The U.S. cancer community is approaching a crisis of sorts: As the elderly population grows ever-larger, cancer diagnoses are reaching record numbers—just as older oncologists are reaching retirement at a faster pace than their younger colleagues are entering the field. The crunch is especially being felt in the already-depleted field of gynecologic oncology, a specialty responsible for diagnosing and treating cancers of the female reproductive system (the cervix, ovaries, uterus, vagina and vulva). Gynecologic oncologists are in such short supply that any further impact on their numbers concerns both patients and the specialists who are already overburdened.
“ It's a perfect storm: a population that's rapidly aging, living longer and, in many cases, managing cancer as a chronic illness.” - Julian Schink, MD - Chief of the Division of Gynecologic Oncology at Cancer Treatment Centers of America ® (CTCA).
With a record number of patients surviving cancer comes a record number of those who also require follow-up care. The American Society of Clinical Oncology (ASCO) predicts that the demand for oncologists of all specialties will outpace the supply by 2020. In its report, “The State of Cancer Care in America, 2017,” ASCO cites two studies addressing the anticipated oncologist shortage. One estimates the number of cancer survivors in the United States to spike by more than 31 percent—to 20.3 million people—by 2026, while the other predicts that 26.1 million Americans will be “living with a history of cancer” in 2040.
“Cancer is a disease of aging, and as mutations develop over time, it’s simply a math issue, and it will not change,” says Maurie Markman, MD, President of Medicine & Science at CTCA®. “It’s part of the aging process. And with baby boomers aging, there’s going to be much more cancer than we’ve ever seen.”
Like Dr. Schink, Dr. Markman credits medical advances for helping patients live longer and, in some cases, continue treatment well into their 80s and beyond. “Advanced cancer is increasingly becoming a chronic illness, and the impact of this is astounding,” he says. Even more so for the field of gynecology oncology, whose highly specialized physicians perform and oversee a number of medical procedures, from diagnosis to treatment, including surgery, chemotherapy, radiation therapy, targeted therapy and immunotherapies.
Following four years of medical school, gynecologic oncologists complete seven to eight additional years of training: first, a four-year obstetrics and gynecology residency—practicing medicine under the supervision of an attending physician—and then, three to four years of more specialized training known as a fellowship. According to the Accreditation Council for Graduate Medical Education, the fellowship must include two years of clinical practice, plus a year devoted solely to research. At the end of the fellowship, the doctor must pass both a written and oral examination, as well as submit a thesis- a scholarly paper he or she has written presenting original research on a subject in the chosen specialty. Even for doctors who want to pursue fellowship training, finding a program can be challenging. Hospitals finance most residency programs with funding from the federal government, but that money can’t be used to pay fellows.
So the burden to pay the doctors in training, as well as to cover the cost of hosting a fellowship program, is left to individual medical centers. “Some hospitals have a lot of money or recognize the need and know the only way they can have a gynecologic oncology program is to fund the fellow, but many do not,” says Dr. Schink. “If you have a fellowship program, it adds a lot of stature to a gynecologic oncology program. Fellows are a very effective part of the workforce.”
Approximately 110,000 women in the United States are diagnosed with a gynecologic cancer every year, yet the country has fewer than 1,000 gynecologic oncologists to treat them. The math adds up to a stark reality: The specialty is experiencing a significant shortage, especially in rural America. And for women with gynecologic cancer, the challenge could be game-changing. Multiple studies have shown that women with cancers of the reproductive system may benefit from seeing specialists trained and experienced in treating those malignancies.
Accurately staging the extent of certain gynecologic cancers heavily relies on the quality of the surgical procedures performed, Dr. Schink explains. “Endometrial cancer, the most common gynecological cancer, isn’t managed by a simple hysterectomy that any gynecologist can do,” he says. “There may be the need for specialized procedures, like sentinel lymph node biopsies and sophisticated robotic surgeries. The extra training is more likely to pay off with better outcomes and fewer complications by someone trained to manage whatever they may find at the time of surgery. And there are plenty of studies that show that, in ovarian cancer, the likelihood of having debulking surgery (to reduce the size of the tumor) that yields positive results is twice as high if the surgery is performed by a gynecologic oncologist versus an obstetrician-gynecologist.” Gynecologic oncologists are five times more likely to completely remove ovarian tumors during surgery, according to the Ovarian Cancer Research Fund Alliance.
To address the looming crisis, researchers in a 2015 study recommended expanding fellowship-training programs worldwide and spreading awareness about both the important role gynecologic oncologists play in cancer care and the need to add to their ranks. Dr. Markman agrees. “This is a very clear, very serious and rapidly growing problem with no simple solution,” he says. “Even if you recognize the problem today, it’s going to take a decade to fix it.”
Learn more about gynecologic oncology.