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15.09.2011: THE MEANING OF THE RECOGNITION OF MEDICAL ONCOLOGY AS A SPECIFIC SPECIALTY IN MEDICINE

EDITORIAL

THE MEANING OF THE RECOGNITION
OF MEDICAL ONCOLOGY AS A
SPECIFIC SPECIALTY IN MEDICINE













by PARIS A. KOSMIDIS, MD
Medical Oncologist
Former ESMO President

















History
The number of patients with malignancies in the world is increasing. It is estimated that more than 10 million new cases are diagnosed every year and that more than 2 million people are receiving treatment. The last decades have seen a rapid growth in medical technology and in the advances of knowledge of cancer cell biology with impact on genetics, screening, early diagnosis, staging, and overall treatment of cancer, including targeted.
These rapid developments have also led to a coordinated, multidisciplinary approach to the management of each malignancy as well the need for a formal training based on guidelines or a curriculum in the various major specialties such as surgery, radiotherapy, and medical oncology.
The establishment of medical oncology as a speciality was created in 1965 when the American Society of Clinical Oncology (ASCO) was founded. A uniform system of training in medical oncology in the United States was formulated by the American Board of Internal Medicine in 1989. In 1997, ASCO published a training resource document for development of a curriculum in medical oncology.
The European Society for Medical Oncology (ESMO) initiated an examination in medical oncology in 1989 for physicians actively working in the cancer treatment. To update the knowledge, skills, and attitudes of these physicians, which is essential to the provision of excellent care, the program of continued education of medical oncology, the ESMO-Medical Oncologist’s Recertification Approval (MORA) program, was introduced in 1994.
The basic objective of these certification systems was to improve the quality of patient care, to create standards for the practice of medical oncology, and encourage a continued professional excellence over a lifetime of practice.
In 1998, a training program for medical oncology was published in accordance with the requirements imposed by the Union Européenne des Médicins Specialistes for recognition of medical oncology as an independent specialty.


Role of Medical Oncologist
    Cancer is a highly complex disease. Due to the systemic nature of disease, cancer requires systemic treatment.
Based on medical innovations such as chemotherapy, targeted treatment, hormonal therapy and to some extent immunotherapy, a whole range of drugs is available to treat each patient’s condition. These drugs can be effective, but are also highly toxic and costly. Medical oncologists as specialists in cancer medical therapy prescribe the most appropriate cancer drug for each patient’s condition and care for the patient throughout the illness, from diagnosis and treatment to end of life. The vast majority of cancer patients must be referred to a medical oncologist at the earliest stage of their treatment.
    Medical therapy along with surgery and radiation therapy constitutes one of the three available treatments in cancer care. The best results for patients are achieved when medical oncologists act within a multidisciplinary team consisting of radiologists, radiotherapists, surgeons, organ-based specialists, pathologists, nurses, psychologists and others.
Needless to say that psychological support of patients and their families is a priority for the medical oncologists.  
Follow-up of cancer patients based on the natural history of the disease is part of the activity of Medical Oncologist.
Based on these, the long cancer survivors are today more than 25 million worldwide.


The meaning of recognition of Medical Oncology
A major step in the history of medical oncology was achieved on 3 March 2011, when the European Commission announced that medical oncology is now included among the professional qualifications covered by the European Union (EU) Directive 2005/36/EC. This means, in simple terms, that medical oncology is now mutually recognized as a medical specialty throughout the EU.  
The inclusion of medical oncology among the disciplines covered by the EU Directive grants automatic recognition of professional qualifications of EU medical oncologists in other EU countries. This replaces previous requirements of examination or training periods enabling a medical oncologist from one EU country to work in another under the same conditions. The advantages of recognition represent a big step forward, especially for young medical oncologists wishing to practice their profession outside their home country.
Additionally, the automatic recognition of the professional qualification helps to address a workforce shortage of medical oncologists, by allowing them free movement across EU borders. Furthermore, the mutual recognition should also help attract more medical students to choose our specialty. For patients, the mobility of medical oncologists may diminish their need to travel abroad to obtain special care not available in their home country.
Recognition surves a major goal of all societies: to decrease inequalities in cancer care. The free movement of medical oncologists will contribute to the harmonization of how medical oncology is practiced in different countries, thus spreading best practice and improving the quality of cancer care for the benefit of our patients.


Consequencies of non-recognition
Mediterranean area is a very large part of the world in which three continents are connected through the Mediterranean sea. There are several different civilizations, traditions, economies and customs.
Common problem is the increasing rates of cancer with some variations in incidence of some special types. Fortunately, many countries in this area have recognized the specialty of Medical Oncology and a curriculum of training exists.
However, it is a matter of grave concern for the care of cancer patients in certain countries in which Medical Oncology is not officially recognized as a specialty.
This has multiple consequences:
-    lack of well-qualified cancer specialists
-    inappropriate use of anti-cancer agents by sub optimally trained physicians
-    reduced chances of cure or stabilization for the patient
-    increase in cost by inappropriate use of highly costly targeted therapies
-    many promising young doctors or scientists will be discouraged from a postgraduate qualification in medical oncology.

Meditteranean countries have faced and will continue to face a major threat from cancer. Medical oncologists must be free from unnecessary administrative restraints and thereby allowed to focus on the safe and effective treatment of their patients in order to win the fight against this terrible disease.



References
1)    Hansen HH, et al. Recommendations for a Global Core Curriculum in Medical Oncology. Annals of Oncology 15: 1603 – 1612, 2004
2)    WWW.ESMO.org: Position paper: The role of Medical Oncologists in the fight against cancer in Europe, 2008
3)    Casali PG. Medical Oncology: the long-awaited prize of recognition. Annals of Oncology, June 30, 2011