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Gynecologic Oncology Specialty: progressing towards recognition in Europe
Critical Reviews in Oncology/Hematology 48 (2003) 249–250
Editorial
Gynecologic Oncology Specialty: progressing towards recognition in Europe
The subspecialty of Gynecologic Oncology has emerged as a major contributor to women’s health care in the last 30 years. The founding fathers had several goals in mind as they formulated the basic structure of the subspecialty in the late 1960s. First and foremost, they were interested in promoting the training and tenure of academic gynecologists capable of practicing the full breadth of gynecologic surgery, including surgery for malignant diseases of the pelvis. They envisioned that the creation of this subspecialty would foster the emergence of multiple centers of excellence in university hospitals where such individuals would be trained. They anticipated correctly. In the 1960s, there were already three to four centers in the United States. Gynecologic Oncology was defined as a subspecialty within the discipline of Obstetrics and Gynecology in the United States since 1969. Today the management of gynecologic malignant disease requires a multidisciplinary approach, which includes surgery, chemotherapy and radiotherapy. The American Board of Obstetrics and Gynecology and the Subspecialty Division of Gynecologic Oncology monitors carefully the training centers to ensure adequate supervision, volume, and education for the trainees. American Gynecologic Oncologists are cancer specialists whose training is first that of obstetrician/gynecologist, after which they have three to four years of structured training in all forms of treatment of gynecologic cancers (surgery, radiation therapy, chemotherapy and experimental treatments) as well as the biology and pathology of gynecologic cancer. The unique aspect of this training is that it allows patients to receive the mode of therapy (i.e. surgery, chemotherapy or radiation therapy) or combinations of therapy most likely to be successful without fragmenting their care among many physicians. The Society of Gynecologic Oncologists and the Gynecologic Oncology Group were founded in 1960 and 1970, respectively, with the main goal of advancement of research in the area of female genital cancer. Following this example of the United States, many other countries have now established national gynecologic oncology societies. The Gynecologic Oncology Group (GOG) is a non-profit organization with the purpose of promoting excellence in the quality and integrity of clinical and basic scientific research in the field
of gynecologic malignancies. The Group is comrnitted to maintaining the highest standards in clinical trials development, execution, analysis and distribution of results. In Europe and other countries a defined subspecialty and a formal Gynecologic Oncology training program has not yet been created, but dedicated centers and dedicated physicians taking care of gynecologic oncology patients exist in all countries. The recognition of this subspecialty is suggested as a means to better ensure that patients receive treatment by specialized physicians in adequate centers. Italy for example has recently seen government approval for the creation of the Italian GOG. The gynecologic oncologist should be fully trained to manage primary treatment and most of the complications related to the care of patients with gynecologic neoplasias. During the subspecialty training program the trainees learn to understand and perform radical pelvic surgery, including intestinal and urology procedures. In addition they are exposed to the principle of chemotherapy and radiation therapy, allowing them to supervise a complete treatment of gynaecologic cancers. They thus learn to: • Perform radical pelvic surgery • Manage vaginal, intestinal, and urologic surgical procedures that may be needed due to the growth of the tumor into adjacent organ systems • Perform pelvic and aortic lymphadenectomy • Perform splenectomy • Deliver chemotherapy with medical oncology collaboration, and monitor patients receiving chemotherapy and assess the need for surgical intervention • Understand the principles of radiation therapy and work directly with the radiation oncologist who administers the treatment An international organization under Belgian law was founded in 1962 by eminent oncologists and named “Groupe Européen de Chimiothérapie Anticancéreuse” (GECA). It became the “European Organization for Research and Treatment of Cancer” (EORTC) in 1968. The aims of the European Organization for Research and Treatment of Cancer (EORTC) are to conduct, develop, coordinate, and stimulate
1040-8428/$ – see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.critrevonc.2003.09.004
250
P.B. Panici, R. Angioli / Critical Reviews in Oncology/Hematology 48 (2003) 249–250
laboratory and clinical research in Europe to improve the management of cancer and related problems by increasing survival but also patients’ quality of life. The Gynecological Cancer Cooperative Group of EORTC meets several times each year to analyze results of ongoing studies and to coordinate future trials. This issue represents selected papers presented at recent meeting held in Rome, which
summarize the present state of the art in cervical cancer. It is one example of how the subspecialty of gynecologic oncology has made the advances which have led to improved outcome and well-being of female cancer patients. P. Benedetti Panici R. Angioli
