Is Rad Onc depressing?

[AJG]

I know that Rad Onc offers a great lifestyle, interesting technology, fast moving field - but, in the end is Rad Onc depressing? I am told that 60 % of patients in Rad Onc are treated for cure. I wonder what percentage of those patients are actually cured. And what about the other 40 % which are treated palliatively. It must be somewhat depressing knowing that these 40 % of patients with metastatic disease will all die from their disease. How depressing is this for the radiation oncologist and how much does this cause the radiation oncologist to reassess his/her own mortality? Or, is the depressing part more of an issue for the medical oncologist as they will likely be taking care of these patients at the end of their lives. Having said all of that, all of the local radiation oncologists I have met are very happy with their job, many believing that radiation oncology is the best medical specialty out there. I guess I just want to be happy with my job, I think my skills are a good fit for rad onc, but I wonder if I might be better off in a specialty where fewer of my patients will die. Please comment, I would really appreciate it.

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[G'ville Nole]

A very good question, and one that I think anybody would seriously ponder before going into any kind of field relating to cancer treatment. Cancer is a nasty disease, and those who work in the field can doubtless relate several heart-wrenching stories per month of people who died "before their time".

My view (after my MS3 experiences) is this: It's heart-breaking for any physician who is a good person to lose a patient, regardless of what field you go into. However, after having done my major 3rd year rotations, what I have discovered is that my cancer patients, although certainly among the sickest, were also the most wonderful and life-affirming people I have ever met. It seems to me that receiving such a grave diagnosis tends (more often than not) to bring out the best in people. That alone makes the field of oncology tremendously appealing to me. Add in the fact that I've seen patients in our head and neck clinic (for example) who are disease free ten and fifteen years out from their radiotherapy, and I see great cause for optimism. Even in patients who are treated palliatively, and ultimately succumb to their disease, I will take solace in having made their final days more comfortable.

Of course, these views are my own. I realize that confronting end-of-life issues is not for everyone. You are certainly justified in asking these kinds of questions; I think anyone considering a career in radiation oncology has to do a little soul searching on this topic. But I would submit that oncology in general is less of a "gloom-and-doom" field than it is perceived to be.

Just my $0.02

 

[AlexanderJ]

The situation described by Sleep Deprived is more of a situation for medical oncologists to deal with. They are the people involved in diagnosis. Rad Onc seems to have little, if any, diagnostic component and is all treatment-oriented. Regarding whether Rad Onc is depressing, I certainly hope I will not be depressed with it. True, we do treat many palliative cases, but my experience is that those people need to be relatively highly functional in order to be a candidate for a treatment like radiation therapy that has potential side effects. The really awful cases and the actual dying of patients seems to be more of an issue for the medical oncologist. Sure, if someone comes to a Rad Onc with metastatic breast cancer to be treated palliatively, you know that that person is going to die. However, when it gets to the point that things really deteriorate with that patient, in all likelihood you will not be taking care of the patient at that time (the medical oncologist will which I think could make the field of medical oncology depressing). Moreover, hopefully you will have successfully provided the prior palliative treatment and can take satisfaction that you made the patient more comfortable in their final months. I know, as a future radiation oncologist, that I will really like and be very fulfilled by the 50-60% of cases that we actually cure (the medical oncologist does not have nearly this high of cure rate). I also hope that in the future, better cancer screening techniques will bring us patients with early stage disease that we can cure. This will increase our cure rate percentage even more. However, there will always be some palliative cases. I really hope that I will get satisfaction from these as well by helping the patient be more comfortable. I guess one thing we need to remember is that 100% of every doctor's patients are going die at some point, whether you are a medical oncologist or a dermatologist. It's just something we all have to accept. Please, anyone comment on my impression of the field of radiation oncology vs. medical oncology. I'm not sure that I could or would want to go into the field of medical oncology - it might be too depressing. Thanks.