Fabian Carol J, Meyskens Frank L, Bajorin Dean F, George Thomas J, Jeter Joanne M, Khan Shakila, Tyne Courtney A, William William N
Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Clin Oncol. 2016 Jan 10;34(2):186-93. doi: 10.1200/JCO.2015.63.5979. Epub 2015 Nov 2.
To assist in determining barriers to an oncology career incorporating cancer prevention, the American Society of Clinical Oncology (ASCO) Cancer Prevention Workforce Pipeline Work Group sponsored surveys of training program directors and oncology fellows.
Separate surveys with parallel questions were administered to training program directors at their fall 2013 retreat and to oncology fellows as part of their February 2014 in-training examination survey. Forty-seven (67%) of 70 training directors and 1,306 (80%) of 1,634 oncology fellows taking the in-training examination survey answered questions.
Training directors estimated that ≤ 10% of fellows starting an academic career or entering private practice would have a career focus in cancer prevention. Only 15% of fellows indicated they would likely be interested in cancer prevention as a career focus, although only 12% thought prevention was unimportant relative to treatment. Top fellow-listed barriers to an academic career were difficulty in obtaining funding and lower compensation. Additional barriers to an academic career with a prevention focus included unclear career model, lack of clinical mentors, lack of clinical training opportunities, and concerns about reimbursement.
Reluctance to incorporate cancer prevention into an oncology career seems to stem from lack of mentors and exposure during training, unclear career path, and uncertainty regarding reimbursement. Suggested approaches to begin to remedy this problem include: 1) more ASCO-led and other prevention educational resources for fellows, training directors, and practicing oncologists; 2) an increase in funded training and clinical research opportunities, including reintroduction of the R25T award; 3) an increase in the prevention content of accrediting examinations for clinical oncologists; and 4) interaction with policymakers to broaden the scope and depth of reimbursement for prevention counseling and intervention services.
为了帮助确定肿瘤学职业中纳入癌症预防的障碍，美国临床肿瘤学会（ASCO）癌症预防劳动力渠道工作组发起了针对培训项目主任和肿瘤学研究员的调查。
在2013年秋季务虚会上，向培训项目主任进行了单独调查，问题与针对肿瘤学研究员的调查平行，后者作为其2014年2月在职考试调查的一部分。70名培训主任中有47名（67%）以及参加在职考试调查的1634名肿瘤学研究员中有1306名（80%）回答了问题。
培训主任估计，开始学术生涯或进入私人执业的研究员中，≤10%会将职业重点放在癌症预防上。只有15%的研究员表示他们可能会对以癌症预防为职业重点感兴趣，尽管只有12%的人认为预防相对于治疗不重要。研究员列出的学术生涯的主要障碍是获得资金困难和薪酬较低。以预防为重点的学术生涯的其他障碍包括职业模式不明确、缺乏临床导师、缺乏临床培训机会以及对报销的担忧。
不愿将癌症预防纳入肿瘤学职业似乎源于培训期间缺乏导师指导和接触机会、职业道路不明确以及报销方面的不确定性。建议开始解决这一问题的方法包括：1）为研究员、培训主任和执业肿瘤学家提供更多由ASCO牵头的及其他预防教育资源；2）增加有资金支持的培训和临床研究机会，包括重新引入R25T奖；3）增加临床肿瘤学家认证考试中的预防内容；4）与政策制定者互动，以扩大预防咨询和干预服务报销的范围和深度。
