Research Assessment #4

Date: ​October 11, 2019

Subject: ​Oncology

MLA Citation:

Kennedy, BJ. “Origin and Evolution of Medical Oncology.” The Lancet, Dec. 1999,

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)90384-7/fulltext.

Assessment:

As cancer has been at the forefront of medicine for the past several years people often

tend to forget how new Oncology is in comparison to the other fields of medicine as the medical

community has spent significantly less time researching and developing it due to the later start.

That is why this particular field of medicine is ever-evolving and improving as the medical field

continues to make more discoveries into improving the way we go about treating both benign

and malignant tumors in an attempt to develop a treatment method that can successfully treat the

tumors with as little unnecessary damage to the healthy tissue as possible. In the article entitled

“Origin and Evolution of Medical Oncology” by Professor BJ Kennedy, Kennedy looks into the

origin of Medical Oncology here in the United States and how it has evolved into the current

system it is presently.

To begin with, I learned from this article about how Medical Oncology began as its medical

subspecialty here in the United States. According to Kennedy’s article, Medical Oncology began

in the year 1972 as people became increasingly aware that we were developing successful

techniques to treat cancer and began to research more into how to properly deal with it. This
information was surprising as it was intriguing to me to see that the job of being an Oncologist

was only first created forty-seven years ago. From this, the job of a Medical Oncologist was

established as one who is a clinician, investigator, and educator. The first Oncological

certification examination was administered in the year 1973, and from that point on in United

States history, the number of Oncologists began to rapidly climb. Coinciding with the creation of

this new specialty was the development of new treatment techniques to treat cancer that enables

doctors to be able to successfully treat tumors that were once deemed impossible to treat.

Additionally, I was able to learn from Kennedy’s article how as times have changed, so too

has the profession of being an Oncologist. When initially created, the profession of being an

Oncologist was designed to specifically treat only cancer. Back in the beginning of Oncology,

the American Society of Clinical Oncology (ASCO) found that there was a sufficient number of

Oncologists to treat patients, but as times have gone on the number of Oncologists has become

insufficient in comparison to the increasing number of patients who are requiring treatment. This

information surprised me as I was under the assumption that the number of Medical Oncologists

have grown in numbers that matched that of the growing number of patients in the United States

who are requiring Oncological treatment. The article then discusses that the cause of the deficit

in the United States results from shrinking graduate programs. After discussing the lack of

Medical Oncologists in the United States, Kennedy then goes on to talk about how the

educational pathway to becoming an Oncologist has developed over time. Originally Oncology

began as a two-year certification program. Then this was increased to three-years as the process

developed into a dual certification for the field of Hematology (the study of blood) and

Oncology. Kennedy then goes on to note that there is continued debate about the relationship
between Oncology and Hematology. Kennedy then goes on to state that an Oncologist’s original

job description incorporated elements of Gerontology (the study of older age) as the medical

community hypothesized that Oncology would generally affect the older population. This

directly led to, according to Kennedy, an increase and training and education for aspiring

Oncologists. The final piece of information I learned from this article is how the field of

Oncology has impacted the medical community. This impact is that the field of Oncology

continues to develop and improve as these Oncologists work tirelessly to improve the way we go

about treating cancer that has not only improved the way we treat cancer here in the United

States but worldwide as well.

All in all, I learned from Kennedy’s article that the field of Oncology and the position of being

an Oncologist is relatively new, and the creation of this subspecialty was the result of

improvements in how the medical community went about treating tumors. The improvements

then led to the ability of Oncologists to be able to successfully treat tumors that were once

deemed untreatable. I also learned from Kennedy’s article that the number of Oncologists is

insufficient to the number of patients who are requiring treatment, although it has not always

been that way. Furthermore, I learned that the educational requirements to become an Oncologist

have changed over time and increased as the definition of an Oncologist has evolved. The final

piece of information I acquired from this article is that the development of Oncology overtime

has positively impacted the worldwide community as it has led to more efficient cancer treatment

techniques that continue to develop and improve, even today. This information that I learned

from this article is important as I was able to learn more about how the field of Oncology has

developed over time, which will help me in the future when I, along with the rest of the
Oncologists, work tirelessly to continue to develop and improve this field of medicine. I will

utilize this information in the future as I work to further develop this field by looking back at the

past and seeing how the situation used to be to see the problems and how it can be corrected for

the future. I will also utilize this information currently in ISM as I will incorporate the history of

Oncology into both my winter showcase and final presentations to help those who view my

presentation be better able to understand the field of Oncology. To sum it up, Kennedy’s article

taught me the history of Oncology which will be useful for me in the future as an Oncologist as I

work to improve the field, and now as I study the field of Oncology in ISM.
Article: ​*Annotations are bold and italicized*

Origin and evolution of medical oncology

B J Kennedy is Regents' professor of medicine emeritus, and Masonic

professor of oncology emeritus at University of Minnesota Medical School,

Minneapolis, Minnesota.

