Now We Are 40 – 10 More Years of MOGA

Abstract

Many of the Medical Oncology Group of Australia (MOGA) members characterised the last 10 years between 30 and 40 as a time of generational change. I guess that comment could be made about any decade, but in that decade, it was accurate in many ways. It marked a time when the founders of MOGA were retiring and the next generation was taking over the Executive and committees. However, it was also the case that younger oncologists, early and mid-career, were taking on the roles of Chair and membership of the Executive group in addition to the more senior oncologists. The functions of MOGA broadened. Some subgroups like the specialist breast group gave way to committees with other functions. Governance procedures tightened as evidenced by the formation of an Awards Committee under Peter Grimison so that this was no longer the responsibility of the Executive. Likewise, a Drug Issues Subcommittee was formed to handle horizon scanning and provide information to the regulatory authorities. The Ethics Committee which I chaired continued andwas put to good use! The external work environment was changing as well. As the Baby Boomers gaveway toGeneration X andY, therewasmore emphasis on work/life balance with more part time jobs and more women entering the ranks of medical oncologists. The private practice option became more prevalent as the workload increased and most oncology drugs were subsidised, the lack of which had limited the opportunities for private practice in the early years of oncology. The pursuit of overseas training after local qualification was thought highly desirable in those early years to increase a new oncologist’s competitiveness for the limited pubic hospital positions available but this was no longer as common as the options for practice increased. It was probably never the case that the expertise in oncology was superior internationally, but overseas training provided a perspective that therewasmore than one approach topracticing cancermedicine andprovided training in clinical research which was often part of fulltime public hospital practice. The digital age has brought electronic medical records (but this is still patchy across Australia due largely to state-based health bureaucracies demonstrating different degrees of foresight and competence in this area), decision aids and an increasing well-developed national evidence-based cancer treatment protocol resource, eviQ. Telemedicine, which had been used to supplementmultidisciplinary input into oncological decisions in rural and remote areas and then for individual remote patient consultations, was adapted to support rural centres participation in multicentre clinical trials. Communication between oncologists and with consumers was also changing with increased use of email and social media platforms such as LinkedIn, Facebook and Twitter. Clinical trials have had a resurgence with the emergence of targeted therapies and now immunotherapies. These have been practicechanging and have provided great opportunities for research and rationally designed trials based on identification of druggable targets. Groups have emerged to co-ordinate early phase trials. TheNSWEarly Phase Clinical Trial Alliance is one such groupwhich facilitates translation research and early phase trials andwhich holds an annual meeting to cover developments in precision medicine and immuno-oncology. The application of telemedicine to clinical trials championed by Sabe Sebasen allows rural and remote patients access to clinical trials as an option when conventional therapy is no longer appropriate. Within oncology we are seeing increasing sub-specialisation and the demise of the general oncologist, except in rural areas, where oncology practice has rapidly expanded beyond the capital cities rapidly replacing fly in fly out visits into rural Australia from those capital cities. The nature of the treatments has changed as targeted small molecules and immunotherapies prove increasingly useful in an expanding number of cancers. Fortunately, this decade has seen an increase in the engagement between oncologists and regulators. There has also been increasing engagement with consumer groups in addition to more emphasis on patient-centred care. We will now explore how these changes influenced the range of MOGA’s activities over the decade between 2009 and 2019.