Hematology and oncology fellows weigh several factors when selecting a career path after fellowship, including clinical interest, desired lifestyle, and finances, but little research is currently available to describe which of these factors fellows value the most. To better describe this area, Luis Gonzalez, MD, a hematology/ oncology fellow at Henry Ford Health in Detroit, Michigan, and his coauthors performed a national cross-sectional study examining factors influencing postfellowship career choices.

"The hematology and oncology fields have experienced exponential growth in recent years, not only in the realm of scientific advances but also in the interests of candidates for fellowship positions,” Gonzalez said in an email to 

. “We aimed to assess the vehicles that motivated fellows to choose a career in hematology and oncology. Knowing this can help programs focus more on their curriculum and base it on what physicians are looking for.”

To conduct their study, Gonzalez and his coauthors distributed an anonymous 25-question survey to hematology/oncology fellowship programs in the US. The survey included items pertaining to fellows’ demographics, educational background, career plans, and factors influencing career choices. Fellows rated each factor as very important, important, neutral, not important, or not important at all. Fellows were also asked to rate their confidence in finding a position that aligned with their career interests using a scale of very confident, somewhat confident, or not confident.

Fifty-six fellows completed the survey; most respondents were men (54%), were aged 30 to 34 years (79%), and had graduated from medical schools located in the US or the Caribbean (68%). Fellows expressed a high likelihood of pursuing hematology/oncology fellowship if they were given the chance to choose again (97%).

Findings from the study presented during the 2024 American Society of Clinical Oncology Annual Meeting showed that clinical interest was most often rated as very important (76.8%) to fellows in choosing their career path. Other factors rated as very important at notable rates included career mentorship (26.8%), lifestyle considerations (23.2%), and research experiences (19.6%; 

“Despite thinking one would consider lifestyle, family plans, or salary as the main drivers for choosing a residency or fellowship in [oncologic] medicine, this was not the case,” Gonzalez said. “The first factor of influence was clinical interest, followed by career mentorship during their residency, and then came lifestyle considerations.”

The top factors that fellows indicated were not important at all in terms of their career choice included having a hematologist/oncologist as a family member (78.6%), family expectations (39.3%), and hematologic or oncologic disease in friends or relatives (32.1%). A significant portion of fellows also indicated that family expectations (25%), hematologic or oncologic disease in friends or relatives (25%), and future family plans (10.7%) were not important.

Factors most often rated as neutral to the fellows’ career choice included specialty competitiveness (39.3%), availability of training programs (37.5%), and research experiences (35.7%).

“These results showed the importance of clinical exposure, mentoring, and scientific development in the early stages of training,” Gonzalez noted. Fellowship programs could start fortifying career mentorship programs, providing increased support for those interested in classical hematology, and fostering research experiences during residency training.”

Additional findings from the study showed that 80% of respondents decided on hematology/oncology as a career during residency. Thirty-nine percent hoped to work in an academic/university setting, and 41% planned to stay within a community setting. Working in a suburban area (45%) was preferred compared with an urban area (39%), and only 2% planned to pursue a career in classical hematology. Beyond classical hematology, fellows planned to pursue careers in hematology/oncology (38%), medical oncology (32%), malignant hematology (16%), and benign/classical and malignant hematology (5%) or were undecided (7%).

In terms of their mentor’s influence on their career choice, fellows responded that it was very important (44%), important (25%), neutral (18%), not important (11%), or not important at all (2%). Future salary had an influence on career choice that was very important (9%), important (47%), neutral (25%), not important (14%), or not important at all (5%).

Fellows were very confident that they would find a career after fellowship that provided intellectual stimulation (73.2%), a job in their clinical area of interest (71.4%), and financial gain (48.2%). They were somewhat confident that they would be able to find work-life balance (58.9%), a career where they would be renowned (57.1%), and a career that would provide them with financial gain (48.2%). Fellows responded that they were not confident they would be able to find grant funding (17.9%), work-life balance (16.1%), and a career where they would be renowned (8.9%).

“The biggest limitation [of the study] was the small number of responses compared with the universe of fellows. Even though we received favorable answers from the program coordinators to send the surveys, all the fellows were not enthusiastic about answering them,” Gonzalez concluded. “[In the future], we want to be more specific and explore the factors influencing career choice in hematology alone.”

Gonzalez Mosquera L, Balanchivadze N, Ali F, Meranda M, Castro OH, Kuriakose P. Factors influencing career choices and post-fellowship perspectives in adult hematology/oncology fellows: a nationwide cross-sectional study. 

 2024;42(suppl 16):9016. doi:10.1200/JCO.2024.42.16_suppl.9016

Articles

Hematology and oncology fellows prioritize clinical interest when choosing their career paths, with mentorship and lifestyle considerations also playing significant roles. A national study by Dr. Luis Gonzalez and colleagues surveyed fellows to understand these influences. The study revealed that clinical interest was the most important factor, while family expectations and personal connections to the field were less influential. Most fellows decided on their specialty during residency, with many aiming for academic or community settings. Confidence in finding intellectually stimulating and financially rewarding careers was high, though concerns about work-life balance and grant funding persisted.

A cross-sectional study reveals insights on factors hematology and oncology fellows weigh when selecting a career path after fellowship.

