Like cancer patients, but feel lost when it comes to cancer biology

[rphaleg]

I’ve been thinking about heme/onc a lot during residency. I’m drawn to cancer patients, both for the complexity of their illness and more so, for the deep emotional aspect of the disease. Even so, I’m perplexed. When I try to read about oncology to gauge whether I am truly passionate about the science/treatment, I dread it. For instance, when reading a review paper on pancreatic cancer, I get lost in all the biochemical/genetic details. Is this a red flag indicating I will not fare well in this specialty? I also tried to see the outpatient side of oncology by attending clinic with some of the oncologists on staff at my institution. While I appreciated that they had strong relationships with their patients, I found myself bored (most were follow-up visits for well-treated pts admittedly) and I couldn’t tell if that was because I didn’t know enough about the cases to appreciate all the management decisions that had already been made or if oncology just isn’t for me. I find myself constantly battling a conflict between a deep desire to take care for this very unique patient population and my seeming inability to engage with the science of the disease process.

I do like end-of-life discussions and intellectually stimulating patients, but I worry whether clinic will become a situation where I am following guidelines on which chemo to give patients in which circumstances without truly appreciating the science of what I’m doing.

Curious if anyone has any thoughts or words of advice. Thank you.

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[Square[]]

You don’t need to know cancer biology. There are plenty of cancer doctors (even in academia) who have very limited understanding of genetics/mol bio.

In my opinion, you are much more likely to enjoy being an oncologist if you pick this specialty because of your interest in taking care of this patient population and NOT because of your interest in cancer biology.

 

[Lccjblu]

Have you considered palliative?

 

[IM_applicant]

Sounds like you're talking about three different things.

One is the science. If you want to go into practice and just treat cancer patients without doing research, you don't really need to know the nitty-gritty of the science. As said above you can take excellent care of patients if you care about them and like taking care of them.

The other issue is outpt vs inpt, end-stage disease vs cured/curable disease. If you are into inpatient, then onc is not a good choice. Most of inpt onc is not onc, it's medicine. That's why a lot of hospitals have IM trained physicians doing onc hospitalist positions for them. If you like the inpt / symptom management / end of life, then palliative may be a good choice as mentioned above. You could also take a heme or onc hospitalist position and see if you like it.

Intellectual stimulation / guideline following. A lot of onc is guideline based. When deciding how to treat someone, the data should guide you, and that data is incorporated into guidelines. I personally don't find that part of onc intellectually stimulating because if you want to do the best for your patients, you should follow the evidence based guidelines. The science is irrelevant if the treatment hasn't been proven to be efficacious.

 

[CatFactorial]

Sounds like you're talking about three different things.

One is the science. If you want to go into practice and just treat cancer patients without doing research, you don't really need to know the nitty-gritty of the science. As said above you can take excellent care of patients if you care about them and like taking care of them.

The other issue is outpt vs inpt, end-stage disease vs cured/curable disease. If you are into inpatient, then onc is not a good choice. Most of inpt onc is not onc, it's medicine. That's why a lot of hospitals have IM trained physicians doing onc hospitalist positions for them. If you like the inpt / symptom management / end of life, then palliative may be a good choice as mentioned above. You could also take a heme or onc hospitalist position and see if you like it.

Intellectual stimulation / guideline following. A lot of onc is guideline based. When deciding how to treat someone, the data should guide you, and that data is incorporated into guidelines. I personally don't find that part of onc intellectually stimulating because if you want to do the best for your patients, you should follow the evidence based guidelines. The science is irrelevant if the treatment hasn't been proven to be efficacious.

Don’t forget that heme malignancies and transplant involve heavy amounts of inpatient service. Also NCCN guidelines are just a starting point and are often left vague to allow for insurance coverage, so it’s not entirely algorithm-based. Lots of scope for the art of medicine.