2015 Presidential Address—Society of Surgical Oncology: The Next 75 Years
It is an honor to stand before you as President of the Society of Surgical Oncology (SSO) to deliver this presidential address. We heard a great talk from Dr. Charles Balch about the history of the SSO during its first 75 years. My goal will be to outline the efforts underway to position the SSO to be successful in advancing its mission over the next 75 years.
I would also like to recognize my fellow officers in the SSO: Dr. Jeff Drebin who has served as President-elect over the last year; Dr. Dan Coit, Vice President; Dr. Dave Bartlett, Treasurer; and Dr. Armando Giuliano, Secretary of the SSO (Fig. 1g–j). These individuals have been extremely supportive and dedicated to the Society throughout my time as an officer of the SSO. I would like to acknowledge several of the immediate past Presidents with whom I have had the honor of serving the SSO during their time as president, beginning with Dr. Bill Cance, Dr. Fabrizio Michelassi (who I also served with on the American Board of Surgery [ABS]), Dr. Mitch Posner (who is also currently President of the SSO Foundation), Dr. Jim Economou (who I have worked with in a variety of capacities, both in the SSO and in the American Surgical Association), Dr. Monica Morrow (who provided tremendous leadership and set the bar for leadership in the SSO during its transition), and Dr. Suzanne Klimberg (who I also served with on the ABS) (Fig. 1k–p). The quality and level of accomplishment and dedication of these individuals is unsurpassed. A special thanks and acknowledgment goes to Dr. Jim Howe, who has served as the Scientific Program Chair for the 2015 SSO Annual Meeting (Fig. 1q). He has done an absolutely fabulous job putting this meeting together here in Houston. These individuals have been instrumental in my journey to this pinnacle today and, not unlike the Sherpas who help on a mountain trek, I would not be standing here today without their help, advice, and heavy lifting.
The SSO began its journey in 1940 as the James Ewing Society. Surgical science was characterized by a paper published by Dr. Alfred Blalock who noticed that partial occlusion of the renal artery in a dog induced hypertension.1 The classic paper from Dr. Whipple, describing a pancreaticoduodenectomy, characterized surgical care.2 At the time the James Ewing Society was founded, the operation now known as the Whipple Operation was actually performed in two stages and was associated with an operative mortality of 30 %. Basic science investigation was characterized by the work of Dr. Barbara McClintock, who I had the pleasure of seeing at Cold Spring Harbor when I was a graduate student at Yale. Dr. McClintock discovered that chromosomes are made up of a linear collection of genes, which determine phenotype. She also discovered transposons in maize in the 1940s, for which she won the Nobel Prize.3 The clinical application of basic discovery in 1940 was highlighted by the first mass production of penicillin. This was the state of our clinical and scientific endeavors 75 years ago. In the present state of surgical oncology, patients are diagnosed with computed tomography (CT) scans and magnetic resonance imaging (MRI) scans. Positron emission tomography (PET) scans are used to identify metastases and recurrences; operations are performed using laparoscopes and space-aged robotic surgical techniques. We have come a long way in a short time. But what is around the corner? What does the future hold? During this past year as President of the SSO, I have tried to position the Society to develop its role as a global leader in surgical oncology. This mission has led me on a trek across the globe. My year as President started in Phoenix at the Annual Meeting in 2014, then on to Iowa City, Chicago, Los Angeles, Chennai, India, San Francisco, Liverpool, New York, Philadelphia, Seoul, South Korea, and now ending here in Houston, Texas.
I would like to acknowledge the hard work of the staff of the SSO. These individuals, under the leadership of Eileen Widmer, provide support for your Society and allow us to fulfill the mission of the Society. One of my trips early in my presidential year was undertaken as a planning retreat to develop the future direction of the SSO and to determine how the SSO could best develop the future of surgical oncology as a profession. The focus of the SSO was developed as ‘four pillars’ (education, quality initiatives, research, and strategic relationships) designed to support the future of surgical oncology in the US and globally.
