The highs and lows of medical oncology
Charlotte Benson is a consultant medical oncologist
Charlotte Benson is a consultant medical oncologist at the Royal Marsden hospital in London—the world’s first cancer hospital—specialising in the treatment of soft tissue sarcomas with systemic therapy, including chemotherapy and targeted agents. In her spare time, she is a keen runner and in 2010 single handedly raised almost £1000 for the Royal Marsden cancer campaign.
I’m not from a medical background, but from a young age I had a real interest in science and nature. I initially thought about being a marine biologist or vet, but finally decided on medicine. Being a contrary person I also liked the idea of doing something different to the rest of my family.
Could you tell us about your training to become a medical oncologist?
My training began as a student at Liverpool University, which I enjoyed very much. I think I knew even then I wanted to be a physician because I was interested in all aspects of general medicine and was spurred on by inspiring teaching. I had little exposure to oncology at medical school, however, only about two weeks.
My house jobs in Liverpool were busy with many admissions and tough on calls, but gave me a firm foundation in general medicine, which is particularly helpful for oncology. I then moved to London and gained my MRCP.
For most of my specialist registrar years I was fortunate enough to train flexibly as a supernumerary trainee. This wasn’t easy to organise and I had to fight hard for funding, but it gave me an excellent opportunity to look after my young children and also have a fantastic career.
Were there barriers getting back into medicine after maternity leave?
I have three children, and it was difficult because the flexible training route was still uncommon then, but is now becoming more recognised. You do feel like you have to prove yourself and you need to be motivated, as well as organised so you can get home for the nursery pick-up. I’m not saying it’s easy but it can be done.
What are the best and worst aspects to oncology?
One of the best bits is getting to know your patients well at a potentially stressful time. Patients often come in regularly for review, and to work with them is a special privilege. I have also been fortunate enough to be working during a time of many advances in medical oncology, and through clinical trials have witnessed the huge improvements these have made to patient outcomes.
Despite all the advances that are coming through we do not have all the answers, and having end of life discussions can be hard. Working in soft tissue sarcoma we see a lot of young adult patients, which is particularly difficult, but these discussions are tough in patients of all ages.
Is the emotional side ever too much?
It is difficult. You can’t become emotionally involved with every case; otherwise you wouldn’t be able to function well as a doctor. We are supported well and make a lot of decisions as part of a multidisciplinary team, which helps share the burden of difficult decision making. Work-life balance is important to make sure you don’t get burnt out.
I did my specialist registrar sarcoma job at the Royal Marsden towards the end of my training. I was struck by how many types of soft tissue sarcoma there were and the challenges in treating these patients who had varying disease types and were of all ages.
As a junior, at first I found it a challenging job particularly because the patients, having such rare diseases, were more expert in their disease than me. Decision making can also be tricky because there is often little to guide you in the literature. I was, however, impressed by the ethos of the hospital and their fantastic staff.
Initially I did a period of research with Professor Ian Judson, who at that time was also working on Phase I clinical trials (early drug development trials looking at new agents) for many cancers—including sarcoma. Meeting Judson made a big impression on me—and he has remained my mentor ever since—but it was only later when I worked with him again, that I realised what an interesting and unique challenge working in the field of sarcoma was.
We now know there are over 50 sarcoma subtypes and there is no one-size-fits-all treatment. With our new understanding of the molecular pathways, we can use tailored approaches for each subtype rather than simply applying the standard treatment for the “same cancer” as has previously been the case for many common malignancies, although this is changing rapidly now too. In sarcoma it is about applying the right treatments for each individual patient. However, sometimes there might be no proven treatments for a particular subtype. The lack of evidence and treatment pathways can be very daunting, but now I recognise this as one of the enjoyable and thought provoking aspects of the job, as this prompts you to think creatively about the options you have available to try to make a difference.
What would be doing if you weren’t a doctor?
I love reading, so my fantasy job would probably be working in a bookshop. I’m sure the reality isn’t half as nice as it sounds though, and I wouldn’t like to have to compete with Amazon.
Any advice for medical students who want to pursue oncology?
Being a medical oncologist is a fantastic job: it’s rewarding with something for everyone. There’s scope for both clinical and laboratory based research, and the icing on the cake is getting to know patients to whom you can make a difference. If you are interested in oncology, it is worthwhile pursuing an elective at a tertiary centre like the Royal Marsden—the National Sarcoma Awareness Week offers some annual funded fellowships, which are worth keeping an eye out for.Alexandra Ho, final year medical student
1Imperial College London
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Cite this as: BMJ 2014;22:g1441