Survey Identifies Factors Most Important to Fellows When Selecting a Career Path

After years of residency, a hematology-oncology fellowship, and several more years as an attending physician with experience in clinical trials (in an academic medical center or hybrid private practice), you’ve decided to explore a career in drug development in biopharmaceuticals. As you stand on the cusp of this decision, you begin to realize how little you know about a career in industry. Where do you even begin to look? Should you consider applying to biotechnology or large pharmaceutical companies? How do roles vary in each of these settings? What is the day-to-day experience like?

My hope is that the following paragraphs shed some light on answers to these questions and outline what a career in biopharmaceuticals can look like. Two caveats to mention up front: first, the content of these lines will be primarily slanted toward my experience in clinical development rather than a pathway in medical affairs, and second, some of my points regarding differences between biotechnology and large pharmaceutical companies may be oversimplifications.

The first step as you begin your search for an initial clinical development position is to talk with individuals who were at a similar career level before transitioning to industry. Although it is valuable to discuss your impending transition with colleagues or mentors who may be in more senior leadership positions within biopharmaceuticals, their experience may not be reflective of the experience awaiting you. Hearing from individuals who were peers before their transition can offer you a realistic perspective as to what roles were offered to them, such as medical director, senior medical director, and therapeutic area clinical lead; what such a role looked like; and what level of compensation to anticipate. Beyond receiving information on what to anticipate, perhaps as important is for these individuals to offer you introductions to recruiters who have helped them in the past, either in-house from large pharmaceutical companies or from independent life science recruitment groups.

Having a recruiter to serve as a guide is not just a luxury but essential to successfully navigating the interview process. Seasoned recruiters can guide you on how to prepare for interviews and provide feedback as you climb the interview rungs about impressions of your prospective employer.

You’ve now been connected to a recruiter who has offered current openings across several exciting oncology-focused companies, which span the spectrum of biotechnology to large pharmaceutical companies. Which type of company should you apply to? Perhaps a primer is warranted.

Biotechnology companies are mostly private, and large pharmaceutical companies are usually public. This means that there is less of a built-in structure for conducting business in biotechnology compared with large pharmaceutical companies. There are not mandated metronomic investor calls or internal decision-making meetings that dictate the pace of each drug project. In biotechnology, internal milestones can be more individually curated depending on the needs of a particular drug program at a certain time. Additionally, the differences in employee numbers between large pharmaceutical and biotechnology companies also carry implications on the scope of your role. Given the vast cadre of experienced individuals in each branch of large pharmaceutical companies, your role tends to be more anchored to the clinical work related to a single trial or several trials with your molecule of focus. In biotechnology, given the smaller company size, your role tends to be more interdisciplinary. Even in clinical development, beyond direct trial work, one day you may be working with your legal team to refine a request for a proposal template and the next you could be working with your manufacturing team to review shipping details for a drug for a trial.

Furthermore, there is less of a distinction between early and late clinical development in biotechnology. For example, an oncology-focused biotechnology company with a diverse portfolio typically possesses 2 to 3 clinical assets and a pipeline that may include several more preclinical compounds identified through a drug discovery platform. The clinical assets are typically in early-phase trials given the cost and scale of conducting phase 3 trials. Regardless of what phase of study a drug is in, you are responsible for the entirety of its development in biotechnology. In contrast, there is a significant distinction between early- and late-phase clinical development in large pharmaceutical companies, with separate teams focusing on individual phases for even the same molecule. If you were involved with an asset that demonstrated exceptional promise in proof-of-concept phase 2 trial findings, it would then be moved out of your hands to colleagues in late clinical development. That is not to say you cannot transition between early- and late-phase clinical development in large pharmaceutical companies, but you can only work in 1 space at a given time.

Due to this more pronounced distinction between phases of clinical development in large pharmaceutical companies, your day-to-day role also tends to be more predictable. In early clinical development, you usually work with the translational science team to get preclinical assets ready for an investigational new drug application and with the pharmacokinetics and biomarker teams to contextualize the results of a phase 1 trial. In late clinical development, you may work more regularly with the regulatory team to plan for an upcoming FDA meeting about your planned registrational trial, with the biostatistics team to refine statistically powered primary and key secondary end points for the trial, and with the medical affairs team to discuss recruitment strategies.

In biotechnology, your day-to-day role may be much more unpredictable. You might be working with a contract research organization to ensure the development of your phase 1 protocol is proceeding as planned, then pivot to a business development meeting about entering a collaboration with another company based on synergy between your drug and theirs, before finishing your day reviewing in vivo data with your scientific team about a preclinical asset. The next day, your interactions could be completely different.

In short, I hope to have highlighted the diverse opportunities a clinical development career in biopharmaceuticals may afford. Given the technological update the field of oncology is actively undergoing with the introduction of new therapeutic modalities and refinement of existing ones, it is undoubtedly an exciting time to be in the field of drug development. Know that you are not alone as you approach the transition; there are others who have made similar leaps and are open to sharing their experiences and learnings. Welcome.

