Several barriers discourage oncology fellows from pursuing careers in cancer prevention and risk-counseling work, according to a new survey study published in the Journal of Clinical Oncology.1

“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,” reported lead study author Carol Fabian, MD, of the University of Kansas Medical Center in Kansas City, KS, and colleagues, on behalf of the American Society of Clinical Oncology (ASCO) Cancer Prevention Workforce Pipeline Work Group. Dr Fabian chairs the Work Group.

For those who navigate their way into cancer prevention, however, the rewards can be profound, Dr Fabian told Cancer Therapy Advisor.


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The Work Group’s initial recommendations include expanding educational resources for fellows, training directors and oncologists; improving funding for prevention training and clinical research; increasing prevention content in clinical-oncology accreditation exams; and working with lawmakers to “broaden the scope and depth of reimbursement for prevention counseling and intervention services.”

They specifically recommended reviving the US National Cancer Institute (NCI)’s Cancer Education and Career Development Program (R25T) funding mechanism for multidisciplinary cancer-prevention mentorship, trainee research, travel funds, and stipends. The R25T program ended in 2013.

“I think it was a real misstep to end that program,” said Shine Chang, PhD, a professor of epidemiology who co-directs MD Anderson’s Cancer Prevention Research Training Program.

“That mechanism was a far superior way to recruit people and provide them with training and experience in cancer prevention research,” Dr. Chang told Cancer Therapy Advisor. “I am very concerned that we’ll not be able to support, sustain, or recreate the infrastructure that had been built over the years through the R25T mechanism over the years. Within the cancer prevention community, it was very well regarded. The trainees did very well and launched to productive careers.”

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Dr. Chang felt so strongly about it that she authored a requiem for the R25T program in 2014.2

Dr. Fabian believes increased opportunities for research would attract more people to the field. “Oncologists like to perform intervention trials. More funding for prevention intervention trials would increase the attractiveness for an academic career in cancer prevention,” she said.

Cancer prevention has grown in recent years to include genetic risk counseling, and “now encompasses a broad variety of activities ranging from identifying the causes and early diagnosis of cancer, to preventing or controlling cancer through behaviorally based lifestyle interventions and use of chemopreventive agents, and, ultimately, to translating this knowledge into practice,” noted Assistant Professor Carrie Cameron, PhD, and coauthors from the Department of Epidemiology at The MD Anderson Cancer Center in Houston, TX.3 Dr Cameron was not involved in the ASCO work group report. 

“Just as for cancer treatment, we are beginning to incorporate personalized medicine into prevention based on an individual’s preferences, life phase—ie, childbearing, personal health history, competing problems, or comorbidities, and genetics,” Dr. Fabian said.

But just as the scope of the field expands—and as baby boomers age into higher cancer risk–the prevention workforce is shrinking, as the number of clinical oncologists with a major focus on cancer prevention, reach retirement age—raising concerns about the field’s ability to replenish their ranks and to meet future challenges.4

In separate questionnaire studies, ASCO’s Cancer Prevention Workforce Pipeline Work Group surveyed 1306 oncology fellows and 70 training directors from cancer centers across the United States to identify barriers to a career focus in cancer prevention.1

Eighty-eight percent of the surveyed fellows reported that they believe cancer prevention is important “relative to treatment,” but only 15% expressed interest in a cancer-prevention career focus. Surveyed training directors put the number even lower, reporting that 10% or fewer fellows will pursue a career focus in prevention.

“For oncologists who have witnessed the ravages of cancer and cancer treatment on patients and their families–the idea of prevention is very attractive,” Dr Fabian  [BF1] said. “It is also very attractive to individuals at increased risk for the disease such as those with affected family members or those who have had a biopsy suggesting a pre-cancerous condition.”

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Dr Cameron and her colleagues at MD Anderson used National Cancer Institute American Recovery and Reinvestment Act (ARRA) funds for an effort further upstream, for pre-med students: a 2010 summer research-experiences program for undergraduates that was designed to spark early interest in cancer prevention careers.3

A survey conducted 8 months after participants completed the program suggested that the curriculum suggested that the program markedly improved students’ awareness of cancer prevention as a career path, but the resulting interest in prevention was “mixed.”3 

Editor’s Note: This article was updated on December 9, 2015.

References

  1. Fabian CJ, Meyskens FL, Bajorin DF, et al. Barriers to a career focus in cancer prevention: a report and initial recommendations from the American Society of Clinical Oncology Cancer Prevention Workforce Pipeline Work Group [published online ahead of print November 2, 2015]. J Clin Oncol.  doi:10.1200/JCO.2015.63.5979.
  2. Chang S. In memoriam: an appreciation for the NCI R25T Cancer Education and Career Development Program. Cancer Epidemiol Biomarkers Prev. 2014;(23):1133. http://cebp.aacrjournals.org/content/23/6/1133.abstract.
  3. Cameron C, Collie CL, Chang S. Introducing students to cancer prevention careers through programmed summer research experiences. J Cancer Educ.2012;27(2):233-242.
  4. Meyskens FL, Fabian C. Oncology workforce needs: an alternative scenario. Updated May 31, 2015. ASCO Annual Meeting “Collective Wisdom” website. http://am.asco.org/oncology-workforce-needs-alternative-scenario.  Accessed Nov. 30, 2015.