Witness and promote the development of oncology disciplines in mainland China
Written by | Wang Hang
Source | "Medical Community" public account
Gu Kangsheng, director of the Department of Oncology of the First Affiliated Hospital of Anhui Medical University, is the "enemy" of malignant tumors with the first and third highest fatality rates in the mainland, lung cancer and stomach cancer.
According to his experience, most patients who have just been diagnosed with malignant tumors are very afraid and unwilling to accept this fact, believing that they "will not live long", the willingness to cooperate with treatment is not high, and they cannot listen to persuasion, and this despair will directly affect the treatment effect.
Professor Gu Kangsheng
In order to help patients adapt to the protracted battle against cancer as soon as possible, Professor Gu Kangsheng will fully understand the patient's condition before treatment, and communicate with the patient according to the different stages of the disease and the patient's physical and psychological conditions.
He will focus on two aspects for patients: one is the treatment strategy under different cancer stages - let patients understand the condition scientifically and rationally, emphasize that early malignant tumors have a better prognosis after treatment, and hope that patients will actively cooperate; the other is the long-term survival status obtained by patients with the same cancer species after treatment - to bring patients confidence and hope for treatment.
Engaged in clinical work on cancer for nearly 35 years, Professor Gu Kangsheng believes that communicating with patients is also a deep knowledge. "For oncologists, it is necessary to adopt different communication strategies according to the patient's tumor stage, but also to maintain contact with the family, develop a personalized best treatment plan, and use medicine to improve the patient's treatment expectations and quality of life."
The significance of "research" for oncology
In the 1980s, Professor Gu Kangsheng graduated from Bengbu Medical College with a bachelor's degree, and his earliest involvement in clinical practice was in 1987.
He did a research project on tumors and became interested in clinical diagnosis and treatment. "I found that there was a lot of room for oncology in both basic research and clinical field, so I wanted to become an oncologist."
This choice was not common at the time. Professor Gu Kangsheng introduced that due to the low level of tumor diagnosis and treatment, coupled with the single means of treatment, especially internal medicine treatment, the scarcity of drugs, and most of the patients who enter the oncology department are advanced, the survival cycle is short, and the treatment effect is poor, which makes everyone generally feel that "there is no sense of achievement in being an oncologist" and is not willing to work in the oncology department.
When he first started, Gu Kangsheng entered the Department of Oncology of the First Affiliated Hospital of Anhui Medical University, which is one of the earliest hospitals in Anhui Province to establish a tumor specialty, although there were not many beds at first, but this time gave him the opportunity to contact more cancer species, laying a solid clinical foundation for tumor diagnosis and treatment, and rapidly improving clinical ability.
He recalled that in the early 1990s, in order to keep up with the most cutting-edge international tumor treatment methods, the department took the lead in establishing a biological therapy laboratory in China, introducing immune cells and cytokine therapy in immunotherapy, and sending them out to study. "After returning from school, I introduced cell biology therapy, including LAK cells and TIL cells, into the department, which greatly improved the clinical treatment level of the department at that time."
In 1993, the former Ministry of Health organized experts to examine disciplines including the Biological Therapy Laboratory of Oncology in the First Affiliated Hospital of Anhui Medical University.
Gu Kangsheng still remembers very clearly: "The inspection team fully affirmed our work, and regarded our laboratory as one of the 13 biological treatment base departments in the country, and the former Anhui Provincial Health Department also issued a document to approve it as the only department in the province that can carry out cell therapy, which promoted the development of the discipline." ”
This experience made him deeply appreciate the significance of "clinical research". After becoming the director of the department, Professor Gu Kangsheng put forward the concept of "developing characteristic disciplines and vigorously improving clinical scientific research", and continued to exert efforts in clinical drug trials, scientific research talent training, and subject research.
Professor Gu Kangsheng
"The entire drug clinical research process has high requirements for doctors, including being familiar with the clinical design of new drug research, the merger of research cases, management, efficacy evaluation and a series of contents, which can enable our department team to get clinical business capabilities and scientific research level exercises and improvements." On the one hand, I encourage everyone to do scientific research in combination with clinical practice, and on the other hand, I have also introduced excellent scientific research talents to promote the overall development of the discipline. ”
Professor Gu Kangsheng introduced that at present, there are 5 wards in the discipline, including 4 sub-specialty wards of thoracic tumor, abdominal tumor, minimally invasive diagnosis and treatment of tumor and tumor biological therapy, as well as an affiliated tumor cell diagnosis room, a clinical research base for anti-tumor drugs and a specialized laboratory of internal oncology. They have organized and participated in the multidisciplinary collaborative diagnosis and treatment team of hepatobiliary pancreatic tumors, gastrointestinal tumors, lymphoma, breast cancer, lung cancer and malignant melanoma MDT in the hospital, providing standardized, high-quality and individualized medical services for patients.
