Generalizations of a generalist - common themes among systemic therapies for common cancers

O ncology, along with the rest of medicine, is becoming increasingly subspecialized. Early leaders in the development of medical oncology trained and practiced as generalists, but that generation has been replaced by the current generation of academic oncologists who start specialization early on, often while still in fellowship. Te advantages of being able to concentrate on just one area of oncology, or even just one disease, are obvious in terms of the ability to gain expertise and to advance research. As a result, most of the current literature is written by subspecialists. However, such focused specialization may deprive oncologists of a potentially useful, broader perspective. Indeed, most of medical oncology is still delivered by generalists. An advantage of treating the full spectrum of neoplasms is that one can see common themes that occur across diferent cancers in both tumor behavior and treatment. And a generalist can gain experience with therapies in a variety of diseases, rather than just one. Bevacizumab, imatinib, and everolimus are examples of agents that are used in multiple cancers. So while the trend is to fragment specialties and diseases even further, it may be useful to look in the opposite direction at commonalities that occur across tumor types. I have observed that the dilemmas patients with diferent cancer types face and the discussions I have with them are often quite similar. Although there are exceptions for each of the views below, they often hold true as teaching points, and I have found them particularly useful in instructing fellows.