By Muhammad Salman Faisal, MBBS, Aakash Desai, MBBS, MPH, Rahul Gosain, MD, and Rohit Gosain, MD
We recently used Twitter Spaces to discuss the role of the community oncologist in U.S. health care, joined by two community oncologists on a mission to educate the broader oncology community: Dr. Rahul Gosain and Dr. Rohit Gosain, who have prominent presences on multiple social media platforms, including on Twitter as “Oncology Brothers” (@oncbrothers), LinkedIn (Rahul Gosain and Rohit Gosain), YouTube (Oncology Brothers), and their OncBrothers website. They both are practicing general medical oncologists.
As a community oncologist, every day will be different and you’ll need to keep up with a lot of new knowledge.
Community oncologists play a critical role in the treatment of patients with cancer, as a majority of patients are diagnosed and treated outside of large academic centers.1 In a general medical oncologist’s clinic, the patient population varies—a patient with metastatic colon cancer in one room, a patient with pregnancy-associated deep venous thrombosis in the next. You also see a lot of patients with classical hematologic diseases, anemia, temporary cytopenia or discussion around anticoagulation; for these patients, you should plan to do a complete work-up and follow-up based on the diagnosis and treatment plan.
Although the job is quite intriguing with constant opportunities for learning, it is quite challenging to stay up to date in the swiftly evolving field—it’s easy to get overwhelmed by everything you need to know. Fortunately, we have a lot of resources available for community cancer care. Our main resources are National Comprehensive Cancer Network (NCCN) and ASCO guidelines that outline the most comprehensive recommendations for patient care for newly diagnosed as well as recurrent disease and present evidence in detail. The NCCN chemotherapy template is another great resource that outlines the chemotherapy protocols and monitoring parameters. Other credible resources include ASCO-SEP, its companion question bank, and major oncology journals.
Alongside these formal resources, we created the Oncology Brothers space to fill the gap with small discussion forums that encompass the most common questions and updates that community oncologists need to know.
Building relationships with other cancer care professionals in your local and regional area is crucial.
The approach to multidisciplinary cancer care in the community depends on the setting in which you practice. A growing number of practices in the community are adopting multidisciplinary care by partnering with a large academic practice or being acquired by these tertiary and quaternary centers. For example, Rahul and Rohit both practice in western New York in conjunction with large academic centers (the University of Rochester and the University of Pittsburgh, respectively) at their satellite clinics. Another multidisciplinary model is for community-based medical oncologists to work in a symbiotic relationship with local surgeons and radiation oncologists in the area, establishing a connection by taking care of patients together. These networks also play a pivotal role in their referral patterns.
An often underrecognized aspect of community cancer care is involvement in cancer research. The clinical trial space is expanding in the community oncology space, with more and more resources available in the community. An effective way to get involved with clinical research as a community oncologist is to partner with a cancer center director in your area. Opening a trial as a principal investigator can be challenging when your practice doesn’t have a research infrastructure in place, but you can bring trials from major centers as a secondary site if you have enough logistical support. If you’re an early-career oncologist at a community practice, make it a goal to find out about the logistical support for research available to you at your primary location.
Collaboration between community oncologists and the academic world often works in two ways: ensuring the standard of care is being delivered and exploring clinical trial options. Sharing knowledge with colleagues at academic institutions can help you provide the best possible care for the patient close to home. A referral at an academic facility gives a patient and a local community oncologist a chance to explore a larger pool of clinical trials.
Community oncology is a great setting in which to develop long-lasting relationships with your patients.
The initial meeting with a new patient in community cancer care can be different compared to academia, since these patients and families are often trying to establish a long-term relationship with their local medical oncologists versus seeking a second opinion and being seen sparsely.
When you see a new patient with the diagnosis of cancer, in any setting, it is of paramount importance to establish connection and trust to discuss their disease and treatment. In a community practice, most of the time, the patient will have been through biopsy and possibly imaging before they see you, so your role in that first meeting is to discuss the intent of treatment, duration, and prognosis. That first visit is often a very stressful—even life-changing—time for a lot of patients, so keep in mind that they may not retain all the details you discuss and plan to reiterate this information in subsequent visits.
During training, you can test the waters to see if a career in community oncology is right for you.
For future aspiring community oncologists, the best way to prepare is to see a variety of different patients. One way of doing this is to rotate in community oncology settings and get more rotations in different hematology and oncology clinics to get yourself accustomed to the wide variety of patients you’ll see in the community.
Dr. Faisal is a hematology and oncology fellow at Roswell Park Cancer Institute. He is a member of the ASCO Trainee & Early Career Advisory Group. Disclosure.
Dr. Desai is a hematology and oncology fellow at Mayo Clinic, Rochester. He is a member of the ASCO Trainee & Early Career Advisory Group. Disclosure.
Dr. Rahul Gosain is the medical director of Wilmot Cancer Institute at Webster and assistant professor of clinical medicine in the Division of Hematology and Oncology at the University of Rochester Medical Center. Disclosure.
Dr. Rohit Gosain is the chair of oncology and hematology at UPMC Hillman Cancer Center at UPMC Chautauqua and adjunct clinical faculty at Lake Erie College of Osteopathic Medicine. Disclosure.
- Garg AK. Community-based Cancer Care Quality and Expertise in a COVID-19 Era and Beyond. Am J Clin Oncol. 2020;43:537-8.