Art of Oncology: New Voices Wanted

In January 2000, Charles Loprinzi and former Journal of Clinical Oncology (JCO) Editor-in-Chief George Canellos announced a new journal feature focused on end-of-life and symptom-directed clinical care. Since the inaugural Art of Oncology (AOO) essay about doing the right thing for dying patients, more than 200 authors have contributed AOO articles on a broad range of topics related to the joys, sorrows, rewards, and challenges of caring for people with cancer. In 2010, I succeeded Charles Loprinzi as the Consultant Editor responsible for the AOO section. During Loprinzi’s decade of judicious guidance, the AOO section thrived and became a valued component of JCO. New AOO essays are routinely among the most frequently viewed articles on the JCO Web site, the AOO section has consistently received favorable reviews in reader surveys, and authors commonly report receiving encouraging and thought-provoking comments about their published work. The first two Kindle eBooks of selected AOO pieces, Art of Oncology: Honest and Compassionate Responses to the Daily Struggles of People Living With Cancer, were released in May 2010 and June 2011; already, hundreds of copies have been sold, and additional volumes are planned. Why has the AOO section struck a chord with JCO readers? We have heard that the body of work published in the AOO section strengthens a sense of belonging to a community of professionals with common challenges and dilemmas. We as oncologists grope through a world of ambiguity together; it is reassuring for each of us to be reminded periodically that we are not alone. In addition, many AOO essays advocate both for those who suffer and for those who respond humanely and compassionately to suffering, while other papers tell engaging stories, remind us of virtues, or help define the standards and norms of our professional culture. By giving valuable journal space to these articles, JCO validates these topics as relevant to daily practice and to a life in medicine. The purpose originally envisioned for the AOO section was to provide a forum for discussing management of patients with advanced cancer—how to improve communication in difficult circumstances, how to make sound clinical decisions grounded in moral and ethical principles, and how to relieve the many burdensome symptoms resulting from cancer or its therapy in a timely and effective way. Such topics remain important to JCO and to the American Society of Clinical Oncology. For example, with the support and direction of our new Editor-in-Chief, Stephen A. Cannistra, JCO will publish a singlevolume special series within the next year, entitled, “Care of the Whole Patient With Cancer: The Science of Psychosocial Care,” which I am looking forward to coediting with Memorial Sloan-Kettering Cancer Center psychiatrist Jimmie Holland and JCO Associate Editor Paul Jacobsen. Over time, however, the AOO section expanded in new directions and its mandate grew broader to include not just end-of-life and symptomatic care but all aspects of the cancer experience. In parallel, cancer care has changed in the past decade. We have learned to integrate supportive and palliative measures throughout the disease trajectory and have formally incorporated communication instruction into professional training programs. Meanwhile, the increasing emphasis on “personalized” medicine (although there has never been a time when medicine was not tailored to individual circumstance) is reflected in the growing heterogeneity of treatment approaches with accompanying new difficulties regarding therapeutic choices, treatment end points, and access to expensive yet effective care. In recognition of these and other changes, the AOO section’s former subtitle, “When the Tumor Is Not the Target” was dropped in 2009. Reducing the size of tumors was never really the primary target of the practice of oncology, and cancer medicine is no different from other areas of medicine in its goal to help patients live better and longer, regardless of the results of particular assays or imaging studies. During this evolution, the number of reflective, observational, and narrative AOO pieces has increased, whereas reviews and didactic essays have become less common. In my view, this is a welcome development, given that review articles have natural homes elsewhere in JCO. AOO has instead become a unique forum for narratives about what it is like to care for people with cancer or to be diagnosed with cancer, as well as for reflections on tragic, heartwarming, frustrating, or enlightening experiences in the oncology clinic. Particularly valuable are articles from physicians in training, including oncology fellows, who benefit from an uncluttered and fresh perspective, encountering for the first time what more seasoned clinicians have long learned to take for granted. The perceptions of these newest members of the profession can help rekindle our own senses of vocation. To ensure editorial consistency, AOO manuscripts are evaluated by a dedicated editorial board with diverse backgrounds and areas of specialization—current members include Gregory Kalemkarian (University of Michigan, Ann Arbor, MI), Timothy Moynihan (Mayo Clinic, Rochester, MN), Daniel Rayson (Dalhousie University, Halifax, Nova Scotia, Canada), Lidia Schapira (Massachusetts General Hospital, Boston, MA), and Charles von Gunten (San Diego Hospice, San Diego, CA)—supplemented by occasional reviews from topic experts. Together, the AOO editorial group looks for manuscripts that move, instruct, or advocate without being tedious or preachy, that give us new ideas about how to teach or how to practice, that have the potential to change JCO readers’ points of view, or that express clearly JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L S VOLUME 29 NUMBER 25 SEPTEMBER 1 2011