Transitioning from a clinical role to a career in biopharmaceutical drug development involves understanding the differences between biotechnology and large pharmaceutical companies. Biotechnology firms, often private, offer interdisciplinary roles with less structured business operations, while large pharmaceutical companies, typically public, provide more defined roles with clear distinctions between early and late clinical development phases. Engaging with peers who have made similar transitions and leveraging recruiters can facilitate this career shift. The dynamic nature of oncology drug development presents exciting opportunities for those entering the field.

Satya (Nanu) Das, MD, MSCI, pens this piece on what a career in drug development in the biopharmaceutical field may look like. 

A Career in Clinical Development in Industry: Choose Your Own Adventure

Beyond the exciting clinical trial updates presented at the 2024 San Antonio Breast Cancer Symposium (SABCS) in Texas, oncology fellows from across the US came together the day before the start of the meeting to share their research interests and network with other fellows and senior faculty members. 

During the OncLive National Fellows Forum

 at SABCS, which took place on December 9, 2024, Tess O’Meara, MD, MHS, and Kelsey H. Natsuhara, MD, presented findings from their studies on profiling tumor-associated immune cells in breast cancer and the impact of telehealth on patient access and treatment use. O’Meara is a fellow of breast medical oncology at Dana-Farber Cancer Institute/Massachusetts General Hospital in Boston, Massachusetts, and Natsuhara is a hematology/oncology fellow at the University of California, San Francisco (UCSF). 

Describing the Immune Microenvironment in Breast Cancer

O’Meara’s presentation, titled “ImmunoPROFILE: Profiling Tumor- Associated Immune Cell Populations in Primary and Metastatic Breast Cancer Tissue,” looked to characterize the immune microenvironment of primary hormone receptor (HR)–positive/HER2-negative breast cancer relative to other breast cancer types via multiplexed immunofluorescence.

 The study included tissue samples from patients with primary and metastatic HRpositive/ HER2-negative breast cancer (n = 145), HER2-positive breast cancer (n = 20), and triple-negative breast cancer (TNBC; n = 36). Investigators evaluated immune cell infiltration in terms of CD8, PD-1, FOXP3, and CD8 and PD-1 cell positivity, as well as PD-L1 combined positive score, tumor proportion score, and inflammatory score.

“ImmunoPROFILE is a pan-cancer effort at Dana-Farber to use archival formalin-fixed paraffin-embedded tissue from primary and metastatic tumors to characterize the immune cell populations that are infiltrating those tumors,” O’Meara explained in an interview with Oncology Fellows. “My project focused on breast cancer, mostly HR-positive tumors with smaller cohorts of HER2-positive [breast cancer] and TNBC.” 

Findings from the study demonstrated that PD-L1 levels per immunohistochemistry staining were correlated with PD-L1 by multiplexed immunofluorescence, supporting the use of the technique in the clinical assessment of immune cell populations. When comparing samples from patients with primary HR-positive/HER2-negative breast cancer (n = 116) with those with metastatic disease (n = 29), PD-1–positive T cells (P = .048) and PD-L1 combined positive score (P = .036) were significantly elevated in those with primary disease. There was also a trend toward higher immune cell staining reported in primary vs metastatic TNBC. 

Additional multiplexed immunofluorescence data showed that there was decreased tumoral immunity in primary HR-positive/HER2-negative breast cancer compared with primary HER2-positive breast cancer or TNBC. There was also increased PD-1–positive immune cell infiltration in HR-positive/HER2-negative breast cancer in samples from patients older than 65 years compared with those who were younger than 45 years. 

“Our most interesting and relevant findings came when we [examined] the primary HR-positive/HER2- negative cohort of cases: how immune cell infiltration differed with tumor [pathologic] grade,” O’Meara said. “We found that there was a stepwise increase of immune cell infiltration across all the populations we looked at with increasing [tumor] grade. With grade 1 cancers, there was the lowest degree of immune cell infiltration. There was somewhat higher infiltration in grade 2, and the highest immune cell infiltration [was observed] in grade 3. This is particularly relevant because the recently published [phase 3] KEYNOTE-756 study [NCT03725059] looked at grade 3 tumors and found that there was a benefit in adding immunotherapy to chemotherapy in high-risk, grade 3, early-stage HR-positive breast cancers. Based on [data from] our study, these trial findings may be driven by increased immune cell infiltration in high-grade, primary HR-positive tumors.” 

Investigators also noted that a higher Oncotype DX score was similarly correlated with increased immune cell infiltration in HR-positive/HER2-negative breast cancer across all the immune cell infiltration markers examined. PIK3CA mutation status was not associated with a change in immune cell infiltration. 

“We need to [determine] which patients with HR-positive primary breast cancer should be receiving immune therapy; if we can better characterize the immune cell populations in these tumors, it can hopefully [allow] us to avoid overtreating all patients with HR-positive primary breast cancer and instead focus on those who are most likely to benefit,” O’Meara said. “[In the future], we are interested in [evaluating] how the different immune cell populations in the tumors are correlated with response to both chemotherapy and immunotherapy.” 

Refining Telehealth for the Delivery of Cancer Care 

In her study, Natsuhara examined the impact of telehealth on patient diversity and care use at the UCSF Helen Diller Family Comprehensive Cancer Center from 2017 to 2019 (pretelehealth cohort) and 2021 to 2023 (posttelehealth cohort).

