PRESENTATION OUTLINE
What are you trying to do over the next 1/2/3 years?
1. You need to learn the vocabulary.
2. You need to learn the paradigm.
3. You need to learn how to make specific decisions.
4. You need to learn how to think.
Be wary of thinking you will learn how to practice "in clinic."
Depth without context warps your learning.
Today, we will begin with the very big picture.
At the end of today's lecture, we will introduce the Tuesday lecture series.
When considering treatment for a cancer, you must consider 4 factors:
The nature of the cancer (extent, biology, genetics, etc.).
The hardiness of the patient.
The nature of the therapy.
Other contributing factors.
The great exceptions: leukemia and lymphoma.
(note: a few others now qualify)
With these, because chemo (+/- XRT) is it, and can often cure, we tolerate high risk.
Otherwise: all we do is make surgery better.
Every decision is made in relationship to surgery.
Can we prepare a patient for surgery?
Can we make surgery more effective?
Might what we do make surgery more difficult?
Might what we do make a past surgery less effective?
In almost all cases, we only care about mOS.
Everything else is a way-station.
In terms of the tumor itself, biology is king.
In terms of the patient, a few important questions:
Specific dose-limiting pre-existing conditions.
You need a real understanding of how potentially toxic something is.
So, with all of this: Tuesdays will help prepare you to make individual decisions.
The entirety of onc (and malignant heme, with some benign there also) has been divvied up.
We will look at the evidence behind answering each.
Each lecture will articulate 3-4 central questions.
By learning to make individual decisions, you will develop a skill set.
Once you add up those skill sets, you will have learned to think.
And all of this will build a scaffold.
Why we have teaching fellows.
And, finally, a word about "the art of oncology."
