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Gastrointest Cancer Res. 2009 Nov-Dec; 3(6): 219.
PMCID: PMC3000067

What Makes GI Oncology Special?

Daniel G. Haller, MD, President, ISGIO

Most of us did not become gastrointestinal oncologists by chance. In my case, I trained at Georgetown as a house officer when Phil Schein and Jack Macdonald came from the National Cancer Institute to start an oncology program. If I recall, we focused on gastrointestinal cancers primarily because few other institutions were at all interested in the field. And, apart from 5-fluorouracil, few drugs were available. With the introduction of doxorubicin and mitomycin, FAM was born, and so was my interest in clinical research. My paper on FAM in colon cancer was notable only for the fact that the nonresponders actually lived longer than the responders.

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We belonged to the Gastrointestinal Study Group (GITSG), and I started attending in my junior residency. After fellowship, I worked in the Cancer Therapy Evaluation Program at the NCI and was the project officer for GITSG; it was a bit daunting having to deal with people much more senior than I, such as Phil Schein, Chuck Moertel, Mike O’Connell, Hal Douglass, and others. What I learned is that GI oncologists are among the most collegial around, and this is not just in the United States. Axel Grothey and I are chairing a meeting in which the format is largely composed of debates, and the hard part is to get people to disagree substantially. There could be many reasons for this. Maybe people choose their discipline because of their personality and GI oncologists are just born amiable. Or, perhaps we share a bit of a “trench mentality.” After all, with a few notable exceptions, we haven’t racked up many home runs, aren't recognized for trendy “awareness ribbons” or panacean walks and marathons, and Bill Gates does not appear particularly interested in any of the diseases we treat.

So, how collegial are we? At the Journal of Clinical Oncology, authors are allowed to suggest up to four reviewers. They are also permitted to offer names of reviewers they would rather not see their paper. Now, here’s an odd thing; generally, when the editors choose the reviewers, few decline. However, if the authors’ selections are included, typically all four decline. I’m not sure of the dynamic at work here. For GI papers, we rarely see authors request exclusion of reviewers; on the other hand, contributors from certain other disciplines (to remain unnamed) will provide cover letters excluding virtually every living expert in the field, save the authors themselves.

How far does our collegiality go? Some years ago, as I was getting ready to prepare one of my post-ASCO presentations on the GI sessions, I realized that I couldn’t face the ponderous task of having to decipher notes from presentations that I hastily scribbled on the pages of my abstract book, nor was I looking forward to trying to reproduce survival curves again on my Etch-a-Sketch. With the arrival of Powerpoint and e-mail, it occurred to me that many people might be willing to share their slides. It seemed sensible to me, since many presenters would likely be in the same boat as I, and would rather have their work presented accurately. Indeed that was the case, and this system has grown over time. Today, Axel Grothey manages the website into which presenters can download their slides, and I think we are all the better for it.

Joel Tepper and I currently co-chair the GI Intergroup, which has been an exercise in collaboration, cooperation, and mutual respect. The cooperative groups have done an outstanding job of fostering clinical research, but all too often collaboration descends into competition, and many studies shave taken far too long to complete, if they were ever completed at all. I believe the GI Intergroup is making an honest effort to improve this by increasing communication and collaboration for large-scale trials, with the goal of having perhaps fewer collaborative trials with enhanced accrual and, it is hoped, positive results. The process has been a learning curve, but for many investigators, protocols that have been through the Task Forces and the Steering Committee have frequently been improved, and the task of enlisting multiple cooperative groups becomes easier when stakeholders are brought in at earlier stages of development. One additional benefit is that enhanced opportunities have emerged for new talent to enter a sphere larger than their own institution or cooperative group.

As collegial as I believe GI oncology is, our colleagues are not entirely loath to engage in spirited debate and even downright disagreement. I recall chairing a session at ASCO in which I almost had to restrain Chuck Moertel and Phil Schein physically. Many of you will also remember a discussion at the ASCO GI meeting in which Chris Willett actually had to debate the merits of a dollar sign. Such events, however, are not particularly common in the GI oncology community. In the early days at JCO, when our impact factor was less than 10, when manuscripts were rejected, authors typically accepted the decision with grace. Now that the impact factor is over 17, vigorous rebuttals are commonplace, and frequently arrive in the form of e-mail communications that should have been rethought before the “Send” button was hit.

The International Society of Gastrointestinal Oncology has sought to focus, among other issues, on mentoring junior colleagues. Apart from transmitting facts, we are also responsible for teaching respect, critical thinking, and professional behavior. Recently, I was honored with a reception to acknowledge the endowed chair I had been awarded. Many ex-fellows came, and it was a wonderful reunion. I asked them whether they remembered a single thing I taught them. Of course the answer was “nothing” when it came to drugs, regimens, and virtually anything one can find in a text or now on the Internet. What they did remember, however, was how I treated them, my colleagues, and patients, how I communicated, and how I thought through clinical problems. Who knew?


Articles from Gastrointestinal Cancer Research : GCR are provided here courtesy of International Society of Gastrointestinal Oncology