As oncology research and medicine advance, Avera ensures patients receive the most advanced and individualized treatment possible through specialization of cancer care.
Specialization in cancer care involves oncologists focusing their practice on — and becoming experts in — specific cancer types.
Oncologists can specialize either through a special interest in a specific disease site or through formal fellowship training. In either case, individuals gain a broad base of knowledge in general oncology and then focus on a specific high-complexity area.
“In order for a physician to stay on top of the latest current trends in cancer care, they literally can’t consume all of this information,” said Katie Van Beek, Avera Vice President for Oncology. “If you subspecialize, you have a much smaller subset of what you need to know. You can become very good at that.”
What Oncology Groups Are Specialized?
Clinical Vice President of Avera’s Oncology Service Line Luis Rojas, MD, joined Avera in 2007 and was among the first subspecialists in gynecologic oncology in Sioux Falls.
“Within cancer, there are some organic, well-established subspecializations,” said Rojas. “As a gynecologic oncologist, I come from the world of obstetrics and gynecology, and I am in a subgroup of individuals who have a formal training program for women’s cancer.
“In medical oncology, there is a possibility of focusing in general hematology and oncology, but if an area of focus is desired, there are two main branches — those who specialize in solid tumors, such as breast cancer, prostate cancer or lung cancer, and those who formally subspecialize in the hematologic (blood) cancers, such as myeloma, leukemia or lymphoma, mastering complex therapeutic options like bone marrow transplant and cellular therapies,” said Rojas.
Other groups where specialization is highly developed at Avera include breast, genitourinary (GU), gastrointestinal (GI), lung, head and neck, skin, hematology, transplant and cellular therapy and sequencing.
What’s Driving Increased Cancer Specialization
The trend toward specialization in cancer care is happening largely because the field is developing and the science is evolving so quickly.
“What has driven subspecialization in the past decade in our professional society is the amount of information that comes out every day,” said Rojas.
For perspective, up until the year 2000, there were about 50 cytotoxic drugs (chemotherapies) available for cancer treatment. From 2003 to 2021, there were more than 124 new FDA-approved cancer drugs approved, with 374 indications for cancers, according to an American Society of Clinical Oncology 2022 publication in the Journal of Clinical Oncology (JCO).
In addition to medical advancements, patient demand is propelling specialization.
“Our patients are coming asking, ‘Who’s the expert in this area?’ and that is also a driver of the trend,” said Rojas. With expert care, patients have access to clinical trials and the most options for treatment.
High Number of Cases Key to Quality Cancer Care
It’s important for providers to experience a high number of cases of a specific tumor type because greater exposure leads to greater knowledge about that cancer type and increased skill in treating it.
“When you’re exposed to higher volume, you see the garden variety cases and you also see those cases that are unique, where you have to come up with the best multidisciplinary treatment plan,” said Rojas. “And the more I do a procedure, the better I become at it.”
A high volume of cases and focus in a particular area of expertise within oncology also allows providers to get immersed in clinical research specific to those cases and their area of expertise.
"You can participate in that research not only to provide it to the patient, but also actively participate as an investigator and go to the meetings that are specific to that discipline so you become proficient," said Rojas.
General Oncologists Crucial Across the Region
General oncologists remain vital for Avera to serve communities across a vast health system, as many rural communities don’t have the patient volume to have a subspecialized physician in each area.
“It’s really about the integration and collaboration of one oncology team throughout our entire footprint,” Van Beek said.
This model provides patients:
- High-quality care close to home without excessive travel to a large institution
- Subspecialized physicians working as direct partners with general oncologists
- Ensuring continuous communication regarding optimal patient care
- The option of a formal second opinion from a subspecialized physician
- Referral to a subspecialized physician if appropriate
