Iwrite this a few days before Thanksgiving Day and a few weeks before the Christmas season peaks. As the holiday season approaches, many of us spend more time thinking of and expressing our gratitude for what we have. Most oncologists are financially well off, dramatically so compared with the average American. In my experience, most have a loving family life. We are usually respected in our communities and tend to participate in efforts to bolster the common good.
Our gratitude should also include how privileged we are to be oncologists in the 21st century. When my colleagues and I started treating cancer patients (for me, mainly childhood leukemia and lymphoma) in the early1960s, the mortality was very high. All of my patients died. If a patient survived, we assumed the original diagnosis was wrong, which was often true; all we had for diagnosis was the microscope. Today, molecular diagnostics are used routinely and influence the type of therapy one gives. Therapy has been refined to reduce some toxic effects and result in a “presumed cured” status for about 80% of children with acute lymphoblastic leukemia. Lymphomas today are also highly curable in children.
One can find similar stories among adult cancers such as breast, colorectal, uterine, and several others. But we still have cancers that seem intractable, even though our diagnostic capabilities have improved. Therapy has not kept pace with cancers of the lung, ovaries, and pancreas, and with glioblastomas and disseminated neuroblastoma in children over one year of age: my intractable “most feared” list.
Equally important, compared with 40 years ago we have a heightened awareness of the need for stronger efforts in pain control, end-of-life care, and the quality of patients' lives in general. Quality improvement has become accepted as a valuable tool along with treatment guidelines and pathways.
Minimally invasive surgery is maturing, lumpectomy has proven successful in many cases and “super radical” and mutilating surgery is rarely used today. Radiation oncology is far more sophisticated; when I started at St. Jude in 1967, we had a only a cobalt machine before linear accelerators were widely available. We have brought into question or abandoned some previously touted approaches that caused patients unnecessary trauma, such as autologous bone marrow transplantation for breast cancer and the more recent studies concluding that the PSA test is diagnostically inaccurate and results in unnecessary surgery, incontinence, and impotence.
In short, we are in a field of medicine backed by extensive research and increasing self-examination of our mode of practice. And more and more we are questioning how we do things…a very healthy exercise.
But we were proud and felt privileged to be oncologists even back in the early days when treatment was not as effective, patients suffered more and they were more likely to die from their disease. Because at the core of our profession is the desire to help people with catastrophic illnesses as best we can. It is our job to give them accurate information, help them choose the right course of action, provide reasonable hope, and, when necessary, to help them face death. We are asked to do all this while acting in their best interests and doing our best to make the quality of their lives and their families' lives the best that it can be.
Although financial pressures occur at some time in our practices, it saddens me to see some of our kind shamefully consumed with greed or engaging in local “onco-wars;” for them, there is never enough income or power and there is no genuine gratitude for the privilege of being an oncologist.
How many people in this world have the honor and privilege of professing and practicing such skills? We should treasure and be thankful for that privilege. This is a good time of year to be grateful for being an oncologist and to honor our profession.