Survey of Gastrointestinal Oncology Training in India – a Model for Third World Countries?

Abstract

Background: Digestive cancers constitute the largest group in terms of cancer related morbidity and mortality. Developing countries like India have a huge deficit of medical oncologists and chemotherapy is often prescribed by surgeons, internists and radiation oncologists. Medical oncologists also have to cater to other fields like breast, uro-gynecology, lung cancer and hemat-oncology which makes specialization in gastrointestinal (GI) cancers difficult. This provides gastroenterologists an ideal opportunity to be more involved in the care of digestive cancer patients. The role of gastroenterologists in management of digestive cancers is being debated worldwide. Traditionally, they are involved in diagnosis, staging and palliation and not in multidisciplinary planning of treatment and instituting chemotherapy. Gastroenterologists have an inherent advantage in the management of digestive tract cancers due to their understanding of gastrointestinal physiology and nutrition. Methods: To study the knowledge, attitudes, practices and level of exposure amongst gastroenterology faculty and trainees in the field of gastrointestinal oncology in India A questionnaire was circulated amongst the faculty of 20 gastroenterology training institutes in the country and responses were collated. A similar survey was circulated amongst the fellows. Results: Digestive cancers constituted an average of 7% of outpatient and 13% of inpatients. Only 1/20 (5%) institutes runs a dedicated cancer clinic. Common cancers seen are oesophagus (55%), hepatobiliary (30%) and gastric (15%). Only 9/20 (45%) of the centers have medical oncology backup for treatment of digestive cancers. All the surveyed institutes (20/20) were involved in screening, diagnosis, and palliation of cancers, whereas only 7/20 (35%) were involved in multidisciplinary planning and treatment decision making. None of the gastroenterologists surveyed were involved in institution of chemotherapy. 13/20 (65%) centers train fellows in detecting premalignant lesions, whereas awareness of chemotherapy was present in only 3/20 (15%) of institutes. Most of the interviewed faculty (80%) believed their fellows should be capable of treating cancers at the end of training. About half of the GI fellows surveyed were aware of chemotherapy protocols but not comfortable using the drugs, whereas the rest were unaware of the same. They were unanimous in the belief that at the end of 3 years training in gastroenterology, GI fellows should be capable of managing digestive cancer patients including chemotherapy. Including this training as part of the curriculum was suggested as a necessary step towards achieving this goal. Conclusion: Role of gastroenterologists in gastrointestinal oncology is expanding. Focused training in this field is required for core competence in treating digestive cancers. Training of gastroenterology fellows in principles of oncology and chemotherapy during the 3 year GI training program can help reduce the shortfall in gastrointestinal cancer specialists in developing nations.