October 30, 2019

Why #RadOncRocks

by Anna Laucis, MD, MPhil, radiation oncology resident at the University of Michigan

Radiation oncology is a great field for medical students to consider.

You may never have heard of the small field of radiation oncology, a cousin to the field of diagnostic radiology. Yet, about a third of cancer survivors will have received radiation therapy at some point during their treatment course and over 50% of cancer patients receive radiation treatments with a more than 40% contribution towards curative cancer therapy.1, 2 So, radiation oncology is here to stay. Medical students have many options to consider for specialty selections. There is a dearth of primary care providers in the U.S., and that shortage is projected to worsen in the coming years.3 However, there is also a growing need for oncology providers as the number of cases of cancer is expected to increase significantly over the next decade and the number of patients receiving radiation for cancers such as breast, head and neck, and rectal is also projected to increase during this time.1,4 Aside from the numbers, radiation oncology is a compelling field that every medical student should consider. It is a technical field but the day-to-day work is very much rooted in quality human connections. Read on to learn more about five reasons why radiation oncology is a fantastic field for medical students to consider.

  1. Close connections with patients
    Cancer patients present to the radiation oncology office at a particularly vulnerable time in their lives. They may have just been diagnosed with a cancer and are presenting to learn more about their radiation treatments. Or they could be bald, having just lost all their hair to chemo. It may be the first real interaction that they’ve had in a healthcare setting (younger patients and also those with neglected cancers come to mind). Or it may be the hundredth time they’ve sat in a doctor’s office, having endured many health battles throughout their lives. Whatever the context, there is no denying that patients often feel scared during these visits. It is the noble role of the radiation oncologist (and other oncology providers) to support and guide patients through their journey. Patients often get treated with radiation for several weeks at a time and have follow-up visits with radiation oncologists, so close connections can develop. Radiation oncologists serve as coaches and cheerleaders to help patients manage side effects and make it through their treatments.

  2. Highly collaborative field
    One of the best aspects of oncology, in general, is that it is a team approach. Radiation oncologists work closely with other oncology providers — surgeons, medical oncologists, nurses, ancillary care providers — to determine the best treatment plans for patients and provide the best quality care. Tumor boards showcase this highly collaborative approach as decisions are made as a team, buffering uncertainties in diagnosis or management with the collective wisdom of experts. Radiation oncology itself is highly multidisciplinary and collaborative, with radiation oncologists serving alongside nursing staff, medical assistants, radiation therapists, physicists, and dosimetrists to deliver excellent radiation therapy plans to patients day in and day.

  3. Opportunities to synergize with immuno-oncology
    You might be thinking — well, if I am interested in oncology, why not just do medical oncology? The buzz of excitement seems to surround immunotherapy after all… and I would not disagree. However, radiation oncology is uniquely positioned to synergize with immuno-oncology therapies. The abscopal effect, for example, is a phenomenon in which the local treatment of a tumor with radiation can have systemic effects throughout the body causing non-irradiated tumors at distant sites to regress.5 The abscopal effect has been observed with concurrent radiation and immunotherapy in multiple trials, although further work remains to determine the underlying mechanism.5 Nonetheless, it is an exciting time to be in oncology as the scientific community continues to uncover new ways to target the immune system using pharmaceutical and non-pharmaceutical approaches.

  4. Exciting technology
    Radiation treatments are delivered using a multitude of high-tech machines. The planning process is very sophisticated, precise, and personalized to each patient’s individual anatomy and disease state. Linear accelerator machines represent the most common devices for delivering external beam radiotherapy. The technology has become so advanced that several centers have combined linear accelerator and MRI technology to allow for real-time visualization of tumors and surrounding organs during the treatment process. There have also been technological innovations such as the development of a specialized hydrogel that helps create physical space between the prostate and rectum for delivery of prostate radiation. And for procedurally minded individuals, there are also many ways to deliver internal radiation and brachytherapy — using specific techniques that allow for placement of radioactive material directly into the tumor.

  5. Plentiful research opportunities
    Finally, radiation oncology is a highly evidence-based field. Academic departments typically have multiple clinical trials open at any given time, and there are opportunities for medical students, residents, and faculty to contribute to the growing body of oncology research. From bench research to medical education to patient-reported outcomes research, there are many ways to contribute to the field of radiation oncology. It is rewarding to be able to take care of individual patients, as well as contribute to generalized knowledge that will hopefully help many more patients in the future.

Still looking for reasons that you or a medical student you know should consider radiation oncology? Check out the #RadOncRocks thread on Twitter for reasons that real-life radiation oncologists love this field, check in with your local department’s program director, and take time to rotate through an elective in the field. Nothing beats actually talking to radiation oncologists to learn the most about this field. There are also several resources you might find useful, including some specific to medical students. Radiation oncology is also an avenue to get involved with the ACR, which has many wonderful resources for trainees on important topics such as well-being and mentoring.

ENDNOTES

  1. Bryant AK, et al. Trends in Radiation Therapy among Cancer Survivors in the United States, 2000–2030. Cancer Epidemiol Biomarkers Prev; 2017
  2. Baskar R, Lee KA, Yeo R, Yeoh KW. Cancer and Radiation Therapy: Current Advances and Future Directions. Int J Med Sci 2012; 9(3):193-199.
  3. AAMC. Looming Doctor Shortage Could Impact Patient Care. Available from: https://www.aamc.org/news-insights/looming-doctor-shortage-could-impact-patient-care
  4. CDC. Expected New Cancer Cases and Deaths in 2020. Available from: https://www.cdc.gov/cancer/dcpc/research/articles/cancer_2020.htm
  5. Liu Y et al. Abscopal effect of radiotherapy combined with immune checkpoint inhibitors. Journal of Hematology & Oncology 2018; 11(104) 

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