 Data from 2020 were excluded due to the irregularity of the COVID-19 pandemic to better isolate the effects of telehealth on outcomes. Using the UCSF clinical data warehouse, Natsuhara evaluated patient demographics, visit data, and treatment data related to the use of telehealth in patients with breast, gastrointestinal (GI), and genitourinary (GU) cancers. In 2023, patients in the respective groups were using remote visits at rates of 26.6%, 70.3%, and 91.9%. 

“I have done most of my medical training during the COVID-19 pandemic,” Natsuhara said in an interview with Oncology Fellows. “[During this time], we saw a rapid transition to telehealth in medicine and what stuck with me was despite the fact that we are now 5 years post-pandemic, we are still seeing a lot of video visits. Telehealth is embedded in the medical system in a way that it wasn’t before, and during training, I started to wonder whether it was improving access to care. We have seen that telehealth can be a great tool for patients who live in rural areas, those who don’t have access to big cancer centers, and patients who can’t afford to take time off work. At the same time, we all recognize that there are a lot of barriers to [telehealth] use, [such as] having an internet-enabled device, a quiet place to have a visit, and the digital [literacy] to [use it].” 

During the pretelehealth period, 5942 unique patients with breast cancer were seen across 32,450 outpatient encounters. The median age at first visit was 58 years (IQR, 48-67). In the posttelehealth period, 11,944 patients were seen across 38,680 unique encounters and the median age at first visit was also 58 years (IQR, 48-68).

Patients with GI cancers seen during the pretelehealth (n = 8332) and posttelehealth (n = 13,301) periods had a median age of 61 years (IQR, 52-70) and 63 years (IQR, 53-71), respectively. The total number of outpatient encounters was 30,899 and 39,671, respectively. 

In the GU cancers group, 10,849 unique patients were seen during the pretelehealth period compared with 22,569 in the posttelehealth period. The numbers of outpatient encounters during these respective periods were 39,167 and 60,958, and the median ages at first visit were 68 years (IQR, 61-73) and 70 years (IQR, 63-76), respectively. 

“We [also] found that the age of patients who were using phone visits in the posttelehealth period was higher than [that of] the patients who are being seen either in person or by video,” Natsuhara said. “This [may] highlight the challenges that older adults sometimes have with using virtual modes, and particularly video; those patients may be opting to do more phone visits. This is interesting because there are data in the literature that [show] the quality of care and the patient relationship conducted over phone are not of the same caliber and quality that we see for video visits. It is important for patients to be face-to-face with their provider and have those nonverbal cues.” 

In terms of patient demographics, patients with breast cancer in the pretelehealth and posttelehealth groups were from San Francisco (24.8% vs 32.2%, respectively), East Bay (17.3% vs 16.3%), North Bay (13.1% vs 12.8%), South Bay (12.8% vs 14.3%), and outside the Bay Area (32.1% vs 24.2%). In the pretelehealth and posttelehealth groups of patients with GI cancers, these respective rates were 24.1% vs 23.1%, 18.5% vs 18.7%, 12.9% vs 13.6%, 10.8% vs 12.0%, and 33.6% vs 32.5%. These respective rates during the pretelehealth and posttelehealth groups with GU cancers were 14.3% vs 17.8%, 16.5% vs 17.3%, 15% vs 15%, 10.6% vs 11.2%, and 44.7% vs 38.7%. 

Although nearly all the percentages decreased from the pretelehealth to posttelehealth periods, the total number of patients seen via telehealth increased across all location demographics during the time frame; this increase was statistically significant in patients with breast and GU cancers from outside the Bay Area, Natsuhara noted. 

In-person visits decreased from the pretelehealth to posttelehealth periods across the breast cancer (98.4% vs 71.5%, respectively), GI cancer (98.1% vs 43.1%), and GU cancer groups (89.4% vs 14.7%). Conversely, video visits rose across the respective groups, from 1.6% to 28.1%, 1.9% to 55.2%, and 3.1% to 81.4%. 

“It’s not necessarily 1 cancer division that’s driving telehealth use, but it seems to be somewhat disease specific, and [related to] a culture within that clinic of how many visits are conducted virtually vs in person,” Natsuhara noted. 

Additional findings by oncology department type showed that medical (2.1% vs 25%, respectively), surgical (0% vs 35.2%), and radiation oncology (0.2% vs 39.1%) visits via telehealth increased in patients with breast cancer in the pretelehealth and posttelehealth periods. Similarly, in the GI cancer arm these respective rates were 2.1% vs 54.8%, 1.4% vs 68.4%, and 0.3% vs 54.7%. In the GU cancer arm, the rates were 2.9% vs 86.8%, 23.6% vs 91.3%, and 0.8% vs 69.2%, respectively. 

“[At UCSF] we have the benefit of having our telehealth program rolled out in 2015, prior to the [COVID-19] pandemic, so we had some historical data to [help us] understand what this increase in telehealth had done to our patient diversity, as well as the numbers and types of patients who are accessing [telehealth] care at our center,” Natsuhara said. “An [important remaining] question I have is, how can we use telehealth to improve access and diversity in our clinical trial patient populations? [In the future], we’ll be examining clinical trial enrollment before and posttelehealth and running additional regression analyses to better understand the nuances and treatment factors [that] matter for patients in using video visits [to] access care.”