Editorial
Gynecologic Oncology Specialty: progressing towards recognition in Europe
The subspecialty of Gynecologic Oncology has emerged as a major contributor to women’s health care in the last 30 years. The founding fathers had several goals in mind as they formulated the basic structure of the subspecialty in the late 1960s. First and foremost, they were interested in promoting the training and tenure of academic gynecologists capable of practicing the full breadth of gynecologic surgery, including surgery for malignant diseases of the pelvis. They envisioned that the creation of this subspecialty would foster the emergence of multiple centers of excellence in university hospitals where such individuals would be trained. They anticipated correctly. In the 1960s, there were already three to four centers in the United States. Gynecologic Oncology was defined as a subspecialty within the discipline of Obstetrics and Gynecology in the United States since 1969. Today the management of gynecologic malignant disease requires a multidisciplinary approach, which includes surgery, chemotherapy and radiotherapy. The American Board of Obstetrics and Gynecology and the Subspecialty Division of Gynecologic Oncology monitors carefully the training centers to ensure adequate supervision, volume, and education for the trainees. American Gynecologic Oncologists are cancer specialists whose training is first that of obstetrician/gynecologist, after which they have three to four years of structured training in all forms of treatment of gynecologic cancers (surgery, radiation therapy, chemotherapy and experimental treatments) as well as the biology and pathology of gynecologic cancer. The unique aspect of this training is that it allows patients to receive the mode of therapy (i.e. surgery, chemotherapy or radiation therapy) or combinations of therapy most likely to be successful without fragmenting their care among many physicians. The Society of Gynecologic Oncologists and the Gynecologic Oncology Group were founded in 1960 and 1970, respectively, with the main goal of advancement of research in the area of female genital cancer. Following this example of the United States, many other countries have now established national gynecologic oncology societies. The Gynecologic Oncology Group (GOG) is a non-profit organization with the purpose of promoting excellence in the quality and integrity of clinical and basic scientific research in the field
of gynecologic malignancies. The Group is comrnitted to maintaining the highest standards in clinical trials development, execution, analysis and distribution of results. In Europe and other countries a defined subspecialty and a formal Gynecologic Oncology training program has not yet been created, but dedicated centers and dedicated physicians taking care of gynecologic oncology patients exist in all countries. The recognition of this subspecialty is suggested as a means to better ensure that patients receive treatment by specialized physicians in adequate centers. Italy for example has recently seen government approval for the creation of the Italian GOG. The gynecologic oncologist should be fully trained to manage primary treatment and most of the complications related to the care of patients with gynecologic neoplasias. During the subspecialty training program the trainees learn to understand and perform radical pelvic surgery, including intestinal and urology procedures. In addition they are exposed to the principle of chemotherapy and radiation therapy, allowing them to supervise a complete treatment of gynaecologic cancers. They thus learn to: • Perform radical pelvic surgery • Manage vaginal, intestinal, and urologic surgical procedures that may be needed due to the growth of the tumor into adjacent organ systems • Perform pelvic and aortic lymphadenectomy • Perform splenectomy • Deliver chemotherapy with medical oncology collaboration, and monitor patients receiving chemotherapy and assess the need for surgical intervention • Understand the principles of radiation therapy and work directly with the radiation oncologist who administers the treatment An international organization under Belgian law was founded in 1962 by eminent oncologists and named “Groupe Européen de Chimiothérapie Anticancéreuse” (GECA). It became the “European Organization for Research and Treatment of Cancer” (EORTC) in 1968. The aims of the European Organization for Research and Treatment of Cancer (EORTC) are to conduct, develop, coordinate, and stimulate
1040-8428/$ – see front matter © 2003 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.critrevonc.2003.09.004
250
P.B. Panici, R. Angioli / Critical Reviews in Oncology/Hematology 48 (2003) 249–250
laboratory and clinical research in Europe to improve the management of cancer and related problems by increasing survival but also patients’ quality of life. The Gynecological Cancer Cooperative Group of EORTC meets several times each year to analyze results of ongoing studies and to coordinate future trials. This issue represents selected papers presented at recent meeting held in Rome, which
summarize the present state of the art in cervical cancer. It is one example of how the subspecialty of gynecologic oncology has made the advances which have led to improved outcome and well-being of female cancer patients. P. Benedetti Panici R. Angioli