Medical oncology in the USA became a designated subspecialty of internal

medicine in 1972 as a result of developments in cancer research, new cancer

therapies, and awareness of the management needs of patients with cancer.

​ he first
Wow the field of Oncology is a very recent development. T

Subspecialty Committee on Medical Oncology of the American Board of

Internal Medicine defined the scope of medical oncology and the subjects of

direct relevance to clinical medical oncology and established guidelines for

training in this new subspecialty. ​The roles of the newly established specialist

were as an educator, investigator, and clinician. The main skill of the medical

oncologist was deemed judgment in matters relating to the total management

of neoplastic diseases. ​The definition of the role of an Oncologist after its

initial creation.
The propagation of new therapies for advanced cancer moved patients from

an untreatable, incurable status into a setting where active treatment

programmes offered control of cancer, holding the promise of life prolongation

and even cure.​ ​How to development of new therapies has had a positive

impact on the worldwide community. ​With continuing progress resulting

from research, the areas of management changed from advanced cancer, to

earlier stages of cancer, to prevention. The training objectives mandated that

trainees see all stages of cancer, know all the aspects of management and

the current status of research, learn to be a consultant in medical oncology,

and interface with other oncological specialists and supporting disciplines. ​A

certifying examination in medical oncology was first offered in 1973. ​This is

interesting, the first time a certification for was 46 years ago.

Subsequently the number of certified medical oncologists increased in the

USA to reach 7622 by 1998 (​figure​). This rapid increase helped to bring much

needed expertise to the community.

FigureCertified oncologists and haematologists in the USA

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Medical oncologists were initially expected to serve as the main care-givers

for patients undergoing cancer treatment. A 1996 survey of medical

oncologists by the American Society of Clinical Oncology (ASCO) found that

the medical-oncology community does not provide or seem to wish to provide

what is defined as primary care. The ASCO survey estimate of 1·8 medical
oncologists per 100 000 adult Americans was in close accord with HMO

estimates of the current number of needed oncologists. ​So, the supply

seemed to be in keeping with the expected demand. However, according to

the Graduate Medical Education Advisory Committee the projected need in

the year 2000 is 3·6 per 100 000 adults, twice that of the current supply.

Currently there are not enough Oncologists to meet the demands.

The chaotic nature of change in medical care adds to the difficulty in

determining manpower needs. ​Declines in clinical revenue and Medicare

support of postgraduate education have led to downsizing of graduate

education programmes. Although predictions of need seem to be on target for

today, these perceptions fail to take account of the projected impending

increased demand based on new technology and the ageing population. One

can conclude that there is no oversupply. ​Why the number of Oncologists

has decreased overtime.

The initial establishment of medical oncology required a 2-year training for

certification. Because of overlap with haematology, a 3-year training was

negotiated for dual certification. The American Board of Internal Medicine

continues to support separate certification boards. There had been a shift in

subspecialty choice from haematology to oncology.​ ​Shift in the education

requirements of Oncologists.​ The number of candidates in the certifying

examinations has emphasised the emergence of oncology. In the 1997

subspecialty examinations, oncology ranked third (739 passed), below

cardiovascular disease (1383 passed) and gastroenterology (828 passed). Of

the ten subspecialties, haematology ranked ninth (154 passed). Almost five

times as many oncologists were certified than haematologists. The old

concept of haematology is changing: the trend is from coagulation to

cardiovascular medicine, from benign haematology to the geneticists.

Haematotherapy involves transplantation and cellular transduction, while

haematological neoplasms merge with medical oncology. ​The initial definition

of the scope of medical oncology included nine items, one of which was

gerontology. The early perception was correct in that the ageing population

would have a major health problem with cancer. A new initiative has evolved

to integrate geriatrics and medical oncology, creating a new specialty of

geriatric oncology. This will encourage the much needed research in older

people, early training, and education at the postgraduate level. ​How

Oncology incorporated the field of Gerontology.

The emergence of the large number of trained medical oncologists brought

oncology expertise to the community and impacted on cancer research and

cancer education. The oncologists orchestrate other cancer disciplines in

developing an appropriate interdisciplinary treatment strategy for each patient,

exploiting their own special competence in drug therapy and internal

medicine, and integrating this care with primary-care physicians. More than 27

years after its designation as a certified subspecialty of internal medicine,

medical oncology is having a major effect on cancer management worldwide.

How Oncology has impacted the worldwide community.