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Journal of Clinical Oncology, Vol 25, No 23 (August 10), 2007: pp. 3551 © 2007 American Society of Clinical Oncology. DOI: 10.1200/JCO.2007.12.2911
More Than a NameDivision of Gyencologic Oncology, New York University School of Medicine, New York, NY To the Editor: We read with great interest the article by Silber et al1 and then turned to the editorial discussing this article by Cannistra.2 In his critique of the original study, Cannistra refutes the findings of Silber and colleagues, questioning that gynecologic oncologists could possibly administer chemotherapy as well as medical oncologists. While Cannistra explains that a gynecologic oncologist's training is "surgically oriented," we would counter that a gynecologic oncologist's training is multidisciplinary and comprehensive and, above all else, patient oriented. In fact, unlike medical oncology, gynecologic oncology is the only board-certified specialty in which training focuses specifically on the care of women with gynecologic cancer. As defined by the American Board of Obstetrics and Gynecology, a gynecologic oncologist is a "subspecialist in obstetrics and gynecology who, by virtue of education and training, is prepared to provide consultation on and comprehensive management of women with gynecologic cancer. Comprehensive management should include those diagnostic and therapeutic procedures necessary for the total care of the woman with gynecologic cancer or complications resulting from them."3 When Silber and colleagues conclude that gynecologic oncologists achieve equivalent survival for ovarian cancer patients relative to medical oncologists over a shorter time period on chemotherapy with fewer resultant adverse events, Cannistra spins a tale that gynecologic oncologists do not notice adverse events, do not offer patients clinical trials, that perhaps patients are not really bothered by adverse events, and, most insultingly, "attract less proactive patients." Are we then expected to conclude that patients who are treated by gynecologic oncologists are not interested in their own health? He goes on to say that all of this has nothing to do with the doctor or treatment anyway—it is all biology. And he ends with a quote from Shakespeare. We counter with our own quote from Othello: "But this denoted a foregone conclusion: 'Tis a shrewd doubt, though it be but a dream." Certainly there are many biases inherent in a Surveillance, Epidemiology, and End Results–based study, and the study by Silber and colleagues is far from conclusive. We recognize that the Journal of Clinical Oncology readership is predominantly from the medical oncology community, but, as gynecologic oncologists offering comprehensive care to patients, this is our Journal, too, and we found these editorial comments quite biased as well. A gynecologic oncologist or at least someone who understands the specialty should have been asked to write an editorial alongside the one by Dr Cannistra. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES
1. Silber JH, Rosenbaum PR, Polsky D, Ross RN, et al: Does ovarian cancer treatment and survival differ by the specialty providing chemotherapy? J Clin Oncol 25:1169-1175, 2007 2. Cannistra SA: Gynecologic oncology or medical oncology: What's in a name? J Clin Oncol 25:1157-1159, 2007 3. American Board of Obstetrics and Gynecology Inc: General and Special Requirements for Graduate Medical Education. Dallas TX, American Board of Obstetrics and Gynecology Inc, 1998
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Copyright © 2007 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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