Global Oral Cancer Diploma program’s Module 6: Treatment Planning tackles topics at the core of the patient journey

The importance of collaborating across the oncological disciplines, careful selection of the treatment team, and close attention to overall treatment efficacy are at the center of the Global Oral Cancer Diploma program’s Module 6: Treatment planning, edited by Prof Vincent Grégoire, MD, chair of the Centre Léon Bérard Radiation Oncology Department in Lyon, France. Grégoire described his motivation for joining the faculty of the program—a collaborative initiative of AO CMF and the International Association of Oral Oncology (IAOO)—and what makes the 10-month, self-directed online program truly unique.

What inspired you to pursue a career in radiation oncology?

When I was in medical school, I was working in the lab during my spare time, working with cells and mice in the field of radiation biology. I got my medical degree and because I was working in the radiation biology lab, I decided to go in the field of radiation oncology just to go from the experimental aspect and animals into the clinical aspects on humans. That was a different time: We didn’t know whether radiation was more effective than chemotherapy; today we know that it is indeed more effective locally than chemo. But at that time, we did not have immunotherapy or targeted agents.

What makes you passionate about radiation oncology?

It appeals to me because it's a mix between three disciplines: the clinical disciplines, dealing with patients; the nuclear physics or engineering discipline because we are working with equipment; and then biology, because we know radiation does interact with a lot of biological systems, so there is this robust aspect of treatment planning.

What keeps you engaged and moving forward in this career?

It's my personality. For me, if you don't move forward, you go backward. So, I'm always trying to discover new things so that at the end of the day, I’ve improved something or am at a different or higher level than I was when I started my day. Every day, you realize that there are things that need to be improved, whether it's achieving better patient selection, better dose distribution, or better understanding of the interaction between ionizing radiation and the biology. All of this is stimulating so many questions and this
obviously stimulates an interested mind.

So, there are still things to be discovered about radiation oncology?

We are always gaining new insights and making new discoveries: technical, biological, clinical, and so everything needs to be constantly rethought and rechallenged. That's what I do in my discipline.

How did you get involved with the AO and the Global Oral Cancer Diploma program?

My involvement with the AO grew out of my involvement in the International Association of Oral Oncology (IAOO), the AO’s collaborator in the Global Oral Cancer Diploma program. My academic field of interest too is head and neck oncology, thus including the oral cavity and head and neck tumors, so I knew quite a few of the people involved in developing the diploma program. When they contacted me to ask whether I was interested in contributing as a module editor, I said, “Why not?” Education is linked to what we do as academic physicians and it seemed that this could be challenging and intellectually rewarding.

What do you see as the surgeon needs that this program fills?

By definition, oncology is a multidisciplinary approach. You can be the best, most skillful, and intelligent surgeon, but if you don't interact properly with the whole interdisciplinary team—diagnostic radiologist, pathologist, medical oncologist, radiation oncologist—your patients will not get the best treatment. Maybe a surgeon will get the leading role for the oral cavity and that's fine with me. But you at least need to know when for this particular patient a particular area of expertise is needed. It’s important to me that our diploma program participants understand that they need other people—other disciplines. I want to teach them who these other people are, what they can offer, and why at the end of the day their patients will be better off if they interact with all the disciplines in oncology. This also reflects AO CMF’s multidisciplinary orientation.

Who is the Global Oral Cancer Diploma program aimed at?

It’s basically meant for young surgeons, but I think it could have value for any of the oncology disciplines; for example, radiation oncologists and medical oncologists could benefit from the program. It could also be valuable for senior surgeons who want to refresh their knowledge as practices have evolved a little bit toward more oncological care of patients compared to functional care of patients who have other diseases of the oral cavity.

The Global Oral Cancer Diploma program brings together leading treatment planning experts from around the globe. How important do you think that is?

From the start, we wanted a faculty to come not just from the United States but from all over the world because our patients are from all over the world. That’s why the faculty is a mix of nationalities. We work in different environments and our patients and tools can be dramatically different.

In your estimation, what is unique about the Global Oral Cancer Diploma program?

It's for sure an evolution to try to target as many potential students as possible, and the internet is the most cost-effective and accessible means of doing that. The fact that the program is online definitely decreases the cost and multiplies the probability that people around the world will have opportunity to take part in by this program.
Without a doubt, this program broadens access to credible educational content delivered by global leaders in oral oncology.

How do patients ultimately benefit from having caregivers who've completed this program?

Our hope is that by raising the level of education, the level of awareness and performance of surgeons and other specialties will improve in five, ten, 15 or 20 years, and that this will translate into a higher cure rate. I think that’s a reasonable assumption because if you look over the last 50 years, for example, we across the board have increased efficacy of cancer treatment; and this increase in efficacy is due not only to new drugs or new radiation or new instruments. It's also—and maybe more so—because we have better surgeons who know how to interact with radiation oncologists, and better radiation oncologists who understand the added value of this or that particular surgical intervention.

And what's the scope of your work as a module editor?

We module editors identify the content and identify the educators who can contribute to the content by maybe refining it based on his or her expertise, so that—ultimately—we have a complete program that is well balanced among the different processes along the treatment path. The challenge is always to select knowledgeable teachers who can teach our learners how to collaborate across the disciplines, who are willing to be challenged by others.

How does the Module 6: Treatment planning help surgeons navigate the patient's oral cancer journey?

The curriculum is designed so that we are following the path of a particular patient from the diagnosis to the follow-up: the different steps for the diagnosis and the different steps for the treatment. Before you start the treatment, you have a multidisciplinary discussion to learn whether you need something more. This module addresses topics like: How do we communicate between ourselves, with the technicians, and with the patients? How are the psychological aspects taken into account? How is the follow-up done? Do you need imaging? Don't you need imaging? If so, which imaging is useful? Which one is not useful at all? In this way, we really follow the full patient journey from diagnosis to late follow-up.

When participants complete the Global Oral Cancer Diploma program, what do you want their key takeaways to be?

Number one: I want them to get better results by discussing and interacting with their colleagues—by offering a multidisciplinary approach. Number two is selection of the treatment team of top, top people. Number three: We must look at overall efficacy of the treatment in terms of quality of life during treatment, quality of the cure, and the quality of life after the cure. This will make it possible for patients to reintegrate into their normal lives as they lived before the diagnosis of cancer. I would add that the patient’s involvement in treatment planning is crucial because whatever we do, and even if we are a top treatment team, it will be a difficult patient journey and—for some— an extremely difficult journey.