Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Perspective
  • Published:

OPINION

Reshaping the critical role of surgeons in oncology research

Nature Reviews Clinical Oncology volume 16, pages 327–332 (2019)Cite this article

Subjects

Abstract

Surgery remains a mainstay in the treatment of most solid cancers. Surgeons have always engaged in various forms of high-quality cancer research to optimize outcomes for their patients, for example, contributing to clinical research and outcomes research as well as health education and public health policy. Over the past decade, however, concerns have been raised about a global decline in the number of surgeons performing basic science research alongside clinical activity — so-called surgeon scientists. Herein, we describe some of the unique obstacles faced by contemporary trainee and practising surgeons engaged in research, as well as providing a perspective on the implications of the diminishing prominence of the surgeon scientist. Finally, we offer some thoughts on potential strategies and future directions for surgical engagement in oncology research to increase the number of research-active surgeons.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Potential roles of surgeons in oncology research.

Similar content being viewed by others

References

  1. Ferlay, J. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int. J. Cancer 136, 359–368 (2014).

    Article  Google Scholar 

  2. Miller, K. D. et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J. Clin. 66, 271–289 (2016).

    Article  Google Scholar 

  3. Sullivan, R. et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol. 16, 1193–1224 (2015).

    Article  Google Scholar 

  4. Morris, E. J. A. et al. Surgical management and outcomes of colorectal cancer liver metastases. Br. J. Surg. 97, 1110–1118 (2010).

    Article  CAS  Google Scholar 

  5. Stein, S. L. Scholarship in academic surgery: history, challenges, and ideas for the future. Clin. Colon Rectal Surg. 26, 207–211 (2013).

    Article  Google Scholar 

  6. Stone, M. J. The wisdom of Sir William Osler. Am. J. Cardiol. 75, 269–276 (1995).

    Article  CAS  Google Scholar 

  7. Are, C. et al. Global curriculum in research literacy for the surgical oncologist. Ann. Surg. Oncol. 25, 604–616 (2017).

    Article  Google Scholar 

  8. Glover, M. et al. Estimating the returns to UK publicly funded cancer-related research in terms of the net value of improved health outcomes. BMC Med. 12, 99 (2014).

    Article  Google Scholar 

  9. Filewod, N. C. et al. Should basic science matter to clinicians? Lancet 391, 410–412 (2018).

    Article  Google Scholar 

  10. Keswani, S. G. et al. The future of basic science in academic surgery: identifying barriers to success for surgeon-scientists. Ann. Surg. 265, 1053–1059 (2017).

    Article  Google Scholar 

  11. Academic Careers Sub-Committee of Modernising Medical Careers and the UK Clinical Research Collaboration. Medically- and dentally-qualified academic staff: recommendations for training the researchers and educators of the future. UKCRC http://www.ukcrc.org/wp-content/uploads/2014/03/Medically_and_Dentally-qualified_Academic_Staff_Report.pdf (2005).

  12. Windsor, J. et al. Building a sustainable clinical academic workforce to meet the future healthcare needs of Australia and New Zealand: report from the first summit meeting. Intern. Med. J. 45, 965–971 (2015).

    Article  CAS  Google Scholar 

  13. Australian Government National Health and Medical Research Council. Funding. NHMRC https://nhmrc.gov.au/funding (2018).

  14. Lawler, M. et al. Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer. Gut 67, 179–193 (2018).

    Article  Google Scholar 

  15. Danielsen, H. E. et al. Prognostic markers for colorectal cancer; estimating ploidy and stroma. Ann. Oncol. 29, 616–623 (2017).

    Article  Google Scholar 

  16. Koay, E. J. et al. Transport properties of pancreatic cancer describe gemcitabine delivery and response. J. Clin. Invest. 124, 1525–1536 (2014).

    Article  CAS  Google Scholar 

  17. Brudvik, K. W. et al. RAS mutation clinical risk score to predict survival after resection of colorectal liver metastases. Ann. Surg. https://doi.org/10.1097/SLA.0000000000002319 (2017).

