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MEDICAL YEAR
IN REVIEW

An Observation on the Evolution

of Community Oncology

By Shruti Sharma, DO

T he practice of community oncology has evolved significantly considered upon enrollment of clinical trials. Academic centers can

in the last ten years. The general focus of community oncology
also provide increased supportive services to patients more readily at
was primarily to bring accessibility of cancer care treatment
Independent organizations have also flawlessly implemented aca-
to patients while academic oncology focused largely on specialty and their community site.
sub-specialty oncology services, research and being the powerhouse for demic procedures and have continued to provide rich resources for pa-
education and training programs. We largely associated clinical trial tients. As we continue to learn from the research being conducted by
availability with academic oncology and looked to them for additional these clinical trials, independent organizations have continued to en-
resources, including research laboratories, libraries and access to exclu- courage community oncologists to become private investigators and
sive research databases. establish leadership roles to ensure that patient care is never compro-
It has been stimulating to see the evolution of community on- mised and remains inclusive. Some comprehensive cancer cen-
cology to include procedures that were traditionally ters also consist of surgery and radiation services within
observed only at academic institutions. Many on- the same organization, which allows for continu-
cologists have started to develop “special fo- ity of care and accessible communication
cuses” instead of remaining as a general among patient treatment teams.
oncology physician. Furthermore, com- As research continues to produce re-
munity hospitals have started investing sults, the knowledge gained from these
in graduate medical education pro- studies keeps academic oncologists,
grams, which subsequently has allowed community oncologists and pharma-
for the development of community- ceutical companies busy, so we can
based hematology and oncology fel- continue to understand the mecha-
lowships. Lastly, clinical trials and nisms of malignant hematology and
research protocols have been investi- solid tumors and manufacture new
gated and implemented avidly in the com- drugs that can help combat these disease
munity setting. processes. With all this vast knowledge, is it
The mesh between community oncology better for patient care, then, to “subspecialize” in
and academic oncology has been beneficial to both oncology or remain a generalist in the community
parties. Some community hospitals have decided to es- going forward? Currently, some community practices en-
tablish an affiliation to an academic center. Other organizations courage oncologists to pick a few focuses to mold their practice into,
have decided to remain independent but incorporate academic proce- while many others still leave this decision up to the physician.
dures within their structure. Is one structure better than the other? Not Conclusively, we have observed significant change in this last decade
necessarily. regarding the structure of academic oncology and community oncol-
Establishing an affiliation to an academic center allows for increased ogy. As the relationship between community and academic oncology
access to numerous clinical trials and research already established by continues to evolve, the goal of both, however, remains unified: to pro-
the academic institution, not necessarily available to independent vide the best cancer care for our patients as close as possible to them.
standing community programs. Furthermore, the reputation obtained
upon affiliation to an academic institution helps increase awareness of Shruti Sharma, DO. She is a Medical Oncologist and Hema-
the community program itself. In addition, this relationship allows di- tologist at Texas Oncology, San Antonio Medical Center and a
versification of enrollment into various trials. Gender, age, race and so- member of Bexar County Medical Society.
cioeconomic status of individuals are all factors that need to be

16 SAN ANTONIO MEDICINE • December 2022