O’Meara T. ImmunoPROFILE: profiling tumor-associated immune cell populations in primary and metastatic breast cancer tissue. Presented at: 

 SABCS Fellows Forum; December 9, 2024; San Antonio, TX.

Natsuhara KH, Rugo HS, Piawah S, et al. Telehealth and cancer care delivery: evaluating the impact of telehealth on patient access and treatment utilization at a comprehensive cancer center using real world data. Presented at: 

Tess O’Meara, MD, MHS, and Kelsey H. Natsuhara, MD, discuss their presentations from the OncLive National Fellows Forum at SABCS.

Fellows Present Their Findings on the Breast Cancer Immune Microenvironment and Telehealth Delivery at National Fellows Forum

Professional burnout is a well-documented issue in oncologists who are established in their careers, but it is an understudied area of need for hematology/oncology fellows, according to Thejal Srikumar, MD, MPH. In response, Srikumar and her colleagues have created a wellness and professional development curriculum at Yale School of Medicine that they hope can foster multi-institutional collaborations to expand these services for fellows. 

“The foundation of [this research] is that institutions need to foster an environment in which there is open communication and trust in psychological safety for their fellows because that is [necessary] before any other work can be done,” Srikumar said in an interview with 

. “We need to focus as a field on destigmatizing asking for help and understanding that the people who we look up to and our leaders in the field have all had their own journeys, and those journeys have ups and downs. It’s OK to talk about them and, most importantly, ask for help.” 

During the 2024 American Society of Clinical Oncology Annual Meeting, Srikumar and her coauthors presented findings from an evaluation of the longitudinal curriculum. Findings showed that fellows were interested in further discussion of work-life balance, management of scholarly expectations, and professional boundary setting. Fellows were then invited to an off-site retreat designed to address their concerns, where senior and first-year fellows connected to discuss their career inspirations, motivations, and methods to prevent professional burnout. 

In the interview, Srikumar, assistant program director of the Hematology/ Oncology Fellowship Program and assistant professor of medicine (medical oncology) at Yale School of Medicine in New Haven, Connecticut, outlined the unique curriculum, the responses to its implementation by fellows, and the future of its development. 

 What is the current landscape of wellness offerings for hematology/oncology fellows? 

: [In order] to understand the landscape of [wellness] training, it’s important to step back and understand the scope of the problem. We know that burnout is rampant in medicine; studies show that there’s a rate of burnout as high as 60% in US oncologists. The Accreditation Council for Graduate Medical Education recognizes that this is a huge issue and recommends that its programs be able to address these [issues]. 

The major problem is that it’s not being done in a streamlined, systematic way and every institution is doing something different. A core part of the problem is that even though we know that burnout is a systemic-level issue it’s treated as an individual-level problem, [as if] it’s an individual’s weakness leading them to be burnt out. 

There’s also a culture in medicine where we’re not talking about it when we’re struggling, we aren’t opening up about our tough times. Specifically, when it comes to trainees and fellows, who are even more vulnerable, oftentimes if they are struggling, they may feel like they’re not able to ask for help, and they’re worried about what the repercussions for those [struggles] might be. There’s a lot of work that needs to be done, not only in the training but also in the culture of medicine in general. 

What did this novel curriculum entail and how was it evaluated? 

Our goal was to provide our fellows with tools to be able to navigate all these struggles, not only in fellowship, but in the years to come in their oncology careers. We focused on the concept of professional fulfillment, which is a sense of contentment, well-being, and satisfaction at work, as well as the idea that you’re on track to achieve the goals that are most important to you. 

We took this concept of professional fulfillment, and we wanted to create sessions that were reflective of what the fellows wanted to do, learn, and talk about. We [conducted] a 2-part needs assessment and in-person brainstorming session, which was just a free-flowing conversation to generate topics and ideas. We also [performed] an anonymous survey to understand [fellows’] pain points. 

We took that information and designed our curriculum based on it. The curriculum had 2 parts. The first part was a fellows’ retreat, a protected day for our senior fellows, and then a separate protected day for our first-year fellows. We had multiple sessions, [such as discussing] the boundaries that we choose and envisioning the future, in which fellows created vision boards about what was most important to them to hold on to moving forward into the future, [as well as] communication skills. 

Separate from our retreats, we had 4 didactic sessions throughout the year, based on the topics that the fellows were interested in. We spoke about grief and awe in medicine and honoring these in oncology, shame in medicine and how we address it, and conflict styles and how we approach others who might have different conflict styles than we do. We also had a session called Truth Rounds in which senior faculty members shared the trials and tribulations they’ve had during their careers and how they overcame them. 

This entire curriculum ran throughout the year. We received [survey feedback] and ended with a focus group to get summative feedback. We also obtained some corollary measures throughout. We used the Mini Z Resident survey [to assess] learning environment, a general efficacy scale, and the Patient Health Questionaire-2 to assess depression. 

What were the key findings from the evaluation of the longitudinal curriculum? 

It was notable how well attended and how well received [the sessions] were. For example, 27 out of our 28 fellows attended the fellows’ retreat, and 95.4% indicated that they found it helpful. When we asked them what they thought was the most meaningful [component], they [highlighted] the ability to connect with their colleagues and share their successes and failures and to get some tools to mitigate burnout. 

