How New Cancer Therapies Are Changing Oncology Jobs

More than 1.7 million people in the United States will receive a cancer diagnosis this year, which equates to 4,750 new cases every day, reports the American Cancer Society. The good news is that oncologists and other practitioners today know more about cancer than ever before—including how it develops and grows and how to successfully treat it.

New cancer therapies offer great hope for the future.

“It’s a remarkable time for innovation in cancer care,” said Debra Patt, MD, MPH, MBA, immediate past chair of the American Society of Clinical Oncology’s clinical practice committee and a breast cancer specialist with Texas Oncology in Austin.

“Diseases that frequently would cause death rapidly are now chronic illnesses and being managed. It’s an amazing time to be an oncologist.”

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Advances are occurring in all realms of cancer care – medical, surgical, radiation and interventional therapies, added Kien Vuu, MD, a clinical professor of medicine at UCLA-David Geffen School of Medicine in Los Angles, and a practicing interventional and diagnostic radiologist.

Len Lichtenfeld, MD, deputy chief medical officer for the American Cancer Society, discussed new approaches to cancer care, including genomics, immunotherapy and CAR-T cell therapy.

“All of these factors have created an environment that is difficult for the typical oncologist to keep up with,” Lichtenfeld said.

New cancer therapies show results, add to complexity of care

Genomics, precision medicine and immunotherapy have left the lab and are entering clinical practice. So much innovation increases the complexity of decisions oncologists must make.

“We now have a lot of subspecialized tools to treat cancer,” said Patt, adding that she uses precision medicine daily to decide whether a patient may be amenable to targeted treatments.

Mark Scholz, MD, medical director of Prostate Oncology Specialists in Marina del Rey, California, reported numerous new therapies exist for prostate cancer, including active surveillance, focal therapies, targeted radiation and immunotherapy. Additionally he said, “imaging with multiparametric MRI can replace the need for the 12-core random biopsy, and radioactive seed implants provide higher cure rates than surgery or other types of radiation.”

Vuu called immune regulators a hot topic in cancer treatment. The patient’s T-cells are removed, modified, grown outside the body and then replanted into the patient.

“It’s shown to have great results in a lot of blood type of tumors,” Vuu said.

Immune checkpoint inhibitors are new and beneficial in medical oncology. In radiation oncology, Vuu said, techniques have become much more targeted on the tumor, with less radiation affecting healthy cells, such as with stereotactic body radiation therapy.

New interventional oncology cancer treatments also are improving cancer patients’ lives. Interventional oncology uses image-guided interventions, often in patients with inoperable cancers, Vuu said. These techniques include ablation of the tumor in the lung, kidney or liver, including metastasis to the liver. Interventional oncologists also can deliver targeted medicine to a tumor through an artery.

Additionally, many cancer centers are incorporating integrative medicine into cancer care, said Vuu, adding that with research, such integrative therapies as mindfulness and stress management, have become more mainstream.

General oncology jobs or subspecialization?

Lichtenfeld said more oncologists are opting to specialize in treating one type of cancer, as Patt has subspecialized in breast cancer and Scholz in prostate cancer care.

“Medicine is complex,” Scholz explained. “To really understand a disease process well you need to focus on one disease. Even so, trying to keep up with all the new developments in prostate cancer is challenging.”

Other oncologists, such as Vuu, have opted to specialize in one type of treatment modality. He was trained in radiology and then specialized in interventional therapies.

Patt described the challenge of working in a field with frequently changing best practices as “a complex problem with information gaps.”

“Most cancer care is practiced in the community by community oncologists that address every cancer,” Patt said.

Evidence-based best practice pathways, a decision-support tool developed within health systems or practices to walk clinicians through cancer treatments, can help them. ASCO supports clinical pathways.

Lichtenfeld added that it is important for oncologists in rural communities and small cities “to survive and thrive.” Reimbursement and technology issues add to the challenge. He said, some patients have to travel hundreds of miles to receive cancer treatments.

Many professional organizations provide continuing medical education (CME), which Lichtenfeld said works well for common cancers, but for rarer cancers, it may be best to reach out to a specialist. Additionally, he said that CME may not be able to fill the gap in genomic knowledge.

“The field changes so quickly, in order to stay on top of it requires a substantial investment of resources, and that usually happens at a larger organizational level than a local physician’s office,” Lichtenfeld said.

Long-term surviving patients also mean a bright future for oncology jobs

With an aging population and the fact that some cancers are becoming a chronic disease, the need for oncologists continues to increase. Oncology jobs are prevalent.

“We need more oncologists and mid-level providers to go into oncology and help manage patients,” Patt said.

Lichtenfeld said that many long-term surviving patients are being referred back to community primary care providers, who also need to become more knowledgeable about long-term cancer therapy complications, such as heart disease in women who have been treated for breast cancer or Hodgkin’s disease.

“Everyone [on the primary care team] needs to be alert to the problems that may be specific to patients fortunate to have long-term survival,” Lichtenfeld said.

Patt indicated that patients on long-term cancer therapies will need to have their toxicities managed and care optimized during survivorship by oncologists.

“It’s a whole new set of long-term disease management,” Patt said. “It’s a good problem to have that more people are surviving their cancer, but there is a tremendous demand for oncology providers and nurses.”

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