Starting from a small department with only a few people, the Department of Oncology of the First Affiliated Hospital of Anhui Medical University has become one of the largest clinical research bases for anti-tumor drugs in Anhui Province in the "Twelfth Five-Year Plan" clinical key specialty (priority development) and APPROVEd by the CFDA. The research results and research teams of the Department of Oncology have been affirmed and recognized by domestic counterparts, and hundreds of postdoctoral, doctoral and master's degrees have been trained so far, many of whom are now experts who can stand alone in the field.
At the same time, the team's academic achievements and strengths are constantly demonstrated. In 2021 alone, the oncology team led by Professor Gu Kangsheng published 105 academic papers, including 49 SCI articles and 10 articles with an impact factor of more than 10 points. The department has also won 1 first prize of Anhui Natural Science Award, 2 second prizes of Anhui Provincial Science and Technology Progress Award, the 8th Wu Mengchao Medical Youth Fund Award and the 16th Anhui Youth Science and Technology Award.
Professor Gu Kangsheng's team project "Screening, Optimization of Treatment Plan and Clinical Application of Prediction Markers for Efficacy of Platinum Drugs for Gastric Cancer" won the second prize of Anhui Provincial Science and Technology Progress Award
Broaden the boundaries of treatment for stomach cancer
In February this year, the National Cancer Center of China released the latest version of the Chinese Cancer Report, "Cancer Incidence and Mortality in China in 2016", because cancer statistics are usually delayed by 3 to 5 years, which is also the most representative data on the mainland.
The report included data from 487 cancer registries, covering about 380 million people. The results showed that more than 8 people on the mainland were diagnosed with cancer every minute, and more than 5 people died of cancer every minute.
In Professor Gu Kangsheng's view, for cancer, whether it is social cognition, pathogenesis, or diagnostic methods and treatment methods, great changes have taken place in the past three decades.
Taking stomach cancer as an example, the report shows that the number of people who develop stomach cancer and the number of deaths are ranked third, with 397,000 and 289,000 respectively. He also interpreted, "From the existing information, the probability of stomach cancer among young people under the age of 35 in our country is not very high, mainly concentrated in the age group of 45 to 60 years old, and there is no obvious trend of rejuvenation." ”
From 2000 to 2016, the mortality rate of stomach cancer with high incidence and poor prognosis actually decreased year by year, but the number of patients increased.
Most of the stomach cancer patients admitted to the treatment were already advanced when they were found. "Because early gastric cancer originates from the mucosal layer, the cancer foci are superficial, and rarely affect the digestive function, so there are few symptoms, occasionally there are bloating, stomach pain and other symptoms, patients will simply think that it is gastritis, indigestion, etc., feel that patience will pass."
He analyzed that this was also related to the resistance to the use of gastroscopy for early diagnosis. It is thought that gastroscopy is painful and difficult to accept, in fact, the current gastroscopy has changed, especially the widespread application of painless gastroscopy, so that gastroscopy is no longer painful.
If it can be detected early, through surgery, more than 90% of the first stage of stomach cancer can be cured. With more and more carcinogenic factors being discovered, such as highly salted and nitrosamine-rich foods, Helicobacter pylori, precancerous lesions, etc., paying attention to and avoiding these risk factors, and active intervention, gastric cancer can be well prevented; in the field of diagnosis, painless gastroscopy has become mainstream, and patients can be involved as early as possible through early screening.
The MDT team conducts clinical discussions
Another change occurred in the therapeutic field. "In the past, the medical treatment of gastric cancer was only chemotherapy, and the number of available chemotherapy drugs was limited, and the efficacy was not high, with the addition of targeted therapy and immune drugs, the clinic could take personalized treatment according to different stages of cancer, and stage II and III patients took perioperative comprehensive treatment, and the efficacy was greatly improved."
But for advanced gastric cancer, medicine can still do limited, a set of the most intuitive figures is that the five-year survival rate of advanced gastric cancer is less than 10%, Professor Gu Kangsheng believes that the current clinical treatment level of gastric cancer, although there has been progress, but also need to develop more targeted drugs and immune preparations.
To this end, "we are still exploring combined optimized treatment options for gastric cancer, looking for more and more predictable markers of immunotherapy that can be used in the clinic, and exploring new options for delaying recurrence in postoperative assistance." ”
As the largest clinical research base of anti-tumor drugs in Anhui Province, he led the department to actively participate in the clinical research of new anti-tumor drugs, and has undertaken more than 30 international multi-center clinical drug studies and more than 100 domestic multi-center clinical drug research, and the quality of the completed projects has been affirmed by the CFDA.