In the summative feedback [we received] at the end of the year from the focus group, we saw the 3 themes emerge that we thought were particularly important. The first was an appreciation for the empathic connection that fellows were able to have with each other, [as well with] the faculty members, regarding their shared lived experiences and feelings. The second was this feeling that there was a longitudinal applicability of the types of skills that we were talking about and that the tools we were giving them would go on beyond just fellowship to help them in their careers. The last one, which we heard repeatedly, was that there was an appreciation for this space to freely communicate and be vulnerable with each other. 

What we hear from fellows year after year is that they want to talk about the same things. They want to be having these same sessions. When we ask what they want to change, we hear that there is a real need to be able to open up with each other in this way and talk about these challenging issues. It makes us feel like they can’t address these needs elsewhere in our standard [fellowship] curriculum in oncology; there aren’t spaces for them to be vulnerable elsewhere. There’s a desire to be able to connect in this way. 

What are the next steps for this curriculum and other efforts in this area? 

We hope to have multi-institutional collaborations on this type of work. Our next direct step is being able to publish these materials and course guides for other institutions to implement, [and] then we can test their efficacy in different environments. Ultimately, our goal is to come together as a field to prioritize this work and determine a way for us to serve our fellows in the best way that we can and give them the skills and tools that they need to be successful and fulfilled in what they do. 

What that looks like for us at our institution is continuing this work year to year and going in with an open mind at the beginning of the year to repeat that needs assessment. Even if it is the same things [our fellows] are telling us [they want], we want to make sure that we are truly listening to them and giving them what they want to hear. This is an area that is being actively developed and is in huge need. We know that burnout is a big issue, and the [current] studies are primarily [examining] physicians as a whole, or certain pockets of physicians. There are not that much [data] focusing on fellows. 

There is a lot that needs to be done within this population, but we know from the studies of physicians in general that other strategies might work, such as coaching, whether it’s one-on-one or small group coaching. Studies show that virtual coaching across institutions can be helpful. 

Another realm in which publications have shown benefit is in different types of communication skills training. That is not just communications with patients; it’s training that has been developed to help better communicate with your peers when you’re struggling and to focus on tools of mindfulness [such as] appreciative inquiry. There is a lot [of information] out there, but it is still something that is under development.

Srikumar T, Stempel JM, Goldberg SB, et al. Longitudinal curriculum to address wellness and professional development in a hematology/oncology fellowship program. 

. 2024;42(suppl16):9004. doi:10.1200/JCO.2024.42.16_suppl.9004

Thejal Srikumar, MD, MPH, discusses the Yale School of Medicine's unique approach to offering fellows a space to address professional burnout.

Novel Curriculum Aims to Address Burnout and Foster Wellness Among Fellows

I recently had the pleasure of hearing a special lecture about the experience of being a medical professional during Hurricane Katrina. It is hard to believe that Hurricane Katrina and its devastation occurred almost 20 years ago. The talk was entitled “Humanistic Challenges in the Midst of Chaos.” This talk was timely given the changes we are experiencing in the country and within our profession of medicine.

There are approximately 26,241 oncologists in the US. Given this size, we often have diverse viewpoints on many things in both the medical and political arenas. Sometimes the political arena spills into the medical one. However, intellectual freedom is important. The ability to engage in respectful discourse, evaluate differing viewpoints, challenge our certainties, and find common ground is the bedrock of intellectual freedom. The ability to debate and think inde- pendently must continue. But similar to Hurricane Katrina or the awfulness of the COVID-19 pandemic, we find ourselves in a pressure point in the country and therefore in oncology.

I recognize that this pressure point may feel good to some but horrible to others. Your colleagues may be experiencing a range of emotions, perhaps changing by the day. There is no magic spell to weather each storm, but remember that individuals are feeling vulnerable and raw. Extending grace and listening, even if you personally want to scream, will become important in the days, weeks, and years to come.

From a personal perspective, I want to briefly touch on some professional strategy techniques that I have found useful through such incredibly challenging times. You may find these useful, or you may not. Take what you like and leave the rest.

My North Star at work is helping faculty find contentedness and abundance surrounding their professional life, whether during chaos or during times of stillness. At present, political divide threatens divisiveness among our physi- cian ranks and can lead to dissatisfaction. Our strength is our team, regardless of political stance. I plan to use professional development as a tool for unification. I can take actions and operationalize solutions that allow us to remain a team, a united force for patient care and for support of each other.

We may think of radical ways of doing this. Maybe, when life does not feel as raw, we can consider a “great debates” series in which we respectfully examine our differing views as they apply to medicine, helping us all find our commonalities to define a path forward, one that is action and engagement centered to fulfill common goals.

This means that I translate my strong feelings into tangible and active steps toward an end product that aligns with my belief system, my moral compass, and my North Star, which is helping faculty find their sweet spot. Approximately 6 years ago, I was dismayed by what seemed to be draconian opioid restrictions and their potential effects on my patients. In order to address these, I teamed with lobbyists from 3 medical societies, testified in our statehouse, and helped enact a carve-out for our patients with cancer. Most actions are not in the political arena but can be just as impactful to the professional ecosystem in which you live.

