About

A medical oncologist is a physician taking care of cancer patients. He/she has training in internal medicine, with subsequent specialization in the comprehensive management of patients with malignant diseases.

His/her training comprises the scientific basis of oncology, prevention, screening, diagnosis, the use and evaluation of specific medical anticancer treatments, and clinical investigation of malignant diseases.

He/she is able to use medical therapies and symptomatic, psychological, supportive, palliative, and after care in daily clinical practice to improve the quality-of-life of cancer patients.

He/she will be trained and continue to update his/her knowledge in the application of such interventions for optimal benefit, taking into account the psychological and social needs of cancer patients and their families.

The standard requirements for training in Medical Oncology are a total training period from five to six (5-6) years, beginning with a training in internal medicine for at least two (2) years, followed by a training program in medical oncology for three (3) to four (4) years. The 3 to 4 year training program in medical oncology must include a minimum of two (2) years full-time clinical training in the diagnosis and management of a broad spectrum of neoplastic diseases.

Hansen H, Bajorin D, Muss H, et al: ESMO/ASCO Task Force on Global Curriculum in Medical Oncology, Recommendations for a Global Core Curriculum in Medical Oncology. Ann. Onc., Nov 2004; 15: 1603-1612

The Philippine Society of Medical Oncology (PSMO) is one with other medical societies in the care of cancer patients and their families in recognizing that cancer is a devastating illness and one that is difficult to treat, much less cure, even with the most advanced medicines, the best trained doctors and the state of the art facilities.

For the utmost benefit of the patient. This is the basic tenet used in any medical intervention. The intricacies of cancer treatment are such that two things are absolutely necessary for the patient to receive the best possible care and for no unnecessary harm to come to the patient:

1. Multidisciplinary team approach
2. Patient education and participation in weighing the risks versus benefits and choosing among the treatment options

For a doctor to treat a cancer patient without the patient being fully informed is to do more harm than good. And yet because of the nature of cancer as a disease, as well as the nature of it's treatment (with surgery, radiotherapy, drug therapy) patients undergoing any or all of these treatment modalities can get worse before they can get better. Taking all these into consideration, who decides what are the best treatment options to offer a patient? A multidisciplinary team of experts. At the minimum, surgical advise must come from the surgeon; radiotherapy advise from the radio-oncologist; and drug/chemotherapy advise from the medical oncologist. Who then decides which of the best treatment options to choose? An
empowered patient.

THE MULTIDISCIPLINARY TEAM APPROACH

There are three modalities used singly, concomitantly or serially in the treatment of cancer.

1. Surgery - is performed by a surgical oncologist trained in general surgery and in surgical oncology, a master in the unique and special surgical techniques used in the biopsy, debulking or excising of malignant tumors.
2. Radiation - applied by a radiation oncologist trained in general radiology and radiation oncology, expert in the planning and use of radiation machines, like the Cobalt machines, linear accelerators and brachytherapy needles.
3. Chemotherapy - given by a medical oncologist trained in internal medicine with additional years of training in medical oncology so that he/she is knowledgeable in the prevention, recognition and treatment of complications of chemotherapeutic medications that inevitably follow the use of these potentially lethal drugs. A medical oncologist is expected to be able to educate the patient on the range of options of chemotherapeutic, immunotherapeutic or hormonal regimens appropriate for the patient's specific type and stage of cancer, taking into consideration the patient's functional status, concomitant illnesses, personal values and financial status.

The Philippine Society of Medical Oncology, Inc. (est 1969) is a scientific, professional organization of competent and caring oncologists committed to the advancement of the science and the ethical and holistic practice of Medical Oncology and to active participation in the national, regional, and global cancer programs.

The PSMO Mandate on the Multidisciplinary Treatment of Cancer articulates the need for both a multidisciplinary team approach and patient education and empowerment in order for the individual to have the greatest benefit from treatment.

As a member of this Multidisciplinary Team, the Medical Oncologist brings to the table the result of three years' specialty training in Internal Medicine and at least two years sub-specialty training in the field of Medical Oncology, together with the wealth of experience he has gathered over years of clinical practice. Such training includes, but is not limited to, chemotherapy and newer biologic treatment administration; specific anti-cancer drug administration; handling and disposal of anti-cancer agents; management of specific acute and chronic adverse drug events; various venous access procedures; various regional anti-cancer drug administration; guidelines on disclosure; and management of oncologic emergencies.

The administration of chemotherapy and other anti-cancer medication is more than just following guidelines and dosing schedules easily accessible via publications and the world wide web.

It is also more than just the insertion of an IV line and/or writing down a prescription and
instructions for its administration. It is also:

• being ready for the common and uncommon acute allergic, anaphylactic, idiosyncratic
  adverse events that may occur every time such medicine is given,
• giving the appropriate medication a day before, 30 minutes before and/or a day or several days after the actual administration,
• knowing, anticipating and educating the patient on side effects that could happen when the patient has been sent home after the procedure,
• judiciously applying the potentially life-saving adjunctive medicines (i.e. colony stimulating factors when complications such as febrile neutropenia occur).

Chemotherapy and other anti-cancer drugs should be given properly by trained individuals
and in tertiary hospitals with the capability to do the necessary work-up and to deal with the adverse events of therapy. Substandard administration may lead to a heavier financial burden on the part of the patient, who subsequently has to purchase additional medication; undergo more tests and hospitalization. Furthermore, this may lead to unnecessary suffering on his part and, more significantly, to a decrease in survival which could have been extended, despite the cancer diagnosis, with the correct treatment medication and administration.

PSMO strongly believes that chemotherapy and other anti-cancer drug administration are life-
saving procedures when done properly, but also could lead to morbidity and mortality when done improperly. We recommend that for the safety, and in the best interest of patients undergoing such treatment, chemotherapy and anti-cancer procedures should be performed by physicians who have been adequately trained and hold credentials (board certified) in recognizing the indication for the procedure; in the medical handling of its immediate and long term side effects; and in the handling, preparation and administration of these drugs.

……NO ONE DOCTOR KNOWS ALL THE ANSWERS…..