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J Oncol Pract. 2007 November; 3(6): 289.
PMCID: PMC2793757

Challenges and Solutions

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Douglas W. Blayney, MD

The Journal completes its third volume with this issue. As we look back, it is clear that practitioners of our profession and our Society are facing tremendous challenges:

  • There is likely to be a coming shortfall in trained oncologists to do the work that we do today.
  • Our secondary customers—those who pay us for our expertise and time, and reimburse us for the drugs we administer to our patients—don't want to pay us as much as they have, while our primary customers—our patients—continue to value our services. Our primary and secondary customers are teaming up to demand that we demonstrate value and measure our service quality in exchange for the money they pay us.
  • There is a technology imperative: adoption of electronic record keeping and decision support technology. No one has yet figured out how to fund adoption of the new technology, nor has anyone developed standards that avoid duplication of effort by all those who might enter data, nor are these acceptable standards for exchange of this data.
  • Regulatory government agencies are under pressure to fulfill their missions, and will continue to exert pressure on practitioners.
  • New drugs and treatment methodologies—some of which take advantage of our newfound knowledge of the human genome, and some of which require close collaboration with our colleagues in radiation oncology, surgical oncology, and nuclear medicine—are being developed at a dizzying pace. The clinical trial apparatus, which has been constructed and nurtured throughout the last 35 years, is under pressure to produce more results and more data for less money, with increasing burdens aimed at protecting patient safety and autonomy.

The JOP has addressed many of these issues, and has chronicled ASCO's efforts to help its members develop solutions.

There is almost certainly a market-based solution to the design of the 21st century workforce. Collaborative patient management with physician extenders(nurse practitioners and physician assistants) is underway and is an increasingly valuable part of our care. Development of clear career advancement paths, training and development enhancements, and enhanced job satisfaction for our nurses, clerical workers, and other medical assistants, is necessary to develop a motivated and skilled workforce to care for the increasing numbers of patients we will manage. These areas cannot be ignored, and we will maintain our focus on them. The Journal will continue to highlight best practices, the efforts of ASCO and its work to mold a solution to the projected shortfall, and contributions from our readers.

Demonstration of value, by developing easily applicable, efficient, and affordable quality measures for the services that we provide to our patients, will continue to be a focus of the JOP. The Quality Oncology Practice Initiative, its derivative projects, and our peer-reviewed Original Research, will all focus on demonstrating value to our primary and secondary customers.

We will continue to offer advice from our experts on adoption of electronic health records (EHRs), and will chronicle the efforts of the EHR Workgroup. Adoption of technology in direct patient management, including documentation of patient visits and chemotherapy and other drug ordering, is developing. The decision-support features (safety and chemotherapy dose range checks and integration with information that patients directly supply or that is entered into outside databases) are not well developed, and will be a subject that we will watch.

Interactions with government agencies, which regulate the drugs and devices we use, and which act as stewards of public dollars paid for our services, will continue to be a focus of the content of JOP.

Our clinical content, which summarizes the ASCO-developed practice guidelines, and which are updated periodically, will continue to expand. We have recently added a feature entitled “How I Treat …” authored by recognized experts, and which will address problems that a practicing oncologist might see once or twice each year. They are meant to be evidence and literature-based, and will not be exhaustive summaries of the medical literature.

In 5 years, when we look back at the JOP's first years, two things will be certain: We won't believe we're doing it so differently, and it was not an easy time. The underlying foundation of our professional activities—that sick and vulnerable people, whose lives are being disrupted by cancer will look to their oncologists for help in providing solutions to their problems—will not change. The JOP's job is to support the oncologist in providing these solutions.

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Articles from Journal of Oncology Practice are provided here courtesy of American Society of Clinical Oncology