Pressure Points Allow Innovation to Happen

This is not the same as toxic positivity, and I recognize that pressure points are not fun. From a more contemporaneous standpoint, the horror of COVID-19 resulted in innovations: a normalization of the ability to work effectively from home, the use of telehealth, and an emphasis on personal boundaries in ways that were not previously acceptable. Every thorn has a rose.

Recalibrating and resisting catastrophizing are important for mental health and for meaningful action that ensures the best future for our profession and our patients. But action is dependent on being willing to get involved. In times of pressure, we must evolve to excel.

I reiterate that this is my testimony of sorts. This is how I contextualize, process, and proceed in times of uncertainty. I invite you to join me on this journey, to help me create programs and opportunities to allow us all to rise, support our members, and serve as an example of how academic medicine can evolve and excel through unprecedented times of pressure and chaos.

This is not an academic vs private practice issue. This is an issue for all of us who practice oncology. But we can distinguish ourselves by doing this well. As oncolo- gists and physicians, our careers are about preventing and relieving suffering. Our individual willingness to become involved with issues that matter to help relieve suffering as well as our collaboration with our institutions and professional societies can make the difference between transcending the pressure points or succumbing to the pressure.

Jill Gilbert, MD, is a professor of medicine and vice chair of Professional Development for the Department of Medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

The lecture reflects on the challenges faced by medical professionals during Hurricane Katrina, drawing parallels to current pressures in oncology. It emphasizes the importance of intellectual freedom, respectful discourse, and professional unity amidst political divides. Strategies for navigating challenging times include defining a personal "North Star," translating strong feelings into actionable steps, and embracing innovation during pressure points. The speaker encourages oncologists to engage in meaningful actions that align with their values, fostering collaboration and resilience to transcend challenges and support patient care.

Jill Gilbert, MD, discusses professional strategy techniques that she has found useful through incredibly challenging times. 

Chaos: Friend or Foe? 

To fulfill the growing need for oncologists with expertise in providing supportive care for patients living with cancer and those who have achieved a cure for their disease, investigators at The Christie NHS Foundation Trust in Manchester, England, have created a first-of-its-kind program to train oncology fellows in this area and offer supportive oncology services to patients.

First announced in October 2024, the supportive oncology program will support approximately 2000 patients annually at The Christie who are living with cancer for an extended period.

 The program combines offerings including psychological support, pain and symptom management, medication optimization, occupational therapy, and end-of-life care. The program also offers patients dietary advice, endocrinology services to address hormonal adverse effects (AEs) related to cancer treatment, cardio-oncology care, and access to a specialist senior adult oncology team for patients with high levels of frailty.

As of January 2025, 3 supportive oncology fellows have been recruited to the program.

 The fellowship takes place over the course of 3 rotational placements lasting 4 months each. The first rotation covers acute oncology, toxicity management, and inpatient care. During the second rotation, fellows work alongside a supportive care team in enhanced supportive care clinics and with the palliative and end-of-life care teams. The final rotation encompasses psychological medicine, endocrinology, and the senior adult oncology service.

During the first 3 days of each rotation, fellows will shadow experienced consultants and then will progress to work more independently with patients. After the training of the initial 3 fellows is complete, 3 new fellows will be recruited to take their places. The fellowship is part of a national pilot program in the United Kingdom (UK) that aims to develop core competencies in supportive oncology. The new national supportive oncology curriculum was developed by the UK Association of Supportive Care in Cancer with support from the Royal College of Radiologists.

“[The creation of this program] was not a hard sell,” Richard Berman, MBBS, MRCGP, FRCP, the leader of the new service, as well as a consultant in Palliative Medicine and Honorary Senior Lecturer at The Christie, said in an interview with 

. “Individuals who work in cancer centers get it. I believe the reason it has very quickly gained traction in the UK is that this is a simple initiative and people understand that it’s something that’s necessary now and in the future.”

In the interview, Berman discussed the rationale behind the creation of the supportive oncology program, it’s potential effect on patients, and what training for fellows in the program will look like.

: What inspired the creation of this supportive oncology program?

: Cancer treatments are advancing; all the money that’s been spent [on cancer research] over the past few decades is paying off and these newer treatments are transforming lives. We are seeing more and more individuals [who] are now living longer with cancer and more individuals are surviving cancer.

In the UK there are approximately 2.5 million people living with cancer, but, because of these treatment advances, by 2040 that number is going to more than double to [approximately] 5.3 million. Services are not set up to be able to cope with that demand, and we don’t [currently] have the expertise to understand how to [care for] these people because traditionally cancer care has focused on diagnosis, treatment, and end-of-life care. But with this growing number of people living with and beyond cancer it’s becoming a concern that this tsunami of people who are going to be living with the disease won’t have care in place and [physicians] won’t be trained in terms of how to [care for] them.

As a palliative care physician, I have seen that the nature of the type of individuals who are referred to me has changed from end-of-life care to seeing more people who are living longer with the disease, sometimes for many years. [For example], patients with stage IV lung cancer would have died within a few months [of their diagnosis] 10 years ago. But now we’re seeing patients with stage IV lung cancer who in some cases are going into remission on some of these newer treatments, such as targeted treatments and immunotherapy, and living for years. There are two problems: the number of individuals that we’re going to have to [care for] and that we don’t understand how to [do so]. [One] may have been trained in how to address pain at the end of life, but I certainly wasn’t trained in how to [treat] pain in patients who are living for many years with incurable disease.

