15th Congress of the European Society of Surgical Oncology (ESSO), 15–17 September 2010, Bordeaux
Dr Murray Brennan – Memorial Sloan-Kettering Cancer Centre, New York, USA
The future for young surgical oncologists
My interest has been, obviously, surgery and the management of the cancer patient and I’ve had a very large training programme from fellows, not only from the United States but from around the world. The reason I’m here today was to receive an award which I accept on behalf of all the people that have worked for me.
It’s very hard to summarise forty years of your professional lifetime in twenty minutes, so I took the approach of just picking out a few things that I thought were important to young people. Here we are in Bordeaux and everyone thinks that mentor and athena were inventions, obviously, of the Greeks when, in fact, it was a Frenchman who first popularised the concept of mentorship; so I talked about mentorship or if you’re a woman, athenaship. I talked about some of the things we’ve learnt, particularly when we’ve been diligent about recording prospective information in the management of most cancer patients. I talked about the crucial nature of databases, both nationally and personally; I talked about the fact that databases tell you not just about outcomes but they actually tell you about biology, they actually can help you predict events and that’s another topic I’m going to talk about shortly. I talked about our focus on improvements in care but I also, as I get perhaps a little more senior, worry about our failure to acknowledge the side effects of what we do, whether it’s surgery, chemotherapy, radiation therapy. We always focus on the benefit, we always want to win the war, we don’t realise the consequences of winning that war to others who may never have needed as extensive treatment.
What is your message to young surgeons?
I think it’s a very exciting time to be a surgeon. People worry about it, I’ve been extraordinarily fortunate. Conversely, I’m not so sure how you’re going to do in the European Working Time directive, that frightens me; I couldn’t possibly train people to be as good as I think they should be in 48 hours a week. We think we can do it in 80 hours a week, so that’s a struggle you’re going to have and the young people are going to have. I don’t think I would tell them anything magical, I think I would tell them to enjoy what they’re doing – the old axiom: if you like what you’re doing you don’t have to work. I would tell them that it’s a lifetime of learning - that it’s not going to medical school, doing a residency and you’re done, that’s just the start of it, if they can enjoy learning. I would tell them that the management of the cancer patient is going to progressively be more and more disease focussed and not discipline focussed; in other words I’d tell them to be less worried about being a surgeon or radiation therapist but more worried about what is the disease the patient has. I would hope that they would manage people with knowledge; I would hope that they would begin to criticize themselves as a lifelong endeavour. One of the things that allowed me to get some things done was I was never satisfied with the status quo and if I thought I was then I would criticize myself. I would encourage them that medicine is a great profession, it still is. I worry about it losing its professionalism, particularly in this part of the world where you really do begin with your 48 hours a week and with your focus on service. If you begin to act like a serviceman, you will be treated as one, not that it isn’t happening in the United States, it is, that’s a disappointment to me. I think if you want to be a professional you do have to give up some things and there is a price to pay and maybe it’s a price I too willingly paid but I still would find it hard to do it differently.
What else were you talking about at ESSO 2010?
The next talk is a follow up on what we’ve learned about a specific disease and it’s called soft tissue sarcoma which is a relatively rare malignancy, you only see about 15,000 a year in the United States. So it’s what we call an orphan disease, nobody focuses research and endeavour on orphan diseases. We actually have several proposals before the United States National Cancer Institute in the hope that we’ll get attention paid to these orphan diseases. So sarcoma is one of those and so I’m going to talk about what we’ve learned particularly about diagnosis and prediction of outcome and where we’ve made progress and particularly where we haven’t made progress in the management of that particular disease. It’s a great example of it being disease specific; it’s not just about the surgery and it’s not just about the radiation, it’s about pathology and diagnosis and imaging and analysis - a lot of things that go into the dissection of that disease.