Are Oncologists Different From Other Doctors?

Neil Chesanow

Disclosures

October 10, 2013

In This Article

An Exciting Science at an Exciting Time

Cancer may be 4000 years old (as far as we know), but after decades of disappointingly slow progress, oncology is now bursting with new insights, promising new therapies, and fresh challenges.

The pace of change is exhilarating but also demanding and stressful. So many clinical trials. So much data to take in. Moreover, the need to understand the data is urgent not just among researchers but also front-line doctors. An oncologist might read about a phase 3 trial of a new chemotherapy agent in April and be using it with patients that summer. Things can happen that fast. In addition to the stress inherent in treating patients with cancer -- what Patel terms "high-stakes medicine" -- there's a constant pressure to keep your knowledge current.

"Everything we knew about systems-based cancers has been turned on its head in recent years," Patel observes. "The science is so fun right now. We are making progress and strides every day for many patients. The cycle of 'bench to bedside' is so much faster than it ever was before. Gains that used to take 10 years, we're now able to do in 5-6 months."

Robert, a cancer specialist in a different part of the country and in a different practice setting, offers a strikingly similar perspective. "Although the biology of medicine is absolutely fascinating, in oncology there has been an explosion in our understanding of agents, such as targeted agents, that we're now using based on that biology," he says. "For someone who has an appreciation of the science, there's just so much going on. It's exhilarating. If you believe that part of living is learning, in oncology you are continually learning."

"It can be overwhelming," he admits, "but a lot of people get a charge out of it."

A Specialty at the Crossroads of Medicine

To add another layer of complexity, the scope of oncology is as broad as medicine itself; every organ and system is prey to cancer. Oncologists note that they must have a working knowledge of -- and keep abreast of new developments in -- a lot more medicine than just oncology.

But then, they consider that part of the fun.

"I like working with multiple specialties," says Patel. "I work hand in hand with pulmonologists, radiologists, radiation oncologists, and surgeons every day. I like being part of a team of physicians that offers interdisciplinary care. I absolutely enjoy the difficult physiologic and metabolic derangements that we deal with in patients with cancer and the idea that I get to see a lot of different medicine."

Sometimes oncologists must temper this enthusiasm out of deference to the patient's feelings. "We'll meet a 38-year-old patient with metastatic lung cancer and then find out that they have an EGFR [epidermal growth factor receptor] mutation, so we know that we'll be able to control their cancer with an oral chemotherapeutic agent," offers Patel by way of example. "They'll have few side effects. And they'll live much longer than they would have 10 or 15 years ago."

From Patel's perspective, this is fabulous news. From the patient's point of view, not so much. "The fact is that the patient still has stage IV metastatic disease, and for someone who's 38, living 3-4 years, compared with 6-8 months 10 years ago, is still a really raw deal," she is the first to concede. "It's a sobering point when I'm saying this, and I realize that this is still horrific to this patient. That's always hard. Until we learn how to cure a patient, none of us is going to feel good about it."

A Chance to Do Research in Private Practice

Patel works in an academic medical center. Robert works in a community setting. Yet both do research. Oncologists say this is another appeal of the specialty: You can be in private practice and devote yourself to patient care -- as over 80% of oncologists do[2] -- yet your community practice can still be a clinical trial site contributing to important research.

Robert's career is a case in point. He started out as a pathologist in an academic setting, Massachusetts General Hospital in Boston, where he spent 3 years doing what pathologists primarily do these days: diagnose cancer. "I spent a lot of time studying cancer from a pathology point of view," he says, "but I concluded that I needed to be more engaged in patient care."

His group, part of the 1000-doctor US Oncology Network, now has 12 staffers devoted to treating "a couple hundred patients a year in clinical trials," Robert says. Recently, for example, they participated in a trial of paclitaxel-gemcitabine for treatment of pancreatic cancer; the drug combination was just approved, an example of the swiftness with which things can change in oncology.

"It's really nice to be in a hybrid position, seeing patients but also feeling that there is a role to play in advancing our knowledge by participating in research protocols," Robert reflects. "It's more work," he adds, "but it's also kind of neat."

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