Principles of Medical Oncology
Authors: Tsimberidou Apostolia M. , Bast Robert C. , Khuri Fadlo R. , Byrd John C. 
Published: October 2022

Overview

The principles of medical oncology have been established over the past seven decades and are now informed by the rules of evidence‐based medicine and empirical guidelines while still focusing on the optimal care of individual patients with cancer. The medical oncologist has multiple roles that contribute to the well‐being of patients diagnosed with cancer. These roles often include coordinating multidisciplinary teams; being the physician who is primarily responsible for a patient's cancer care; prescribing conventional and novel systemic therapy; modeling life‐long learning; conducting translational, clinical, and practice‐based research; practicing evidence‐based precision medicine; and educating patients and their families in the prevention, detection, treatment, monitoring, and management of the symptoms and complications of cancer and its treatment.

The practice of medical oncology is evolving rapidly. During the past decade, improved understanding of the genetic, epigenetic, transcriptional, proteomic, and metabolomic aberrations in cancer cells and the immune response of patients to their cancers has provided exceptional opportunities to manage and ultimately to cure cancer. Technological breakthroughs in basic and translational science linked with innovative clinical trials have produced a plethora of approved drugs, targeted agents, monoclonal antibodies, and immunotherapies. After the diagnosis of cancer is confirmed, the medical oncologist must be able to describe, at appropriate times, the likely course of the disease, the benefits and risks of anticipated therapies, and opportunities to participate in clinical trials. They must also acknowledge the many unknowns and uncertainties, tailoring communication to the intellectual and emotional level and needs of the individual patient.

Effective care involves the careful choice of agents, often guided by new technologies, and the monitoring of tumor response and the effects of treatment on normal organs. The medical oncologist must be expert in supportive care and often must guide patients through advanced planning and end‐of‐life issues.

Recent declines in cancer mortality in the United States, Europe, and Japan reflect advances in prevention and early detection, improved multidisciplinary care and adjuvant therapy, and new drugs and immunotherapies that produce durable responses in a significant fraction of patients with cancer. Providing optimal care to cancer patients across our diverse society remains a significant challenge, and inequities have been highlighted recently by the COVID‐19 crisis. Medical oncologists must champion access of all cancer patients to optimal care. In the twenty‐first century, medical oncologists must overcome the challenges of keeping up with exponentially growing information, mastering new approaches to practice such as telemedicine, and maintaining resilience from burnout. In this unique moment in history, increased harmonization of discoveries, advances, policies, and practices will become increasingly important.