BETHESDA, MdI went into community oncology to treat
patients, said Richard Kosierowski, MD, an oncologist in
private practice outside Philadelphia, but I have a
responsibility to the community as well.
Three-fourths of all cancer patients are treated in the community,
not in tertiary care centers, as are a like proportion of clinical
trials participants, he noted. In this setting, oncologists treat not
only patients but families, Dr. Kosierowski said at the 22nd annual
meeting of the American Society of Preventive Oncology.
The community oncologists responsibility, Dr. Kosierowski said,
goes beyond treatment intervention. It includes primary cancer
prevention such as smoking cessation, chemoprevention in breast
cancer and prostate cancer, surveillance of high-risk patients, early
cancer detection, and public education.
Like everything else in medicine, the world of community oncologists
is in flux, he said. Once, community oncologists were tied to
hospitals, but the advent of managed care has pushed more cancer
treatment to outpatient services. This results in more paperwork and
more administrative time for the physicians staff. At the same
time, Dr. Kosierowski said, it is harder for an individual physician
to hire more people to deal with the extra paperwork than it might be
for a large institution.
A Good Oncology Nurse
The same forces have also separated the doctors office from the
social services that came with the hospital. The staff becomes
more important, he said. You need a good oncology nurse
to communicate with patients.
The job of educating the public takes on new importance, especially
as nutrition is given more weight as a preventive strategy. But
financial pressures militate against this role for physicians and
their staffs. As valuable as disseminating the latest information on
cancer to the public might be, it is not a reimbursable procedure.
There is no J-code for educating the public, he said,
but this is a job that has to be done.
Other changes may be in the wind. Stark II legislation regarding
Medicare reimbursements could alter the landscape again, since
proposed regulations to implement Stark II would restrict
reimbursement for chemotherapy given in the office.
Ten or 15 years ago, chemotherapy was part of hospital
care, he noted. Then it moved to the doctors office
to save money. Now, with the possibility that Stark II regulations
will limit chemotherapy reimbursement, we dont know where
chemotherapy will be delivered in the future. Maybe it will move back
to the hospital, meaning community oncologists will have to cut back
on their staffs again.
Community oncologists will have to coordinate their work with other
institutions, services, and providers, Dr. Kosier-owski said. For
example, since prevention programs are needed for hospital
accreditation, there are incentives for hospitals and physicians to
Community oncologists set high goals for caring for their patients
and their families, for both their medical and their psychosocial
needs, Dr. Kosierowski said. The next era in oncology will see an
enhanced role for prevention, screening programs, early detection,
and the value of educating the public to take advantage of these developments.