    Article  Google Scholar 

  18. Mann, M., Tendulkar, A., Birger, N., Howard, C. & Ratcliffe, M. B. National institutes of health funding for surgical research. Ann. Surg. 247, 217–221 (2008).

    Article  Google Scholar 

  19. Halloran, C. M. et al. PANasta trial; Cattell Warren versus Blumgart techniques of panreatico-jejunostomy following pancreato-duodenectomy: study protocol for a randomized controlled trial. Trials 17, 30 (2016).

    Article  Google Scholar 

  20. Smith, N. D. et al. The RAZOR (randomized open versus robotic cystectomy) trial: study design and trial update. BJU Int. 115, 198–205 (2015).

    Article  Google Scholar 

  21. Cunningham, D. et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N. Engl. J. Med. 355, 11–20 (2006).

    Article  CAS  Google Scholar 

  22. Neoptolemos, J. P. et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine versus observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA 308, 147–156 (2012).

    Article  CAS  Google Scholar 

  23. Blencowe, N. S. et al. Integrated surgical academic training in the UK: a cross-sectional survey. Postgrad. Med. J. 93, 581–586 (2017).

    Article  Google Scholar 

  24. United Kingdom Joint Committee for Surgical Training. Certification guidelines & checklists. JCST https://www.jcst.org/quality-assurance/certification-guidelines-and-checklists (2018).

  25. O’Callaghan, J. et al. Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland. BMJ Open 7, e018086 (2017).

    Article  Google Scholar 

  26. Juan, X. Q. Strategy of rejuvenating the country through science and education [Simplified Chinese] (Beijing Science and Technology Press, 2002).

  27. Hvistendahl, M. China’s publication bazaar. Science 342, 1035–1039 (2013).

    Article  CAS  Google Scholar 

  28. Shanafelt, T. D. et al. Burnout and career satisfaction among American surgeons. Ann. Surg. 250, 463–471 (2009).

    PubMed  Google Scholar 

  29. The University of Chicago Department of Surgery. Research & other opportunities. UChicago https://surgery.uchicago.edu/education/residency/general/research (2018).

  30. Royal Australasian College of Surgeons. Research and travel scholarships. RACS https://www.surgeons.org/member-services/scholarships-awards-lectures-prizes/research-and-travel-scholarships/#RESEARCHRELATED (2018).

  31. ZonMw. Agiko stipends. ZonMw https://www.zonmw.nl/en/research-and-results/fundamental-research/programmas/programme-detail/agiko-stipends (2011).

  32. Densen, P. Challenges and opportunities facing medical education. Trans. Am. Clin. Climatol. Assoc. 122, 48–58 (2011).

    PubMed  PubMed Central  Google Scholar 

  33. Dyrbye, L. N. et al. Work-home conflicts have a substantial impact on career decisions that affect the adequacy of the surgical workforce. Arch. Surg. 147, 933–939 (2012).

    Article  Google Scholar 

  34. National Vascular Registry. Vascular services quality improvement programme. VSQIP https://www.vsqip.org.uk (2018).

  35. Society for Cardiothoracic Surgery. Outcomes. SCTS https://scts.org/outcomes (2018).

  36. Advisory Committee on Clinical Excellence Awards. Clinical excellence awards: application guidance. GOV.UK https://www.gov.uk/government/publications/clinical-excellence-awards-application-guidance (2018).

  37. Smyth, L. More than half of Northern Ireland consultants get cash awards. Belfast Telegraph https://www.belfasttelegraph.co.uk/news/northern-ireland/more-than-half-of-northern-ireland-consultants-get-cash-awards-28744679.html (2010).

  38. Collins, A. Deal to reform clinical excellence awards agreed. Health Service Journal https://www.hsj.co.uk/workforce/deal-to-reform-clinical-excellence-awards-agreed/7022009.article (2018).

  39. Freed, G. L., Turbitt, E. & Allen, A. Public or private care: where do specialists spend their time? Aust. Health Rev. 41, 541–545 (2017).