We’ve been guided by the Multinational Association of Supportive Care in Cancer and used their definition of supportive care, which is prevention and management of the AEs of cancer and cancer treatments across the whole cancer continuum. It doesn’t matter where you are in the cancer journey, [patients] have supportive care needs across the board, including cancer survivors.

In the UK, there’s a lot of interest from the government and NHS England in supportive oncology because there’s research that has shown that by providing this type of care for patients, they have better outcomes in terms of symptom burden and quality of life. [Patients] who are going through cancer have enough stress and are upset, so if they have a problem related to their cancer or treatments, they need to be able to quickly access the right person.

Supportive oncology [also] benefits the health economy. Many studies have demonstrated that it helps to reduce costs because we see patients in a timely, proactive way, meaning that their problems don’t escalate to needing to be admitted to the hospital. There was a large national analysis of supportive care this past year which showed significant savings. In that study, across 8 cancer centers over 12 months, there was an 8.5-million-pound savings through supportive oncology. If you [scale] that up across all cancer centers in the UK there is a [potential] savings of 500 million pounds to the NHS. We are working with the government and NHS England to get this rolled out nationally and an important part [of that rollout] is that we need to train clinicians on how to [deliver supportive care].

What will training in the supportive oncology program entail?

These clinicians will provide care across the whole cancer pathway, irrespective of disease stage. They’ll need training in the main areas of cancer care practice, such as acute oncology and managing pain and symptoms in a way that’s consistent with disease stage. How you manage a patient’s pain at the end of life, often using opioid therapy, is not the same as how you might manage pain in a patient who is living for many years with the disease and is not the same as how you manage pain in an individual who has survived cancer.

We’re all conscious of the opioid crisis, and we don’t want to have millions of people on high doses of opioids for years and years. We need to do the research and then train our clinicians on how to manage pain in people living for longer with the disease [and do the same] for other symptoms too. How you manage sickness at the end of life is not the same as how you prevent and manage sickness in people who are undergoing chemotherapy.

[Clinicians] will also need to understand endocrine problems, because many cancer treatments cause endocrine problems, and they’ll need to understand how to manage other treatment toxicities, particularly those associated with the newer treatments. One of the challenges is that there are new treatments coming out all the time and these doctors will need to be kept up to date. Our fellows [will also receive] psycho-oncology experience and will undergo training in how to [care for] older patients with cancer [with higher levels of] frailty.

[Clinicians] will be able to deliver care across the board and they’ll receive palliative and end-of-life care training too. It’s not too complicated, we’re doing this to make sure that we’re [ready for the] future and understand how to [care for] these patients. If we don’t do this, there’s going to be a public health crisis in the not-too-distant future.

What makes a fellow a good fit for this program?

[Potential fellows] need be a member of one of the Royal Colleges. We’ve [chosen to also include] general practitioners because whilst it’s important that supportive oncology is delivered in the cancer centers, it’s also important that general practitioners and community [clinicians] can continue to provide that care at home. Now, they don’t have much expertise in these areas. [We hope] that this will become a standard part of oncology and palliative care training.

Have there been any challenges in terms of launching the program?

One of the biggest challenges has been making it clear to the palliative care community what supportive oncology is because the terms supportive and palliative have always been put in the same box. Supportive oncology is a much wider [scope] than palliative care. The world is changing and there are these new cohorts of patients who need a different type of care.

The second challenge is that there needs to be some national driver for change. Without that, [cancer centers] are not going to [offer supportive oncology services] unless they’re interested. Cancer centers need to deliver supportive oncology because it’s needed. This care is essential alongside treatment.

What are the next steps for further implementing and expanding the supportive oncology program?

It’s encouraging that the Royal Colleges in the UK are hugely supportive of it. The hope is that supportive oncology becomes a recognized medical specialty in the future; it’s going to have to be because there will always be individuals who need this type of care.

A new type of cancer care doctor is born. News release. The Christie NHS Foundation Trust. January 13, 2025. Accessed February 10, 2025. https://www.christie.nhs.uk/about-us/news-at-the-christie/latest-news-stories/a-new-type-of-cancer-care-doctor-is-born

New supportive oncology service launched at The Christie. News release. The Christie NHS Foundation Trust. October 8, 2024. Accessed February 10, 2025. https://www.christie.nhs.uk/about-us/news-at-the-christie/latest-news-stories/new-supportive-oncology-service-launched-at-the-christie

The Christie NHS Foundation Trust has created a supportive oncology program to train fellows and offer services for patients living with cancer.

Vol. 17 Num. 1 | Oncology Fellows

Survey Identifies Factors Most Important to Fellows When Selecting a Career Path

A Career in Clinical Development in Industry: Choose Your Own Adventure

Fellows Present Their Findings on the Breast Cancer Immune Microenvironment and Telehealth Delivery at National Fellows Forum

Novel Curriculum Aims to Address Burnout and Foster Wellness Among Fellows

Chaos: Friend or Foe?

First-of-Its-Kind Supportive Oncology Program Offers Unique Training Opportunity for Fellows