Future Directions for Postdoctoral Training in Cancer Prevention: Insights from a Panel of Experts

Future Research Needs

The panel first made suggestions about what they considered to be important cancer prevention research needs in the foreseeable future (1, 2). Panelists proffered several broad and specific areas needing more research or emphasis. These included computational science (e.g., statistics, mathematics, and informatics), behavioral science, communication, economics, and policy. Also suggested were health services research, the gene–environment interaction, genomics and other types of “omics,” dissemination and implementation (including innovation, sustainable science, and implementation in low resource settings; refs. 3, 4), transdisciplinary team science (5–7), evaluation, and systems science (7, 8). Finally, there was support for increased prevention research in global health, cancer or health disparities, and lifestyle risk factors (e.g., tobacco, diet, and physical activity).

Several participants stressed the importance of new, or newly adapted, research designs and methodologies. Examples included mathematical modeling (e.g., network analysis of social or behavioral factors, N-of-1 designs, and improved understanding of signal-to-noise ratios) and moving beyond single risk factor studies (9). Other specific ideas included assessing and interpreting scientific evidence, the challenge of reproducibility of scientific findings, refining evaluation of early detection methods (e.g., biomarkers), use and understanding of large and diverse (“big”) data sources, conducting more rapid and responsive research studies (10), communicating risk and uncertainty to lay audiences, and examining multilevel influences, such as the role of culture on normative population behaviors (7).

Broadening and Expanding Disciplines Involved in Cancer Prevention Research

Two long-standing challenges to the field are the absence of a widely accepted definition of cancer prevention and clearly defined career paths (1, 11). Cancer prevention covers topics that range from subcellular mechanisms to international health policies. Across the academic, government, and private sectors, there are few officially recognized departments, or other organizational units, devoted solely to cancer prevention.

Cancer prevention is multidisciplinary and many people may not identify or consider themselves cancer prevention scientists, although the intent of their activities may be to prevent or lower the incidence of cancer or other chronic diseases. Another challenge is that potentially interested individuals from some health science disciplines (e.g., physicians), or disciplines outside of science (e.g., engineers), may not learn about career opportunities in cancer prevention, or learn of them during mid-career, when transition to a new field would be more difficult. Thus, it is important to expose students to cancer prevention in their undergraduate and graduate studies through activities such as integrating cancer prevention into curricula, lectures available across universities, and applied training opportunities.

Many panel members thought it feasible and desirable for postdoctoral programs to recruit individuals from selected nontraditional disciplines (e.g., mathematicians, lawyers, etc.) and teach them cancer prevention principles; this would have the added benefit of fostering more diversity of perspectives. The following specific disciplines (in no priority order) were identified as needing more recruitment efforts to encourage them to become fellows in cancer prevention programs:

• Medicine (e.g., primary care physicians and oncologists)

• Nursing and allied health professions

• Health services

• Engineering (e.g., systems or chemical engineers)

• Mathematics (including statistics)

• Computer science (e.g., simulation modeling)

• Law

• Political science/public policy

• Others (e.g., economics, toxicology, etc.)

Several specific strategies were suggested by panelists to help gain the interest of individuals from underrepresented disciplines and potentially recruiting them into fellowships; these are summarized in Table 1.

Curriculum

Cancer prevention researchers come from different disciplines and pursue divergent academic and nonacademic career paths. Acknowledging these differences, panelists discussed core expectations for cancer prevention scientific knowledge and research skills for trainees regardless of discipline, recognizing that the ultimate goal is reducing population-level cancer incidence and mortality. With this in mind, four core science-related recommendations emerged, each with curriculum implications.

First, cancer prevention fellowship programs should strive to ensure that fellows understand the basic biology of cancer and how interventions can interrupt biologic processes (12, 13). Second, programs should provide essential epidemiologic and biostatistical training to promote in-depth knowledge of study designs, biases, and probability. Epidemiology and biostatistics were emphasized because they form the basis for providing, and interpreting, evidence that can lead to clinical- and population-based recommendations (14, 15).

Third, programs should provide behavioral science instruction so that cancer prevention researchers can better understand the theoretical and evidenced-based approaches to overcome barriers to behavior change (16). Finally, programs should provide training in effective knowledge synthesis and translation (17). This includes identifying, critically assessing, and summarizing the scientific literature on a cancer prevention topic, and being able to translate and communicate syntheses to scientific and lay audiences for purposes such as patient-provider communication or guideline or policy development. Specific strategies to assist fellows with these recommendations are listed in Table 1.

Panelists were aware of the National Postdoctoral Association (NPA) core competencies (discipline-specific conceptual knowledge, research skill development, communication skills, professionalism, leadership and management skills, and responsible conduct of research; ref. 18). They agreed that NPA competencies in areas besides scientific training were critical aspects of postdoctoral cancer prevention training because they are essential for scientists to function more effectively in the roles they may assume throughout their careers. Specific skills training mentioned by panelists for postdoctoral cancer prevention fellows were:

• Leadership

• Writing

• Oral presentations

• Media relations

• Management

• Human relations (including working as part of a team)

• Budgeting

• Negotiation

Career Preparation

The final topic considered was outplacement or career opportunities for fellows post-training. The two broad areas discussed were: (i) career options besides those in academic institutions; and (ii) academic career-specific issues, including the relative value of multidisciplinary training. Attendees acknowledged that most scientists with doctoral degrees, or who complete postdoctoral fellowships, will not become tenure-track researchers in academic settings. This is not unique to cancer prevention but extends broadly to the biomedical sciences (19). Many potential career options are available to fellows, such as basic research in private industry, government service, consulting, and working for nonprofit organizations. Most cancer prevention training programs, however, focus on preparing individuals for academic positions. Training program leaders need to recognize the diversity of employment options available and do more to help fellows identify, and prepare for, a variety of career paths.

Regarding academic careers, some panelists reiterated that the multidisciplinary nature of cancer prevention research was considered both a strength and a concern. For example, scientists with multidisciplinary training are not always required or desired for academic positions depending on the goals of the department—multidisciplinary research requires a team-based approach that some institutions may not promote or support. Other well-recognized concerns included traditional means of recognition, promotion, and tenure of scientists who predominantly engage in team-based research (5, 20). The means of securing recognition, promotion, and tenure in academic institutions has traditionally reinforced individual achievement and highly focused (e.g., more narrow) research topics, rather than applied team science. Moreover, the provision of multidisciplinary training may be more difficult if funding relies on mechanisms that tend to be hosted by a single department or laboratory. Panelists were optimistic, however, that multidisciplinary training should be valued at all levels and different career sectors, and believed cancer prevention research will continue to need contributions from different disciplines and rely upon team-based approaches. Specific strategies to improve fellows' career preparation are listed in Table 1.

Conclusion

Preventing cancer remains a critical goal in the United States and worldwide (21–23). Postdoctoral cancer prevention fellowships can play key roles in training scientists, clinicians, and others in the conduct of high-quality research, and ultimately to develop and implement effective approaches to prevent or control cancer. For cancer prevention, as for other scientific areas, it is important to periodically revisit the focus, curriculum, and career outcomes of training programs given the new and emerging areas of research, technology, methods, systems, and practice.

The major topics and strategies addressed by experts at the April 2013 meeting can help form the basis for cancer prevention training programs to consider modifications or new directions, and keep them updated with the changing scientific and employment climate for doctoral degree recipients and postdoctoral fellows. The suggestions discussed at this meeting are a valuable first step; implementing them will require concerted efforts by individuals and organizations at many levels.