    Article  Google Scholar 

  40. Royal Australasian College of Surgeons. Critical literature evaluation and research (CLEAR). RACS https://www.surgeons.org/for-health-professionals/register-courses-events/skills-training-courses/clear (2018).

  41. Royal Australasian College of Surgeons. For the financial year ended 31 December 2016. RACS https://www.surgeons.org/media/25150837/RPT-2016-12-31-Final-2016-Financial-Report-signed-.pdf (2016).

  42. Royal College of Surgeons England. Research fellowships. RCS https://www.rcseng.ac.uk/standards-and-research/research/fellowships-awards-grants/fellowships (2018).

  43. Hibberd, A. D. Translational research by surgeons: how far and how wide? ANZ J. Surg. 85, 601–602 (2015).

    Article  Google Scholar 

  44. NHS England. Clinical entrepreneur training programme. NHS https://www.england.nhs.uk/ourwork/innovation/clinical-entrepreneur (2018).

  45. Bhangu, A. et al. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infect. Dis. 18, 516–525 (2018).

    Article  Google Scholar 

  46. Are, C. et al. Global curriculum in research literacy for the surgical oncologist. Eur. J. Surg. Oncol. 44, 31–42 (2018).

    Article  CAS  Google Scholar 

  47. RIFT Study Group. Right Iliac Fossa Pain Treatment (RIFT) Study: protocol for an international, multicentre, prospective observational study. BMJ Open 8, e017574 (2018).

    Article  Google Scholar 

  48. CholeS Study Group, West Midlands Research Collaborative. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br. J. Surg. 103, 1704–1715 (2016).

    Article  Google Scholar 

  49. Bharamgoudar, R., Sonsale, A., Hodson, J. & Griffiths, E. The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy. Surg. Endosc. 32, 3149–3157 (2018).

    Article  Google Scholar 

  50. Sambunjak, D., Straus, S. E. & Marusic, A. A. Systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J. Gen. Intern. Med. 25, 72–78 (2010).

    Article  Google Scholar 

  51. Steiner, J. F., Lanphear, B. P., Curtis, P. & Vu, K. O. Indicators of early research productivity among primary care fellows. J. Gen. Intern. Med. 17, 854–860 (2002).

    Article  Google Scholar 

  52. Kibbe, M. R. & Velazquez, O. C. The extinction of the surgeon scientist. Ann. Surg. 265, 1060–1061 (2017).

    Article  Google Scholar 

Download references

Acknowledgements

Reviewer information

Nature Reviews Clinical Oncology thanks P. Dasgupta, R. Harries, M. LaQuaglia and D. Blazer for their contribution to the peer review of this work.

Author information

Authors and Affiliations

  1. School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK

    Robert. P. Jones

  2. North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK

    Robert. P. Jones & Graeme J. Poston

  3. Division of Surgical Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA

    Chandrakanth Are

  4. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Thomas J. Hugh

  5. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, Netherlands

    Dirk J. Grünhagen

  6. Department of Surgery, Shanghai Zhongshan Hospital, Shanghai, China

    Jianmin Xu

  7. Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Charles M. Balch

Authors
  1. Robert. P. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chandrakanth Are
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas J. Hugh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dirk J. Grünhagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jianmin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charles M. Balch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Graeme J. Poston
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to all stages of the preparation of this manuscript.

Corresponding author

Correspondence to Robert. P. Jones.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Related links

Dutch Institute for Clinical Auditing (DICA): https://dica.nl

GlobalSurg: http://globalsurg.org

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jones, R.P., Are, C., Hugh, T.J. et al. Reshaping the critical role of surgeons in oncology research. Nat Rev Clin Oncol 16, 327–332 (2019). https://doi.org/10.1038/s41571-018-0149-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41571-018-0149-1

Search

Advanced search

Quick links

Nature Briefing: Cancer

Sign up for the Nature Briefing: Cancer newsletter — what matters in cancer research, free to your inbox weekly.

Get what matters in cancer research, free to your inbox weekly. Sign up for Nature Briefing: Cancer