The urgent need to develop research clinical oncology medical scientists

Beijing Shijitan Hospital, CMU, Capital Medical University, School of oncology, Capital Medical University, Beijing 100038, ChinaCancer is b

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Beijing Shijitan Hospital, CMU, Capital Medical University, School of oncology, Capital Medical University, Beijing 100038, China

Cancer is becoming a global problem. In developed countries such as the United States, the mortality rate of malignant tumors has declined since 2006. Developing countries, including China, the incidence and mortality of malignant tumors increased year by year. According to the recent annual report by the National Institutes of Health (NIH), the number of people dying of cancer in the world is expected to rise to 10 million 30 thousand by 2020. And more than 70% of all cancer deaths worldwide occur in low - and middle-income countries. Our data show that, whether in the city or rural areas, the incidence of cancer has been more than cardiovascular disease, rose to the first place. For the understanding of the concept of cancer, that has been from the past "incurable" gradually transformed into a "chronic diseases like diabetes and inflammation". [1]

1 the goals and expectations of malignant tumors in the government and academia have been forced to decline

1975 U.S. Nixon administration proposed that by the year 2000 will break the cancer. In fact, from the beginning of 2000, people's expectations of a cure for cancer fell every 5 years to a level that extends survival (2005), improved quality of life (2010), scientific rational treatment (in 2015). China for such a populous developing country, how to make good use of the limited medical resources and capital investment, to improve the level of clinical treatment of tumors in China, as far as possible to avoid the medical treatment in the process of "improper treatment" and "overtreatment" phenomenon, improve the quality of life of patients and prolong the survival time of patients is. A major problem in clinical practice China tumor. In the past, medical experts to the organ to classify cancer, such as lung cancer, gastric cancer, liver cancer, and the future will be classified according to genes. The treatment of tumors is becoming more and more complex, the previous analysis of the size of the tumor will be seen, the number, and now will be analyzed by high-throughput sequencing. People's understanding of the causes of cancer is generally less, patients and doctors need to continue to improve their awareness of the disease.

2013-05-01 published "Nature", through the method of whole genome sequencing, discovery of endometrial cancer and breast cancer 30% gene homology; this is further evidence that the molecular heterogeneity of the molecular level between tumor and tumor and tumor homology will make the future clinical tumor treatment becomes more difficult. In the case of the United States, the annual meeting once a year of Clinical Oncology (ASCO) is the largest and the highest level of the world clinical research clinical oncology clinical research event, but 25 years of clinical studies in the United States has obvious curative effect of tumor was only 57%, far not reached the expected target, but spent huge amounts of money and resources. One of the reasons is the lack of organic combination of clinical research and basic research, the lack of basic medical knowledge and the level of research to reveal the role of drug conversion.

The U.S. government's research and development of anticancer drugs and cancer research is much higher than China's. Great achievements have been made in the field of tumor immunity, anti-tumor monoclonal antibody and the development of targeted drugs. However, only a certain amount of progress has been made in the treatment of clinical tumors. It is far less than originally expected, and thus again and again stressed the need to strengthen the tumor genotyping, intracellular signaling pathways, the second generation of high-throughput gene sequencing, etc.. All in all, only rely on the experience of cancer treatment era of the past will gradually become the consensus of clinical oncology doctor. At present, our country is able to take advantage of the knowledge and skills of social services for clinicians, so that more people can enjoy health protection, and teaching hospitals to continuously improve the ability of innovation, and strive to make some achievements in achieving an international level. The author believes that to achieve the above two requirements, the former mainly rely on government investment, by increasing the necessary human and hardware resources can be realized; the latter must rely on a large number of clinical medical scientists (Physician Scientists) and the use of training. There are obvious geographical differences, especially the realistic conditions in China's medical institutions, medical treatment conditions, is a pressing matter of the moment how to use the limited medical resources and capital investment, in the protection of the patient's basic medical service basis, develop the clinical oncology medical scientists achievements, in the country and even international influence in the field of science.

2 to guide clinical practice with evidence-based medicine, to strengthen the systematic education and training of clinical research in oncology

Clinical medicine is a practical subject. To guide people's clinical treatment has changed from the past experience medicine to evidence-based medicine. Evidence based medicine is used to guide individualized therapy, using genomics and proteomics to study the effects of molecules related to tumorigenesis and metastasis. Derived from experience medicine to precise individualized treatment, must be made by qualified clinical scientists to complete [2].

As far as the internal medicine is concerned, the research and development of antitumor drugs is the key to the clinical treatment of tumors. With the continuous growth of China's economy, more and more attention has been paid to the development and investment of new drugs, and the field of new drug clinical research in China is gradually entering a new era of accelerated development. However, clinical research in recent twenty years, mostly to foreign pharmaceutical companies as the main body to carry out this way, the clinical aspect of the study in clinical practice enables clinicians to gradually understand the antitumor drugs in various phases of clinical trials, but also can promote the clinical research of anticancer drugs in our country to a certain degree on. But at present the system of continuing education requirements still need to increase the special training following: the curriculum, clinical research conducted by specialized professional and systematic training of researchers; to improve the quality of clinical trial evaluation means; establishing perfect data management and statistical analysis system; establish and perfect the system. Anti tumor drugs ethical system; the clinical research results can well guide the clinical treatment and the lack of international recognition of the clinical research on various standardized documents, follow-up, and data processing method [3].

The above reasons lead to the difficulty of international recognition of the clinical data and the results of anti-tumor drugs in china. Our government has realized the defects of medical development in our country, the establishment of the national major science and technology projects in the "12th Five-Year" period, including batch set up high quality development of antitumor drugs in each stage of clinical research and technology platform of the quality management system project.

