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M edical oncology is a subspecialty of internal medicine that deals with tumours originating in a... more M edical oncology is a subspecialty of internal medicine that deals with tumours originating in all organ systems. 1 Medical oncologists provide sys-temic therapy with either palliative or curative intent for large numbers of cancer patients. An emphasis on providing patient-centred care closer to home, coupled with population aging and distribution, is shifting demand for cancer care services from larger urban hospitals to regional centres in local communities. The majority of medical oncologists in Canada are concentrated in larger regional centres, often in close proximity to radiation oncology units. 5 Historically, it has proven difficult to recruit new oncology graduates to the community oncology milieu, and this difficulty threatens to impede "close-to-home" access to cancer services in many parts of the country. However, differences between academic and community oncology practice are steadily being eroded through improved communications technology and distributed medical education. 3 This article profiles a number of dynamic nonacademic medical oncology practices across Canada to provide an up-to-date view of the realities of community oncology practice. Based on leading practices, it also presents a hypothetical optimal community oncology practice model. IntroductIon Oncology services in Canada are predominantly centred in larger metropolitan areas, often in conjunction with designated radiation oncology services. However, the current emphasis on ambulatory cancer care is increasingly directing patients toward community-based services. In provinces such as British Columbia and Ontario, more than 50% of all chemo-therapy is now delivered outside of metropolitan tertiary cancer centres. 2 In Alberta the figure is approximately 30%. In order to support a more diffuse delivery of cancer services, British Columbia has developed an extensive community oncology network with reliance on part-time or full-time general practitioners in oncology (GPOs). The number of full-time certified community medical oncologists is considerably smaller and recruitment has proven difficult. As a result, many patients are required to travel considerable distances for their initial medical oncology consultation and for assessment of significant changes in their clinical condition. 2 While patient treatment preferences for community vs academic settings have not been extensively studied, one investigation in relation to gynecologic oncology revealed that 88% of patients in the community setting believed they had received adequate information, compared with only 63% in academic practices. 4 The failure of community or smaller regional cancer programs to attract certified medical oncologists can be partly explained by issues such as restricted spousal employment opportunities, a desire to remain close to extended family in a major metropolitan area, and a lack of exposure to community practice during postgraduate oncology training. However, poor understanding of the real differences between academic and community oncology practice, and
M edical oncology is a subspecialty of internal medicine that deals with tumours originating in a... more M edical oncology is a subspecialty of internal medicine that deals with tumours originating in all organ systems. 1 Medical oncologists provide sys-temic therapy with either palliative or curative intent for large numbers of cancer patients. An emphasis on providing patient-centred care closer to home, coupled with population aging and distribution, is shifting demand for cancer care services from larger urban hospitals to regional centres in local communities. The majority of medical oncologists in Canada are concentrated in larger regional centres, often in close proximity to radiation oncology units. 5 Historically, it has proven difficult to recruit new oncology graduates to the community oncology milieu, and this difficulty threatens to impede "close-to-home" access to cancer services in many parts of the country. However, differences between academic and community oncology practice are steadily being eroded through improved communications technology and distributed medical education. 3 This article profiles a number of dynamic nonacademic medical oncology practices across Canada to provide an up-to-date view of the realities of community oncology practice. Based on leading practices, it also presents a hypothetical optimal community oncology practice model. IntroductIon Oncology services in Canada are predominantly centred in larger metropolitan areas, often in conjunction with designated radiation oncology services. However, the current emphasis on ambulatory cancer care is increasingly directing patients toward community-based services. In provinces such as British Columbia and Ontario, more than 50% of all chemo-therapy is now delivered outside of metropolitan tertiary cancer centres. 2 In Alberta the figure is approximately 30%. In order to support a more diffuse delivery of cancer services, British Columbia has developed an extensive community oncology network with reliance on part-time or full-time general practitioners in oncology (GPOs). The number of full-time certified community medical oncologists is considerably smaller and recruitment has proven difficult. As a result, many patients are required to travel considerable distances for their initial medical oncology consultation and for assessment of significant changes in their clinical condition. 2 While patient treatment preferences for community vs academic settings have not been extensively studied, one investigation in relation to gynecologic oncology revealed that 88% of patients in the community setting believed they had received adequate information, compared with only 63% in academic practices. 4 The failure of community or smaller regional cancer programs to attract certified medical oncologists can be partly explained by issues such as restricted spousal employment opportunities, a desire to remain close to extended family in a major metropolitan area, and a lack of exposure to community practice during postgraduate oncology training. However, poor understanding of the real differences between academic and community oncology practice, and