Interventional Oncology?

[mwmm]

I'm a medical student trying to figure out what specialty to go into. I've always been really interested in oncology and definitely want to be the primary physician for cancer patients. That said, the procedural aspect of interventional oncology fascinates me and is something I know I'd really enjoy. As of right now, it seems that's only a subspecialty of interventional radiology. Is there any possibility that a medical oncologist could train in interventional oncology and do those procedures? Considering that cardiologists can train to become interventional cardiologists, is this too much of a stretch?

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[Sye]

I'm also very interested in this question. Love the subject matter (Oncology, cancer biology) but also really like to do procedures and be hands on also. Is there any chance a hem/onc fellow could get some interventional training?

 

[darkelven29]

Historically interventional oncology comes from interventional radiology and usually means delivering chemo-embolization or other localized therapy.

GI is also involved in endoscopic procedures in cancer patients.

Traditional heme/onc do very few procedures, usually no more than bone marrow biopsy and maybe intrathecal chemotherapy.

 

[mwmm]

Historically interventional oncology comes from interventional radiology and usually means delivering chemo-embolization or other localized therapy.

I know that but angioplasty was invented by an interventional radiologists and is now a staple for interventional cardiologists. If one subspecialty of internal medicine can learn interventional procedures, why can't another one?

I understand traditionally heme/oncs don't do many procedures but is there any actual barrier for them do learn and do it? Would it be possible for a medical oncologist to learn interventional procedures and incorporate it into their practice?

I guess what I'm asking is, can oncology take a similar route to cardiology in terms of interventional procedures?

 

[tallash]

I have not heard of any oncologists training in this field. But I can guarantee that if a trend starts the interest in Hem/Onc will significantly increase unless reimbursement schemes dramatically change (which I don't think they will).

 

[gutonc]

Why is that though? It seems like a natural progression for the field. We have interventional cardiologists, interventional gastroenterologists, interventional pulmonologists, and interventional nephrologists. Why aren't oncologists developing and using interventional procedures?

Because it's not a natural extension of any of our training. GI gets trained to scope and interventional GI is a natural extension of that. Pulm gets trained to bronch and EBUS and SuperD is a natural extension of that. We get trained to do bone marrows and LPs (and the occasional thora or para-centesis). There is no way you could easily translate those procedures into what is required of an interventional radiologist.

Also, many of us went into Onc because we didn't like procedures. I'm really good and fast at bone marrows but I dread them. Totally ruins my day and doesn't pay well enough. And I would put money on reimbursement for those procedures going down in the not-too-distant-future.

If you want to spend your career doing catheter-based therapy, do Rads-->IR. If you want to be an oncologist, be an oncologist.

 

[sacrament]

My question is, is there anything actually preventing a medical oncologist from learning and doing these procedures?

As has already been mentioned: I can't imagine who you would get to train you. No formal IR training program is going to agree to take you on as a special case. Theoretically, you could finish your oncology training and then out there "in the real world" you could convince/bribe/blackmail somebody to mentor you in however X number of cases are required for credentialing. But I imagine that any reputable hospital (i.e. any hospital in the United States that is delivering this sort of care) will still require that you actually have some formal IR training before they would give you privileges in that sphere. Pragmatically, I think this is essentially impossible.

 

[mwmm]

As has already been mentioned: I can't imagine who you would get to train you. No formal IR training program is going to agree to take you on as a special case. Theoretically, you could finish your oncology training and then out there "in the real world" you could convince/bribe/blackmail somebody to mentor you in however X number of cases are required for credentialing. But I imagine that any reputable hospital (i.e. any hospital in the United States that is delivering this sort of care) will still require that you actually have some formal IR training before they would give you privileges in that sphere. Pragmatically, I think this is essentially impossible.

That's what I wanted to know. Thank you.

 

[irwarrior]

I am an interventionalist in practice. IO is an interesting field and certainly growing in its applications. We primarily treat patients with primary liver cancer, liver dominant metastases, renal cancer, metastatic lung cancer, unresectable St1 lung ca, palliative treatment of bone mets. We also do biliary and GU interventions for biliary or ureteric obstructions. We palliate patients with SVC syndrome with SVC stents. Place ports for chemotherapy and biopsy various organs.

The caveat is that though it is feasible for anyone to learn this field. It would take about 2 to 3 years of advanced imaging training and 2 years of interventional training to get the fundamental technical and imaging skill set required to do the scope and breadth of current interventional oncology.

The field of IO is rapidly growing and encompasses a great deal of procedures and growing number of cancerous conditions

hepatocellular carcinoma
-chemoembolization (conventional, drug eluting beads, internal beam radiation therapy/Y90)
-ablative therapy (RFA, microwave, PEI)
cholangiocarcinoma
(transcatheter treatment/unresectable intrahepatic cholangio)
metastatic CRC
-growing role for nonresponders to systemics


IR is becoming a far more clinical specialty especially as it recently has got its own boarding by the ABMS. There are dedicated IR training pathways such as the DIRECT pathway.

Consider checking out the various websites that discuss IO further including the interventional radiology forum on studentdoctor as well as

www.io-central.org and www.sirweb.org, www.cirse.org

 

[dozitgetchahi]

I think this is analogous to saying 'I trained as a medical oncologist - why can't I do rad onc too?' Just because some other specialty has 'oncology' in its name doesn't mean medical oncologists can just jump into it.