Why choose medical oncology? Expert perspective

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Published: 23 Oct 2017
Views: 4565
Dr Charlotte Graham, Dr Christy Ralph, Dr Paul Nathan, Prof Peter Selby, Dr Sophie Papa, Dr Peter Hall, Dr Ruth Board

Dr Charlotte Graham (King’s College London, London, UK), Dr Christy Ralph (Leeds Institute of Cancer Studies & Pathology and St. James's institue of Oncology, Leeds, UK), Dr Paul Nathan (Mount Vernon Hospital, Northwood, UK), Prof Peter Selby (St James University Hospital, Leeds, UK), Dr Sophie Papa (Guy's Hospital, London, UK), Dr Peter Hall (University of Edinburgh, Edinburgh, UK) and Dr Ruth Board (Royal Preston Hospital, Preston, UK) spoke with ecancer at the ACP immunotherapy workshop about personal, professional and patient-led experiences that led them to choose specialising in medical oncology.

They share their highlights of working in the field, and offer advice for any junior doctors who are currently considering pursuing oncology.

Dr Charlotte Graham - King’s College London, London, UK
Dr Christy Ralph - Leeds Institute of Cancer Studies & Pathology and St. James's Institute of    Oncology, Leeds, UK
Dr Paul Nathan - Mount Vernon Hospital, Northwood, UK
Prof Peter Selby - St James University Hospital, Leeds, UK
Dr Sophie Papa - Guy's Hospital, London, UK
Dr Peter Hall - University of Edinburgh, Edinburgh, UK
Dr Ruth Board - Royal Preston Hospital, Preston, UK


What made you pick medical oncology?

CR: I was fascinated by the difficulty of the subject and the honesty with which the teams and the patients tackled their challenges.

CG: I’m a haematology trainee and I’ve got a particular interest in haematological malignancies. I think it’s one of the most interesting areas – we work in the laboratory as well as in clinical care and you can really see a difference in patients if they’re managed appropriately.

PS: I was fortunate enough as part of my training, with my then interests, to work at the Royal Marsden Hospital with a couple of outstanding oncologists, Tim McElwain and Michael Peckham, and it was just an overwhelming experience for a young doctor at that time. Those of you who know the history will know that around about that time the first successful chemotherapies for testicular cancer were coming through with cisplatin; the medium, early to medium, results of the treatment of Hodgkin’s Disease, combination chemotherapy, were coming through. So I was meeting large numbers of people who had been cured of their cancer by these approaches who would never have been cured even two or three years before. I was delivering these treatments on the ward and it was just an overwhelmingly exciting experience for a young doctor and I’m still trying to recover from that.

PH: This is something which I just found really interesting. A lot of oncologists do really worthwhile research in the lab or developing drugs through clinical trials.

PN: Medical oncology, personally for me, was the obvious place for me to end up because I have an interest in drug development. I think it’s a fascinating thing to take a disease that has got limited treatment options and you’re trying to improve it. That’s really fascinating at multiple levels, not just a scientific level and an academic level but also a direct clinical level with patients and instructing that interaction. I think that mixture of treating people whose disease threatens them adds something to the doctor-patient relationship. Then you’ve got the academic element of that as well and I think you can develop a very enriched clinical career because of that.

What do you enjoy most about medical oncology?

SP: It’s a combination of science and humanity for me. So I have a lab, which is wonderful, so I’m really fortunate and I get stuck in to trying to answer the difficult questions at a very early point. As a consequence of that I surround myself with really talented young scientists who are dedicated and much more intelligent than I am. And then I get to go to clinic where I understand what I’m doing and I’m helping people on a daily basis. You’re told when you apply to Medical School you must never say I want to be a doctor because I want to help people but the reality is for most of us that’s what it is, that’s a big part of it, and I definitely get satisfaction from that.

CR: I think there’s something about seeing the day on day and week on week effect of the things that you do that’s quite interesting and challenging and throws you back into the kind of research questions about why that’s happened and trying to interrogate that and pull it apart.

RB: What I like about being a medical oncologist is that relationship you get with your patients and the fact that because they are on treatment they come in quite regularly, you get to know them well. You get to find out what their priorities are because often they have a life-limiting cancer and so it’s important to know what their priorities are in terms of quality of life and quantity of life. I really like that communication aspect of the job and I like educating the patient so that they can help make their own decisions about their own disease and what treatments they may or may not want, weighing up the risks and benefits of toxicities.

CG: Probably the satisfaction of a long-term relationship with patients and also I enjoy the laboratory side.

PS: For a medical oncologist there are many, many exciting parts and there are many different individual responses to that question. I think people love the science, so medical oncology is grounded firmly in understanding the science of what we do, whether it be with immunotherapies or vaccines or chemotherapies. I enjoy the colleagues – oncologists are very patient-centred doctors, they are trying always to squeeze the best survival, the best quality of life, the least toxicity out of what are difficult and challenging and complex treatments, so they’re great colleagues to work with. But probably the top of the list for me is that patient-centred dialogue, it’s the interaction with patients. If you work with your patients, if you concentrate on their needs and their issues and what they want you will always benefit them. If you concentrate on the treatment and you concentrate on the disease you might or might not feel to be achieving anything useful. But if you concentrate on the patient, as you can in oncology, you will always feel a sense of value of what you’re doing which is a great stimulus, of course.

What advice would you give to somebody thinking about a job in medical oncology?

PN: One of the issues with current medical training is that there’s more pressure to finish your training as soon as possible and it becomes more difficult for people to do extra jobs, perhaps outside a core training programme, to get a taste of things. We have doctors doing one year Fellowships with us and that gives them a taste and an opportunity to do research, write papers, enrich a CV. I know sometimes it’s scary to think of interrupting your career to do something because there’s so much institutional pressure to finishing early but really you’ve got so much time as a consultant or as a senior lecturer, having a couple of extra years in your training that really helps you confirm that it’s the right thing for you is time very well spent and I’d encourage people to do that.

RB: If a junior doctor or a medical student is thinking about a career in oncology I’d say that you have to like people - you spend a lot of time with patients as an oncologist, talking to them. You have to have a passion for science – medical oncology is very much about cellular mechanisms of cancer and new drugs, new drug development. Whilst you might not be directly involved with that, I don’t, for example, run a lab or a phase I unit but I’m still enrolling patients into a number of cancer studies, I attend lots of conferences where it’s all about the science of the new drugs, it’s very exciting to be involved in that area.

PS: I think medical oncology is a great career. I think the balance between the exciting science and the opportunity to practice a very patient-centred kind of medicine is an excellent one. You can find that elsewhere in medicine but it really comes out very strongly, it’s very exciting, it’s very satisfying, it’s very worthwhile. So oncology allows those who want science and to focus on the benefits for patients to really have a satisfying career.

CR: I think that if you find the group of doctors who think like you, that’s probably going to be a comfortable place to end up working long-term. In the end both your patients and your colleagues have to be groups of people that you get on with.

SP: It’s an incredibly exciting place to be working at the moment and if you just look at it from a financial perspective, the greatest investment in medical research is in and around cancer – cancer biology, cancer evolution, cancer prevention and cancer therapeutics. So if you’re interested in being at the cutting edge of science whilst also being a clinician there is no better place to be. It’s a fantastic career, I feel incredibly fortunate that I’ve ended up in it.