Become a good oncologist
In Gu Kangsheng's eyes, it is not easy to be a good oncology physician, at least to have advantages in basic knowledge, research ability, professional English and other aspects.
"Tumor is a comprehensive discipline, involving a wide range of fields, such as cardiovascular, digestive, kidney, respiratory, infection and other disciplines in internal medicine, as well as solid imaging expertise, so under the premise of mastering the basic skills, with the relevant knowledge and treatment skills of other disciplines; Secondly, foreign languages are also very important, you can learn the frontier information of tumors in academic exchange conferences at home and abroad, and you must have strong clinical research capabilities."
The Department of Oncology of the First Affiliated Hospital of Anhui Medical University
This year is the 35th year that Professor Gu Kangsheng has taken root in the frontline of clinical and scientific research, and he not only focuses on the development of the department and improves the diagnosis and treatment ability, but more often, he is also thinking and paying attention to how to take care of the emotions of patients and their families.
"Cancer has a long course, high case fatality rate, difficult to cure, people inevitably feel afraid, patients know that cancer comes, few people will be prepared, panic, confusion, collapse, etc. are actually normal manifestations, at this time need to have professionals stand up and tell them what to do."
He treats doctor-patient communication as a science and subdivides it into several stages. "If it is the early stage of diagnosis, I will not say that it is a tumor directly, but euphemistically express that some problem has been found somewhere, and it should be further clarified, in order to make the patient cooperate."
Once the diagnosis is confirmed, Professor Gu Kangsheng will give advice according to different stages. "Early patient prognosis is good, give professional medical treatment strategies can be, if it is a terminal patient, I generally talk more implicitly, such as telling patients that we have some treatment measures may help you, and then cite some successful cases after treatment, patients are confident when they see the effect."
When communicating with the family, Professor Gu Kangsheng summarized it with "seeking truth from facts" and "acting according to one's ability", not only to tell the family about the progress of the disease, possible consequences, and prognosis, but also to persuade the family to choose the most suitable drug in combination with their own economic conditions.
Although he is nearly 60 years old, Professor Gu Kangsheng still can't stop. On Mondays, Tuesdays and Fridays, he needs to rush to the various hospitals of the hospital, and the rest of the time to carry out ward rounds, consultations, academic seminars and other matters, and the schedule is full.
Professor Gu Kangsheng's team and graduate students
Relying on the First Affiliated Hospital of Anhui Medical University, the department also undertakes the teaching of the course "Oncology" for undergraduate and master's students, the teaching and assessment of foreign languages of "Oncology" of the International College, and the teaching of foreign students entering clinical practice, and participated in the English version of the textbook organized by the People's Health Publishing House.
Every year, there are more than 20 doctoral and master's degree graduates from his oncology department, and he also accepts trainees from other hospitals in the province, and cultivates cancer professionals by holding various forms and ways such as the Anhui Provincial Conference of Oncology, the Anyi Oncology Forum, the Seminar on New Advances in Clinical Oncology, and the Residency Training Class in Oncology.
"I very much encourage young people who are interested in the development of the field of oncology to continue their studies and continuously improve their comprehensive capabilities through clinical and scientific research." He told the "medical community" that this is not only for the development of the discipline, but also for the fate of cancer patients.
Expert Profiles
Professor Gu Kangsheng
Doctor of Oncology, Chief Physician, Second-level Professor, Doctoral Supervisor of Oncology, Postdoctoral Co-supervisor
Director of the Department of Oncology of the First Affiliated Hospital of Anhui Medical University, Director of the Department of Oncology, Anhui Province", "Jianghuai Famous Doctor" in Anhui Province
Member of the Expert Committee of the Department of Oncology of the Oncology Branch of the Chinese Medical Association
Standing Committee Member of oncologist Branch of Chinese Medical Doctor Association
Member of the Board of Directors of the Chinese Society of Clinical Oncology (CSCO).
He has been engaged in clinical and scientific research in the department of medical oncology for a long time, with special attention to the individualized treatment of lung cancer, gastrointestinal tumors and malignant lymphoma. He has published 2 monographs on oncology and participated in the compilation of 9, of which he participated in the compilation of the national "13th Five-Year Plan" English version of the planning textbook "Oncology" as the editorial board, published more than 100 papers as the first author, including more than 20 SCI papers; and served as the editorial board of "Clinical Oncology" and "Anhui Medicine"; presided over nearly 100 national clinical drug research, more than 10 national and provincial scientific research projects; and won the second prize of the Anhui Provincial Science and Technology Progress Award as the first person to complete it.
Source: Medical community
Editor-in-charge: Ling Jun
Proofreader: Zang Hengjia