A study published in the "Revista Clínica Española" (RCE), a publication of the Spanish Society of Internal Medicine (SEMI), indicates that 65 percent of people with cancer in Spain end up being admitted to wards where there are internists. This wide presence, the researchers point out, would support the recognition of internal medicine as a structural activity within the care circuit of the oncology patient.
"From an organizational point of view, we consider it beneficial to recognize it as a structural professional in the care of the oncology patient, due to its integrative clinical approach and its ability to provide continuity of care as the patient's reference doctor during hospitalization, in constant communication with their referring oncologist and coordinating the actions of the other specialists involved," highlighted Adrián García, the first author of the article and a specialist in internal medicine who is a member of SEMI.
With the increase in the prevalence of cancer and the greater clinical complexity of these patients, SEMI emphasizes that the role of the internist has been gaining weight in the care of patients with solid tumors. Currently, three models of organization in oncological hospitalization are described: admission assumed by internal medicine; admission in oncology attended only by oncologists, and an oncology model with the participation of internists, that is, a shared care scheme.
The RCE study has been developed based on information gathered from 481 public and private hospitals in Spain, with the aim of determining the actual presence of the internist in the care of cancer patients. To this end, specific surveys were conducted directed at both internists and oncologists.
Of the contacted centers, 188 of the 481 hospitals (39.1%) responded, representing 51.2 percent of public centers and 16.7 percent of private ones from the 17 autonomous communities. Among the hospitals that responded, in 181, oncology patients were admitted: in 102 of them, 56.4 percent, the responsibility lay with medical oncology, while in 79, 43.6 percent, it was in the hands of internal medicine.
In the hospitals where admission was managed by medical oncology, in 37.3 percent of the services there was an internist on the hospitalization floor, which configures a model of shared care. Overall, in 64.5 percent of the centers, oncology patients were hospitalized in units with the presence of internists, either through direct internal medicine assistance or under the shared model, while in 35.4 percent they were admitted in units managed solely by oncologists, always under the umbrella of the oncology service.
In small hospitals, with fewer than 200 beds, hospitalization was clearly dominated by internal medicine, which accounted for 76.8 percent of these centers. In contrast, in larger hospitals it was more common for the admission to be led by oncology: this occurred in 59.6 percent of the centers with between 201 and 500 beds, in 95.7 percent of those with between 501 and 1,000 beds, and in 88.9 percent of those exceeding 1,000 beds.
Public hospitals concentrate more admissions managed by oncology
According to the type of management, patients were admitted to medical oncology in 60.6 percent of public centers, in 44 percent of private ones, and in 35.7 percent of private ones integrated into the public network. In the rest of the hospitals, the hospitalization of cancer patients was left in the hands of internal medicine, which thus accounted for 64.3 percent of the private centers in the public network, 56 percent of the private ones, and 39.4 percent of the public ones.
Thus, the authors conclude that oncology-dependent admissions are more common in the public network. However, more than a third of oncology services choose to establish a model of shared assistance with internists. This approach is especially widespread in Catalonia, where it has been implemented in 100% of the services that responded to the survey, followed by the Community of Madrid and Andalusia, although with clearly lower percentages, as detailed in the work.
According to the author, the greater presence of the internist in small private hospitals highlights the unifying role of internal medicine services in these environments. Among the reasons that could explain this are the lack of specialists in more specific areas in hard-to-reach areas (and even the absence of a dedicated oncology service in some regional hospitals) or the need to optimize resources, with the internist being a versatile, cross-cutting, and efficient profile that performs hospitalist functions, as described in part of the Anglo-Saxon literature.
In addition to their work in hospitalization wards, the internist also intervenes in the urgent care of cancer patients and in monographic consultations dedicated to specific problems, especially thromboembolic disease (ETEV) and immune-mediated toxicity.