As general internists, we care for patients across the spectrum of many diseases, including cancer. For cancer care, we are at the forefront of developing and promoting recommendations for prevention, risk reduction, and screening. We are often the ones to diagnose cancer and help our patients navigate the early phase of treatment. During later phases of the cancer continuum, general internists’ roles include co-management with oncology colleagues, facilitating transitions from active treatment and at the end-of-life, and guiding patients through decision making and goal setting. Recognizing this unique contribution of general internists, a group of SGIM members launched the Cancer Research Interest Group in 2006. During its first 10 years, the Interest Group galvanized efforts in clinical care, research, education, and policy.1 The group, now Cancer Care, Education, and Research, continues to be active within the Society. Since 2006, the population of cancer survivors, or individuals living with and beyond cancer, in the United States grew from approximately 10 million to 17 million.2 Internists must be prepared to care for this growing population and lead innovative research and medical education efforts across the cancer continuum.
As members of SGIM, we were interested in exploring whether our organization has kept up with the population trends and led innovation across the cancer continuum. To do so, we characterized cancer-related abstracts presented at the 2015-19 annual SGIM meetings for their content across the cancer continuum (prevention, screening, diagnosis, treatment, survivorship, and palliative/end-of-life).3 Of 3,437 scientific abstracts, we found that 304 (8.8%) related to cancer. Among cancer-related abstracts, our further findings revealed a robust emphasis on cancer screening (47.7%) with moderate attention to prevention (17.1%) and treatment (18.8%) but missed opportunities for research in other phases of the cancer continuum, especially survivorship (4.0%) and end-of-life care (9.5%). These findings held true across Scientific, Innovation in Clinical Practice, and Innovation in Medical Education abstracts. This emphasis likely reflects the comfort and experience internists have with earlier phases of the cancer continuum and our limited training and integration in survivorship and end-of-life care. It is also possible that the abstracts presented do not fully represent the breadth of research conducted by SGIM members but rather showcase those that are submitted and/or accepted for presentation. Furthermore, abstract presentation may not reflect the actual attention to these phases of care in day-to-day clinical practice.
The national calls to improve cancer survivorship care began as early as 2005 by the Institute of Medicine (now National Academy of Medicine) in From Cancer Patient to Cancer Survivor: Lost in Transition, a book that emphasized the need for quality care including prevention, surveillance, intervention for consequences of cancer and cancer treatment, and coordination between specialists and primary care providers.4 Several organizations launched initiatives to answer this call. For example, the American Cancer Society published breast, colorectal, prostate, and head and neck cancer survivorship care guidelines for primary care physicians. The American Academy of Family Physicians (AAFP) has published primary care recommendations for caring for survivors of a variety of cancers. As a collaborative effort to promote education and collaboration between primary care and oncology specialists, the AAFP, American College of Physicians, and American Society of Clinical Oncology (ASCO) hosted an annual Cancer Survivorship Symposium. ASCO also developed core competencies and a curriculum for physicians caring for cancer survivors. Despite these efforts, translating the calls for changes in practice take time and may still be trickling down, particularly when generalists are challenged by the poor communication and coordination in our health care systems and electronic health records (EHR). The urgent need for innovation in clinical care, research, and policy to advance cancer survivorship care remains.5
We call upon SGIM as an organization to take an active role in addressing the need for research and innovation in clinical care, education, and policy across the cancer care continuum, with specific attention to survivorship and palliative/end-of-life care. For example, further research in survivorship, in collaboration with our oncology colleagues, could include the development and evaluation of new long-term care models for post-treatment cancer survivors, secondary cancer prevention and screening, management of mental health, and management of late and long-term treatment effects. General internists can expand upon palliative and end-of-life research in areas such as communication, advance care planning, and symptom management. Creating EHR tools to identify cancer survivors and incorporating prompts for surveillance testing, similar to those that currently exist for those patients with diabetes, can improve the quality of care. Encouraging providers to annotate the problem list with cancer history (for example, type of cancer, year of diagnosis, treatment exposures) may be a simple quality improvement project. Fostering collaborative relationships between internists, oncologists, and other specialists can offer a team-based approach to improve clinical care and promote academic scholarship. SGIM members can develop and incorporate cancer continuum curricula into medical school, residency training and continuing medical education. Lastly, we encourage SGIM members to get involved in local and national efforts in cancer-related guideline development and dissemination.
In 2030, there will be more than 22 million individuals living with and beyond cancer—we will continue to see more of these patients in our clinical practice.2 We urge SGIM and its members to lead interdisciplinary research, education, and policy changes to improve the lives of this growing patient population.
- Nekhlyudov L. SGIM cancer research interest group: A five-year journey building collaborations…and friendships. SGIM Forum. 2011;34(10):6-7.
- American Cancer Society. Cancer treatment & survivorship facts & figures 2019-2021. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2019-2021.pdf.
- Amundsen DB, Choi Y, Nekhlyudov L. Cancer care continuum research and educational innovation: Are academic internists keeping up with population trends? J Cancer Educ. Jul 24 2021;doi:10.1007/s13187-021-02073-4.
- Hewitt M, Greenfield S, Stovall E. From Cancer Patient to Cancer Survivor: Lost in Transition. The National Academies Press; 2005.
- Kline RM, Arora NK, Bradley CJ, et al. Long-term survivorship care after cancer treatment: Summary of a 2017 National Cancer Policy Forum workshop. J Natl Cancer Inst. 2018 Dec 1;110(12):1300-1310. doi: 10.1093/jnci/djy176.
Clinical Practice, Health Policy & Advocacy, Leadership, Administration, & Career Planning, Medical Education, Research, SGIM
Ms. Amundsen (email@example.com) is a fourth-year medical student at Johns Hopkins University School of Medicine. Dr. Choi (firstname.lastname@example.org) is an assistant professor in the Division of General Internal Medicine at Johns Hopkins University School of Medicine. Dr. Nekhlyudov (email@example.com) is a professor of medicine at Brigham and Women’s Hospital.
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The Mary O’Flaherty Horn Scholars in General Internal Medicine Program was created…