Medical Oncology

A NextGen Pathways in Medicine Article
By Frank Chen

Introduction

Medical oncology entails diagnosing and treating patients with cancer. It is broad in the sense that doctors can take on a variety of roles, including patient care, teaching, basic research, and clinical research. Because of the strong foundations necessary to effectively treat cancerous tumors, the pathway to becoming a medical oncologist is somewhat extensive. Certification involves training as a specialist after graduation from medical school in internal medicine and a subsequent fellowship in oncology. Generally, physicians complete one year of internship, followed by three years of residency in internal medicine and oncology. Oncology itself is a very broad field, including various other focuses like pediatric oncology, radiation oncology, surgical oncology, and gynecological oncology.

Practicing

Dr. George P. Canellos, the William Rosenberg Professor of Medicine at Harvard Medical School, took the time to enthusiastically discuss some of the dynamics of being a medical oncologist.  In terms of everyday lifestyle, work can be categorized between outpatient and inpatient settings. In outpatient settings, physicians serve as the coordinator of care for the typical cancer patient. He or she administers chemotherapy and recommends any additional steps, such as the possibility of surgery or radiation therapy. Discussions with surgeons and other involved team members are integral to ensure the proper management of treatment regimens, as action plans are combined in consideration of other therapies in order to ensure the best possible results for each individual patient. Inpatient settings are generally reserved for more severe or terminal cases, in which extra time spent at the hospital is necessary to provide for proper recuperation and/or examination.

Dr. Canellos commented that the bulk of patients are seen in an outpatient setting, in specialized locations like the Dana Farber Cancer Institute in Boston, where no extended periods of stay are necessary. Inpatient care is generally provided for in large-scale hospitals, like Brigham and Women's Hospital. Another important consideration for students who are interested in pursuing a career in medicine is the fact that much of medical oncology is practiced in an academic setting, attached to the major resources that research-based universities can provide for in terms of patient care.

Pros and Cons

In terms of the advantages and disadvantages of medical oncology in particular, Dr. Canellos mentioned that they vary widely according to the niche that each doctor finds for him/herself. However, one of the largest rewards of the specialty includes having the unique potential to make such a large life-saving impact on individual patients who seek intensive care to treat their serious conditions. The drawback relates to the severity of each condition on a case-by-case basis, because just as there is a large chance to make an immeasurable improvement on the quality of life for cancer patients, there is also a non-negligible potential for situations that are challenging to ameliorate. Thus, it is often important for medical oncologists to adopt a sentiment of detached compassion, as it can be a very taxing lifestyle to adopt if no boundaries are set between clinic and other areas of everyday existence. Delicate bedside manner is also a must, as direct interactions with patients are a much-valued highlight of the specialty.

Another interesting perspective that Dr. Canellos offers to the field is the consideration that research is often a common component of many oncologists' careers, especially those that choose to work in an academic setting. As the former chair of the Lymphoma Committee on Cancer and Leukemia, Dr. Canellos led clinical trials which, among many other initiatives, investigated more effective treatment regimens, antibody therapies, and transplantation effects on lymphoma patients. Other medical oncologists decide to choose roles as physician-scientists, who practice medicine in a clinical setting in addition to life as laboratory researchers as well. Thus, medical oncology offers those who aspire to practice the specialty a great deal of versatility in approach.

Direction of the Field

Finally, Dr. Canellos commented on the overall scheme of the field, by relating its direction to the fundamental reliance on great strides made in both the basic research and clinical research forums, as both patient care and teaching constantly evolve in response to this type of progress. Medical oncology is unique in the sense that both research and patient care are intimately linked, as a concerted, dedicated front is established to make advances that may lead to future therapies that are effective for specific cancer cases. Although important developments have indeed been carried forth, he expressed how as a physician himself, progress in terms of new discoveries can be considered frustratingly slow at times. Nonetheless, with the promise and optimism that the field wields for those who are afflicted with cancer, it is highly comforting to know that medical oncologists like Dr. Canellos are working tirelessly everyday to optimize quality of care for cancer patients everywhere.
 
Frank Chen is a writer for the Next Generation and a member of the Harvard class of 2010.

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