Society of Surgical Oncology (SSO) Educational Programs
Education in Surgical Oncology is a key mission of the SSO. The SSO Training Committee under the leadership of the former chair, Dr. Russell Berman, and current chair, Dr. Kevin Roggin, has supported the educational programs of our Society. I am pleased to note that we now have Board certification in surgical oncology with a new certificate of added qualifications in Complex General Surgical Oncology. The principles of Surgical Oncology Fellowship Training have remained dedicated to education in multidisciplinary care, the surgical management of complex cancer care, education in clinical trial design and research, community outreach, patient counseling, including the appropriate and timely use of palliative care, and leadership in oncology.4
The Breast Oncology Fellowship is another highlight of our educational program. There are now 42 SSO-approved breast oncology programs that have been developed in collaboration with the American Society of Breast Surgeons (ASBS) and the American Society of Breast Disease. We also have six new applications for additional programs. This is a 1-year multidisciplinary training program with a new curriculum, which is being rolled out in July 2015. There are strict requirements, as well as a site visit by the SSO Training Committee. I am further pleased to note that during the past year the SSO was awarded Accreditation with Commendation from the Accreditation Council for Continuing Medical Education (ACCME) for our educational programs. A note of recognition goes out to Dr. Danny Takanishi, the former Chair of the SSO Continuing Medical Education (CME) Committee, and Dr. Glenda Callender, who is the current CME Committee Chair. This accomplishment would not have been possible without their dedication. The CME Committee is responsible for all SSO CME activities and the accreditation with commendation demonstrates the exceptional content of the SSO CME offerings and the robust efforts to assure that our programs are free of bias and conflicts of interest.
Many new additional educational programs are now in place and being developed to educate future surgical oncologists. The Fellows Institute continues to be an important and valuable educational resource for Surgical Oncology and Breast Oncology Fellows. This program is co-sponsored by the SSO, the ASBS, and the Americas Hepato-Pancreato-Biliary Association (AHPBA). The Surgical Oncology Self-Assessment Program (SOSAP) was developed to provide a comprehensive review course for fellows preparing for the qualifying examination in Complex General Surgical Oncology. SOSAP is also a valuable resource for CME and MOC for general surgeons whose practices largely involve oncology. The SCORE project is being led by Dr. Russ Berman in conjunction with the ABS to develop a teaching curriculum for surgical oncology trainees in surgical residency and fellowships. The virtual meeting and Best of SSO allow local and international members to have access to the educational programs of the SSO annual meeting. These programs are being expanded globally to our international partners. Annals of Surgical Oncology will continue to be an important forum for dissemination of cutting-edge research and reviews. The journal also recently started a new CME program offering self-assessment MOC credits. In addition, we are nearing completion of an expanded 10-year contract with Springer, with whom we hope to develop other unique products in surgical oncology.
SSO Quality Initiatives
The next important area we have focused on are quality initiatives. The strategic group in Quality has been led by Dr. Sandra Wong, with major contributions from Dr. Sharon Weber, Dr. Jonathan Zager, Dr. Ned Carp, and Dr. Doug Tyler. The goal of the Quality Committee is to promote high-quality, cost-effective, multidisciplinary cancer care for surgical patients. In order to accomplish this, we have developed a Quality Workgroup. These individuals are involved in developing surgical quality metrics in conjunction with the Commission on Cancer, the oncology National Surgical Quality Improvement Program (NSQIP) National Cancer Institute (NCI) Center Consortium, as well as the National Comprehensive Cancer Network. In addition, the SSO has sponsored the publication and endorsement of patient-care pathways. Examples of these important position papers include the recent publication in Annals of Surgical Oncology on breast cancer margins,6 and an upcoming review on neoadjuvant therapy in breast cancer. These two examples have been developed under the leadership of the Past-President, Dr. Monica Morrow. Ongoing development of quality metrics in melanoma and gastrointestinal cancer are also being proposed.
Research needs to play an expanded role of the SSO moving forward. The strategic plan for research in the SSO was led by Dr. Jeff Drebin, and has been taken over by Dr. Rich Alexander, as Chair of the newly formed Research Committee. The goal of the SSO research mission is to foster basic, translational, and clinical cancer research. This is accomplished through educational symposia and lectures designed to aid SSO members in developing research projects and preparing successful research grants. Facilitating the interaction of appropriate mentorship needs to be an expanded activity of the SSO. The SSO has also funded awards; there is the ongoing Clinical Investigator Award (CIA), which is an award given by the SSO for US$100,000. There is a new initiative to develop seed grants, as well as more substantive grants, to support basic and translational science. The SSO Foundation will play an important role in fundraising to continue the SSO grant funding mechanisms.
SSO Strategic Relationships
We have expanded our strategic relationships with the goal of leveraging the expertise in the SSO to facilitate the development of surgical oncology and advance the mission of the SSO. Our partnerships with corporations will play an increasing role in the SSO working with our members and the SSO Foundation, which was re-branded this year from the James Ewing Foundation. However, we recognize that strategic partnerships with corporations may involve a conflict of interest, but we are moving forward in a way that the SSO can advance its mission through collaboration with companies to advance research and clinical care. Many of these companies have embraced the goal of improving patient care in oncology and this is clearly an area in which we can work together.
