Would you expect a world-renowned dumpling restaurant to also offer a critically acclaimed baklava?
It would be highly unusual for a chef to specialize in both kinds of foods. Yet, we expect community oncologists to be experts in all cancer types that walk through their door. One community oncologist in a small group practice attests “I am responsible for treating it all.”
In practice, “treating it all” means dealing with 10-15 different types of cancer in a single day while under intense time pressures . If we don’t require a chef to excel in multiple cusines, it is unreasonable to expect a community oncologist to stay abreast of the latest advances in 10-15 different types of cancer, especially given the exponential growth of medical information today.
Community oncologists try hard to keep up to date with the tsunami of medical information by reading widely; however, they must focus on the cancers they see most often. The most commonly diagnosed cancers in the US are prostate, breast, lung and bronchus, and colorectal . Since community oncologists are on the frontline of cancer care they also diagnose and treat less common cancer types and even some benign hematology cases. This is especially a challenge for the 10.5% of America’s oncology workforce who are rural oncologists .
Despite their best efforts to stay up-to-date, there are a handful of scenarios where community oncologists confront uncertainty. Community oncologists highlighted the following scenarios:
- When cancer patients exceed second-line or third-line therapy
- When encountering rare or uncommon cancers
- When encountering a patient that has an unusual set of comorbidities
- When new evidence could change the current standard of care
Below are real-world examples of these scenarios encountered by Primum: