The oncologic surgeon is well trained in general surgery, and then has overlying training in special oncologic surgery. He must be knowledgeable about radiation therapy, chemotherapy and immunotherapy so that he is immediately aware of the advisability of multidisciplinary management of his patient… he should have 2 years of specialized training in oncology.” Lewis Guess in the first published presidential address of the Society of Surgical Oncology (Founded as The James Ewing Society) in 1966.1
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Cancer patients will increasingly receive more than one modality of treatment delivered by cancer physicians from different medical specialties (e.g., internal medicine and surgery). Increasingly, those physicians providing cancer care will also be specialists, or even subspecialists, who confine their practice to a narrow scope of malignancies, such as breast cancer and gastrointestinal cancer, because it is challenging to keep up with the application of novel information in this expanding field, which is growing exponentially.
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There is a substantial reorganization of cancer care delivery taking place around the globe that is focused around the multidisciplinary care of patients by physicians, united more around a specific disease management approach, such as breast cancer, than by their boarded medical specialty, such as surgical or medical oncology.2–4 Therefore, contemporary cancer care is becoming a team approach! Besides physicians, other stakeholders of the multidisciplinary team have also become valuable assets to this concept and include patient navigators, nurse practitioners, social workers, survivorship personnel, clinic coordinators, clinical trial nurses, hospital chaplains, and community outreach representatives.
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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.4–7
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It has been estimated by the World Health Organization that by 2030 surgical diseases will contribute significantly to the burden of global health. The treatment of cancer at its best involves a multimodality approach for local control with surgery and radiation as well as systemic control with a variety of oral and intravenous medications. Likewise, patient characteristics as well as awareness, physician preferences, hospital type, and country8,9 impact the care administered for a particular cancer.3,10,11
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So what is the role of the surgeon in this evolving environment of cancer care delivery? How much do surgeons need to specialize, or limit the scope of their practice to keep up with a rapidly advancing field? How can practicing surgeons incorporate new devices, diagnostics, and drugs into their surgical practice? How do we need to train and certify the next generation of surgeons who will be a future partner in providing multidisciplinary cancer care? Does specialization make a difference in the outcomes of ...