The SSO has worked collaboratively with other societies in several ways. As one example, the SSO was involved in a joint training conference involving the AHPBA and American Society of Transplant Surgeons (ASTS). Dr. Rohan Jeyarajah organized the conference during the ACS in San Francisco. The SSO representatives included Dr. Berman and Dr. Mitch Posner. There was also an opportunity for me to meet with the AHPBA President, Dr. Elijah Dixon, and ASTS President, Dr. Peter Stock, to discuss other ways for our societies to work together to advance training and clinical care. Other collaborative discussions are underway with the AHPBA, ASBS, and the American Association of Endocrine Surgeons to offer joint symposia and potentially coordinate meeting locations and times.
Several years ago the SSO Executive Council approved a plan to expand our relationships with international surgical societies. We now have formal memorandums of understanding (MOUs) with the European Society of Surgical Oncology, the Indian Association of Surgical Oncology, the Brazilian Society of Surgical Oncology, the Mexican Society of Oncology, and the Japanese Society of Gastroenterological Surgery. These important international relationships have expanded the scope of the SSO to becoming a global society and in the near future are likely to include the Korean Society of Surgical Oncology and the newly formed Latin American Society of Surgical Oncology. The MOUs developed with these international partners have developed new faculty exchange programs, joint symposia and plenary sessions at our annual meetings, International Career Development Exchange programs, and Best of SSO for presentations at their annual and regional meetings. Many individuals have fostered the development of international relationships by the SSO but special recognition goes to Dr. Balch, Dr. Coit, Dr. Posner, Dr. Leon, and Dr. Anderson. Expanding these international relationships are a critical part of the SSO having greater recognition as a global surgical oncology leader.
The Future of Surgical Oncology
As another example of the changing landscape in oncology care, consider another cancer that is commonly treated by surgical oncologists—melanoma. There have been tremendous strides made in understanding the biology of melanoma. New biologic insights are being discovered with the identification of pathways, which drive the growth and progression of melanoma. Based on these pathways, new drugs are coming online which specifically target key drivers of melanoma growth and progression. There has been an explosion in our understanding of tumor immunology and the complex immune response involving tumor antigens, T cells, and dendritic antigen-presenting cells. From these findings, multiple clinical trials are being developed, which are based on a better understanding of the immunologic basis of melanoma, and with impressive results.
The outlook for research funding for surgeons is particularly concerning. Data from a paper published in Annals of Surgery show that NIH awards to academic surgeons is declining relative to their nonsurgical colleagues (Fig. 6d).7 The total medical school surgical faculty over this time period was noted to increase by 132 %; however, NIH awards to surgical faculty decreased by 47 %. In addition, it was noted there was a growing gap between awards for surgical and non-surgical faculty. Sadly, the research career of the majority of surgeon-scientists is short, with only 20 % engaged in research by 59 years of age.
So, what can the SSO do? First, we need to place a greater emphasis on research in residency and fellowship training. We need to partner with the NCI to strengthen the role of surgical oncology as a recognized scientific field. Surgeon-scientists bring a unique perspective to oncology care and we have a fundamental role in oncology research. We need to advocate for more funding for cancer research, particularly solid organ cancers treated by surgical oncologists. We need to increase the recruitment of students who have an interest in basic cancer biology and who will be capable of advancing scientific discovery in surgical oncology. Finally, you can make a difference. One easy thing everyone here can do is to support the SSO Foundation, which provides educational and research funding for young surgical oncologists.
The surgical oncologist of the future will no doubt need to remain a surgeon, but he or she will also need to be a geneticist, a molecular biologist, a bioinformaticist, a pharmacologist, and a radiologist. In order to accomplish this task, we need to train the best and the brightest in surgical oncology. Surgical oncology has a brilliant future, if we are willing to evolve beyond operative therapy of the cancer patient. We need to embrace the future, and the SSO needs to create the tools and structure to prepare the next generation to be successful surgical oncologists of the future. It has been a tremendous honor to serve as your president. I thank the leadership of the SSO for the opportunity to serve you as the 2015 SSO President.
Conflict of interest
The author declares that he has no conflict of interest.
- 6.Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 2014;21(3):704–16.PubMedCrossRefGoogle Scholar