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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 574-575

Are we training enough?


Consultant Surgical Oncologist, Putuonuo Nursing Home, Kohima, Nagaland, India

Date of Submission08-Aug-2021
Date of Decision10-Aug-2021
Date of Acceptance15-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Keduovinuo Keditsu
Putuonuo Nursing Home, P O Box 129, New Market Road, Kohima - 797 001, Nagaland
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_181_21

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How to cite this article:
Keditsu K. Are we training enough?. Cancer Res Stat Treat 2021;4:574-5

How to cite this URL:
Keditsu K. Are we training enough?. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:574-5. Available from: https://www.crstonline.com/text.asp?2021/4/3/574/327772



We read with interest the article by Chandveettil et al. titled, “Changing trends of invasive mediastinal evaluation in India: A questionnaire-based survey.”[1] Despite a tepid response from the invited clinicians in the National Cancer Grid Centers across India, I appreciate the efforts made by Chandveettil et al. in bringing forward some important conclusions.[1]

At the outset, the online survey had an alarmingly low response rate of 20%, where only 70 out of 347 invited clinicians participated. The authors assume that the remaining 80% of clinicians may either not be performing or not have been exposed to these procedures. This reflects poorly on the performance for lung cancer treatment in various centers across the country. Perhaps the authors could consider a telephonic follow-up of the non-responders. The resulting information would help us to confirm the authors' assumption and/or provide a clearer estimate of the existing lacuna. Do we need more training programs to create awareness regarding mediastinal staging procedures in these centers?

Chandveettil et al. have rightfully stated the limitations of their study – a small sample size, 84.3% of participants belonging to academic institutions with only a small proportion (35.8%) treating high volumes of patients, and the resultant non-generalizability of their results. However, considering that approximately 45%–60% of patients with cancer in India undergo investigations and treatment in private hospitals,[2] as opposed to government-run district hospitals/medical colleges/tertiary level institutions (42%),[3] it would be interesting to conduct a similar survey in large private hospitals across the country with dedicated thoracic oncology departments, to gauge the disparity in terms of equipment and practice.

Even though the primary objective of this survey was to assess the changing trends in mediastinal staging in lung cancer in India, it has to a greater extent unveiled an important reality about oncology practice in our country, i.e., the variation of practice based on the availability of equipment and expertise.

The study has highlighted disparities in the infrastructure, mediastinal staging facilities, and procedure-related expertise across India. Availability of mediastinoscopy and endobronchial ultrasound/endoscopic ultrasound was 52.9% and 60%, respectively, in the majority of large academic institutions. This disparity further translates into non-uniformity in practice and patient management. Availability or lack thereof can create decisional biases. The authors have rightfully stated that, “There is significant variation in practice largely related to the availability of equipment and expertise, rather than individual preferences, cost, or other practical issues.” Are we compromising on patient care due to the lack of resources and training?

Despite lung cancer being among the most common cancers worldwide, and in India, the need for standardizing staging methods have not reflected proportionately in clinical practice. This may be attributed to the fact that only a small percentage of patients with lung cancer are diagnosed with localized (14%–17%) or locoregional disease (30%), while the majority are diagnosed with distant metastasis;[4] hence, the need for mediastinal staging seems to be limited to a smaller proportion, despite the huge disease burden. Whether it is invasive or non-invasive mediastinal staging, our ultimate goal as oncologists is to ensure accurate staging and optimal treatment planning.

The authors have concluded that there is a dearth of expertise in invasive mediastinal staging and a need to improve its knowledge and implementation. Most oncologists have a fair knowledge of lung cancer management guidelines, but how many are practically capable and adequately trained? How can we improve the implementation of these staging procedures? Krishnamurthy suggests that an enhanced infrastructure in every institution managing patients with lung cancer could bridge the gap between guidelines and clinical practice.[5]

Perhaps experienced thoracic/surgical oncologists, thoracic surgeons, and pulmonologists treating lung cancer in high-volume centers, particularly academic institutions, need to focus on training the residents in both invasive and minimally invasive procedures wherever the facilities are available. Training must not end in theoretical knowledge; it must translate into practical application and safe and efficient implementation. The onus is on the administration of the institute to consider improving facilities and to design teaching programs to ensure that budding thoracic oncologists are capable of performing such procedures when they complete their residency.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chandveettil J, Kattepur AK, Pareekutty NM, Kumbakara R, Balasubramania S. Changing trends of invasive mediastinal evaluation in India: A questionnaire-based survey. Cancer Res Stat Treat 2021;4:231-7.  Back to cited text no. 1
  [Full text]  
2.
Rajpal S, Kumar A, Joe W. Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, 2014. PLoS One 2018;13:e0193320.  Back to cited text no. 2
    
3.
Nair KS, Raj S, Tiwari VK, Piang LK. Cost of treatment for cancer: Experiences of patients in public hospitals in India. Asian Pac J Cancer Prev 2013;14:5049-54.  Back to cited text no. 3
    
4.
Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al. Cancer statistics, 2020: Report from National Cancer Registry Programme, India. JCO Glob Oncol 2020;6:1063-75.  Back to cited text no. 4
    
5.
Krishnamurthy A. Bridging the gap between guidelines and practice for invasive mediastinal staging in non-small-cell lung cancers. Cancer Res Stat Treat 2021;4:360-2.  Back to cited text no. 5
  [Full text]  




 

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