Exploration on the development mode of 3 tumor Medical College

Along with the progress of medicine and tumor development, continuous learning and Reflection on the successful experience of advanced countries in the international culture system of our own limitations, the author believes that the overall development of the concept of teaching hospital Chinese tumor must be from the simple to the clinical diagnosis and treatment, clinical research and development into a research oriented hospital, and we need to cultivate a large number of clinical cancer scientists become the main force of the reform, to shoulder the historical responsibility of this major change. As mentioned are appointed by the president of the National Cancer Advisory Committee, H. Kim, Lyerly professor at Duke University in the United States in a speech: "the focus of clinical cancer research is exploring genomics in the disease development, the only way to make people avoid detours, select more effective drugs to treat patients, ultimately achieve the effect of both the satisfactory and can reduce the medical consumption to achieve this goal more excellent clinical medical scientists need to." Medical scientists is a bridge between clinical medicine and basic medicine, as a qualified or excellent clinicians should have clinical knowledge and experience of clinical basic skills, profound solid, and rise to scientists must based on the scientific aspects of continuing education and learning, to understand the development of frontier disciplines related to the mastery of technology the means to solve the key problems of [4]. At the present stage, our country lags behind the western countries in the aspect of clinical research, especially in the aspect of bioinformatics. In western countries, the incidence of early-stage breast cancer accounts for 70%~80% in clinical cases, and their goal is to look for more early cases, "the search for a cure for cancer in situ". "And our country is now in the 'discovery' stage, the proportion of patients with stage I is only 10% ~ 15%, IV patients accounted for the highest proportion".

In order to prove that the doctor must adhere to the research work. From the beginning of 2000, he led the team to study for high-risk, specific chemotherapy combined with immune reconstitution treatment method and three young patients with negative, according to the different metastasis sites of breast cancer by targeted therapy, with breast cancer stem cells as target cells, after 10 years of clinical research, 5 years after surgery in patients the survival rate increased by 55%[5]. From the clinical practice to be keenly aware of using scientific methods to see the problem. Even a very strong professional knowledge of doctors, but also do not want to deny a treatment, because medicine is evolving, people will become more and more profound understanding of the tumor, more and more professional.

In 2011, Capital Medical University established the Capital Medical University cancer medical school, the purpose is to strengthen the combination of basic disciplines of tumor and clinical subjects, strengthen the integration of resources within the system and oncology of Capital Medical University campus hospitals and research institutions in. Taking the academic construction as the goal, to promote the construction and development of the whole tumor discipline, to strengthen the cultivation of high level tumor talents, and strive to be the base for the cultivation of tumor clinical scientists. Taking a broad view of the famous medical institutions in the world, we can find that most of the teaching hospitals attach great importance to the training of scientific research and clinical professionals. From the beginning of young doctors into clinical practice, we should pay attention to the cultivation of scientific research ability. Most of the major research projects in the United States most of the hospital from the clinician, the problem posed by the clinician, the organization of basic researchers to conduct scientific research. This model on the one hand to improve the level of clinical, but also created a large number of outstanding scientists such as clinical medicine, Affiliated Hospital of Harvard University, Johns Hopkins University School of medicine, Duke University and other well-known medical institutions require clinicians engaged in research work. Outside the box, so, we also need to implement this mechanism in clinical teaching and training, because only in this way can really promote the overall health level of our country, is conducive to the birth of a new clinical and research direction and method, which will become the tumor medical schools in China and its clinical teaching hospitals common direction.

[reference] please fill 5 references, and please mark in the text!

[1] Ren Jun, Jiang Wenguo. Encourage clinicians to be scientists. Beijing: Guangming Daily: January 12, 2009 Tenth Edition

[2] Liu Wenjia. Ren Jun: cancer front Hengdao immediately. Beijing: Guangming Daily: September 18, 2009 12 Edition

[3] Beijing Cancer Hospital. Continuous innovation and pursuit of excellence -- Professor Li Jun, director of breast tumor, Department of oncology, cancer hospital. Beijing: Peking University: 2009; 5 (2): 38

[4]Song GH, Wang XL, Jia J, Yuan YH, Wan FL, Zhou XN, Yang HB, Ren J, Gu JZ, Lyerly HK. Elevated level of peripheral CD8+CD28- T lymphocytes are an independent predictor of progression-free survival in patients with metastatic breast cancer during the course of chemotherapy. Cancer Immuno Immunother. 2013; 62 (6): 1123-30

[5] Ren J, Di L, Song G, Yu J, Jia J, Zhu Y, Yan Y, Jiang H, Liang X, Che L, Zhang J, Wan F, Wang X, Zhou X, Lyerly HK. Selections of appropriate regimen of high-dose chemotherapy combined with adoptive cellular therapy with dendritic and cytokine-induced killer cells improved progression-free and overall survival in patients with metastatic breast cancer: reargument of such contentious therapeutic preferences. Clin Transl Oncol. 2013, DOI 10.1007/s12094-013-1001-9

(received 2013-05-20; 2013-06-06 time)

Project supported by the 1 Beijing high level personnel training program of health system 2009-2-16;

2.2012 years of Beijing city ten Baiqian health personnel "ten" level for funding;

Author: Ren Jun. MD, Professor, chief physician, tutor of doctor of medical oncology, tumor immunology, doctoral supervisor, deputy director of Department of oncology, Capital Medical University, director of the Capital Medical University cancer center affiliated Beijing Shijitan Hospital, CMU. Tel: (010) 63926317 Email:renjun9688@yahoo.com

 

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