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The Community Oncologist

Introduction to the New Section

^a East Jefferson General Hospital, Metairie, Lousiana, USA; ^b Jackson Clinic, Jackson, Tennessee, USA

Although the elements of oncological practice are not mutated when one leaves the academic environment to enter the domain of community oncology, the mindset certainly shifts. In the confines of the cancer center, the emphasis is on conducting a scientifically valid experiment. The patient, who is generally referred specifically for a treatment protocol, must meet all pre-expressed criteria for entry on the protocol—age, stage, performance status, organ function, absence of previous malignancy, etc. The protocol-imposed treatment specifics of scheduling, dosing, and follow-up must perforce be adhered to diligently. We are taught that a clinical trial, whether randomized or otherwise, is good medicine [1], not only for the greater good of advancing knowledge and improving treatment for others, but also for the intended direct benefit to the participating patient, the subject of the experiment.

Moreover, anything less is unethical. However, upon entering the community, we frequently find that a clinical trial is not an option: there may be no appropriate trial open locally, and the patient may not wish to travel to the nearest mecca or may not wish to participate in "an experiment." And not infrequently, data from well-done trials or published guidelines are not applicable to the patient at hand. Then what do you do, doc?

To help answer this question, we are launching a new section in The Oncologist, which we perhaps uncreatively will call The Community Oncologist. Because the focus of The Oncologist has always been on the practicing oncologist, it is appropriate for the reader to ask: in what new directions will we be going? First, we will publish solicited reviews of new and developing areas of therapeutics, as exemplified by the accompanying review, "Therapeutic Vaccines in Prostate Cancer" by Tarassoff et. al. [2]. There was a day when the practicing oncologist did not need to know about cancer vaccines, as they were unsuccessful or unproven. Now, vaccines are rapidly scoring victory after victory in treating lymphomas and leukemia, in cervical cancer prevention, and even in treating pancreatic cancer and melanoma. Drs. Tarassoff, Arlen, and Gulley have reviewed the rapid progress in prostate cancer vaccines for us.

We will also publish issues facing us daily in practice, questions that frequently arise for which there may not yet be definitive phase III-level answers. What is (or will be) the role of microarray testing (e.g., the already available Oncotype DX assay [Genomic Health, Redwood City, CA])? What is the implication of the microscopically positive sentinel node in T1a or -b N0 breast cancer? How should we integrate advances in imaging into practice? What do we do with patients with multiple primary cancers? Should we preemptively test for dihydropyrimidine dehydrogenase deficiency or altered uridine diphospho-glucuronosyltransferase enzymatic activity in patients about to receive 5-fluorouracil or capecitabine or irinotecan? What about the still unanswered questions about the optimal duration of adjuvant trastuzumab? And should we be offering trastuzumab to women with stage I disease? Are there data to support adjuvant therapy for stage III small bowel cancer?

Most important, we want this section to be reader-driven. We invite you to suggest topics addressing the quotidian issues you face in practice. We will plan panel discussions of problematic issues, not only strictly oncologic but also ethical and psychological, and invite readers to submit cases for discussion.

Although this format lends itself to informality, we will adhere to evidence-based opinions when the literature allows, tempered by experience. We hope you will find these discussions useful and welcome comments, now and later.

	REFERENCES

Top References

 

1. Kaufman D. Cancer therapy and the randomized clinical trial: good medicine? Cancer 1993;72(9 suppl):2801–2804.[CrossRef][Medline]
2. Tarassoff CP, Arlen PM, Gulley JL. Therapeutic vaccines for prostate cancer. The Oncologist 2006;11:451–462.[Abstract/Free Full Text]

This Article Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gurtler, J. Articles by Kaufman, D. Search for Related Content PubMed PubMed Citation Articles by Gurtler, J. Articles by Kaufman, D.