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Interventional Oncology: the Fourth Leg of the Cancer Treatment Stool

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Interventional Oncology: the Fourth Leg of the Cancer Treatment Stool 1357 Journal of the National Comprehensive Cancer Network The Last Word Interventional Oncology: The Fourth Leg of the Cancer Treatment Stool Melanie B. Thomas, MD I recently had the opportunity to read some of the proceedings from the 2014 Society of Interventional Radiology (SIR) Annual Scientific Meeting and thought that the excitement surrounding the nascent field of interventional oncology is palpable. As a practicing medical oncologist who manages the often complex needs of patients with gastrointestinal malignancies, I have experienced first-hand the rapid expansion of diagnostic and therapeutic options provided for these patients by our interventional radiology colleagues. In 2014, interventional oncology has indeed evolved to be the Melanie B. Thomas, MD “fourth leg of the cancer treatment stool,” or table, as it were. Welcome to the table! Melanie Thomas, MD, is a gastrointestinal medical My own oncology practice, which principally includes patients with hepatocellular oncologist with a special interest carcinoma (HCC), is a testament to integration of the panoply of interventional in pancreatic, gallbladder, biliary, colorectal, and hepatocellular radiology procedures into state-of-the-art cancer treatment. Without the support and cancers. She is Associate Professor services of superb interventional radiologists, it is simply not possible to adequately care at the Medical University of South Carolina and Associate for patients with complicated HCC. In early 2011, my colleague Marcelo Guimaraes, Director of Clinical Investigations MD, proposed that we create a joint hepatobiliary clinic. During this weekly combined at the Hollings Cancer Center. In this role, she has expanded the interventional radiology–gastrointestinal oncology clinic, we concurrently evaluate Center’s clinical trials portfolio and manage patients with HCC, cholangiocarcinoma, metastatic colorectal cancer, across all tumor types to ensure that more patients with cancer and neuroendocrine tumors. The goal of this clinic is to ensure close coordination of have access to high-quality clinical patient care, consistent incorporation of the best medical evidence into treatment trials. She has developed a robust clinical trials program for all decisions, and access to clinical trials when appropriate. gastrointestinal cancers and has As I was reading about the SIR meeting, several words, phrases, and themes completed several investigator- initiated trials of novel targeted resonated with me: team, multidisciplinary, evidence-based, collaboration, tumor board, agents in liver cancer. Dr. coordination of preprocedure and postprocedure care, clinical trial. These concepts are the Thomas came to the Medical University of South Carolina sine qua non of state of the art, multidisciplinary cancer care that patients expect and from the University of Texas MD deserve. Anderson Cancer Center where she completed Medical Oncology I personally welcome and celebrate the emergence of interventional oncology Fellowship training and was on as a specialty with a full seat at the cancer care table. But I respectfully ask that faculty in the Department of Gastrointestinal Medical Oncology my interventional radiology and interventional oncology colleagues listen, observe, for 6 years. Dr. Thomas has learn, and embrace the lexicon of how we as oncologists converse with our patients received several awards including the ASCO Foundation Clinical over the arc of their cancer journey. Research Career Development Award, NCI Clinical Investigation Because I am a medical oncologist, I can only speak from the perspective of a medical Team Leadership Award, and oncologist, although I regularly share patient care responsibilities with radiation and the Charleston Regional Business surgical oncology colleagues. In oncology, we enjoy longitudinal relationships with Journal Health Care Hero Award. Dr. Thomas is the founder patients—hopefully for many years, but often not. Medical oncologists are commonly and President of CanLiv—The the first cancer specialists that patients visit, and we are often the last one they see. Hepatobiliary Cancers Foundation (www.canliv.org), a 501(c) 3 Patients ask us very direct questions: “Will my cancer return?” “How long will I live?” nonprofit medical education “Will this cancer take my life?” “Is one treatment option better than another?” “What and research foundation created to accelerate research and are the benefits and side effects of the treatment options?” “Will I be alive and well therapeutic discovery for cancers enough to celebrate my daughter’s wedding next spring?” of the bile ducts, gallbladder, and liver. Patients often ask these us these questions not once, but many times. They ask these questions when they have forgotten the answers from previous discussions, when they are seeking an answer different from what they’ve already heard, when they are at a decision point in their journey, and if their cancer has recurred or progressed. In every such conversation with patients and family members, the concept of the level The ideas and viewpoints of evidence that supports our recommending a particular treatment, its side effects, expressed in this commentary are those of the author and do not and attendant quality of life, is central to the words we can offer when it is difficult to necessarily represent any policy, find the right words. position, or program of NCCN. © JNCCN—Journal of the National Comprehensive Cancer Network | Volume 12 Number 9 | September 2014 1358 The Last Word Thomas We can encourage a positive outlook and support spiritual beliefs, but patients want facts to weigh in their decision-making. When the best possible evidence of benefit does not exist or is weak or conjectural, then oncologists are left with a void in our conversation and our relationship with patients that cannot be filled with empty promises. In my view, a “seat at the table” for interventional oncology comes with the obligation to expend the time, effort, and resources to consistently conduct prospective, controlled, adequately-powered research studies that demonstrate the benefits and risks of interventional oncology–proffered treatments to a degree of certainty expected of new chemotherapy drugs. Our patients, your patients, deserve nothing less. © JNCCN—Journal of the National Comprehensive Cancer Network | Volume 12 Number 9 | September 2014.
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