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Digestive cancers as a group have the highest incidence of all cancers worldwide. More than 3 million new cases occur each year, with 2.2 million deaths. A Working Party was organized by OMGE to evaluate the role of the gastroenterologist in the overall management of patients with digestive cancers and to make recommendations for improving the management and continuity of care of these patients.A survey was developed and sent to OMGE’s member organizations. The survey asked questions in four main areas: practice directly related to these patients, including prevention, treatment, follow-up, and administration of chemotherapy; training of fellows in gastrointestinal programs in the area of digestive cancer; postgraduate education in digestive cancer; and society interactions in digestive cancer. Ninety surveys were distributed to leaders of member societies of OMGE worldwide.ResultsOf the 90 surveys, 47 responses were received from 47 countries. Collated responses to the survey are listed below.Gastroenterologists administer chemotherapy often/occasionally (30%) or rarely/never (69%). Gastrointestinal cancer treatment is administered by a multidisciplinary team of medical oncologists, gastroenterologists, radiation oncologists, and surgeons often/occasionally (57%) or rarely/never (40%). Gastrointestinal cancer treatment is planned by a multidisciplinary team of medical oncologists, gastroenterologists, radiation oncologists and surgeons often/occasionally (71%) or rarely/never (27%). Gastrointestinal cancer prevention programs are organized by gastroenterologists occasionally/often (68%) or rarely/never (30%). The top two components of cancer prevention programs are educational lectures for a medical audience and cancer screening guidelines, regardless of whether gastroenterologists or other individuals organize the programs. Among respondents with a gastrointestinal training program, fellows are trained most often in screening (94%), pathology of gastrointestinal cancer (94%), and follow-up of gastrointestinal cancer patients (91%), and least often trained in surgical oncology (51%), radiation oncology (20%), and alternative medicine (14%). The top five topics that respondents believe should be presented at postgraduate courses and clinical symposia are: new therapeutic approaches (97%), chemoprevention (90%), screening (88%), palliative care (85%), and the biology of gastrointestinal cancer (84%). Low scores were given for alternative medicine (48%) and lifestyle and cancer (75%). Ninety-one percent of respondents believed there should be more interactions between gastrointestinal and oncology societies. DiscussionThe management of patients with cancer has become exceedingly complex. Patients with digestive cancers are faced with an enormous increase in the range of options available for diagnosis and treatment. This usually works to the patient’s advantage, providing a benefit that has strikingly reduced the likelihood of deaths from cancer. However, patients may become lost in the maze of specialty medicine without a doctor who provides continuity of care throughout their illness. This can be disconcerting to the patient and family, and counterproductive for the specialists involved in the case. It was this perception that led OMGE to organize a working party to evaluate the role of the gastroenterologist in the management of patients with digestive cancers. The gastroenterologist is often the first physician to see the patient and make the diagnosis, and refer the patient for treatment. Often, however, the gastroenterologist does not remain involved during a long course of treatment, but may be called back to help in diagnosis or palliation at a later stage.The purpose of the international survey reported in this paper is to evaluate the gastroenterologists’ role, and serve as a basis for making recommendations to OMGE. The recommendations that this working party has made to OMGE are listed below. Others have also addressed this issue. A dialogue with other interested societies regarding this issue would be a good beginning, with a matrix provided by the newly formed International Digestive Cancer Alliance, whose mission is to raise awareness of digestive cancers worldwide.OMGE Working Party RecommendationsMore interaction among physicians in the management of patients Gastroenterologists should be part of a digestive cancer team Gastroenterologists should be involved with patients throughout their management Fellowship training should include the full range of cancer management Postgraduate meetings should include multidisciplinary sessions on digestive cancers
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