Maurice,

Many of the top oncologists I worked with were always optimistic and driven by concern for their patients. They were open to try out new new drugs to save the lives of their patients. High rates of failures of new drugs in cancer led to change in regulatory rules by the FDA and EMA to speed up testing of drugs from laboratory to clinics. NCI and EORTC played a key role along with Cancer charities and patient advocacy groups. There are several new exciting cancer drugs. The FDA has approved 7 new cancer drugs this year. The current success was build on lessons learned from failures of hundreds of new cancer drugs during the last 3 decades.

Krishan, you write "Several new drugs for cancer patients with gene defects like BRAF, Philadelphia chromosome or ALK+NSCLC have given high overall response rates including complete response, increased overall survival and progression free survival." But what does "high" or "complete" mean in terms of total disappearance of a cancer from the body of a patient and that there should be no worry that this cancer or some other cancer precipitated by utilizing this therapy will appear later in its place? I am sure that you are referring to a progression in the value of newer cancer drugs related to the older ones but can the newer drugs provide the oncologist with the basis to tell the patient "I can now cure you of your cancer"? And can the newer drugs provide the oncologists with the intellectual and emotional support to say to themselves "I feel comfortable within myself with what I told the patient and I feel wonderful that I am able now to cure and not simply to repeatedly try to prevent my patient from dying." ?

Kim,as far as I know, from my experience in medical school education, there is nothing taught to the students to be able to FULLY cope with a career filled with heavy work load, disruptions in their own family relationships and repeated failures to cure. What they are taught and experienced, in contrast, is the necessity to look at patients in a humanistic way as close individual human subjects and not as distant diseased objects. They are taught the value, personally to the doctor and the patient, of physician empathy with regard to the patient as a person and the patient's symptoms, if that can be accomplished. This then goes beyond simple "sympathy", like the words of interest and some support made by the patient's neighbor over the fence at home. All of these teachings are aimed to connect the physician closer to the patient and I am sure that when this closeness becomes patently unproductive in terms of the beneficial to the patient results, oncologists, in particular, will begin to feel depressed and wondering whether to continue with their profession and specialty. So I am back to my original question as to what keeps oncologists from becoming "burned out" and depressed about their life and the life of their patients. ..Maurice.

Krishan, but is that "anticipatory excitement" regarding the development of new drugs which will be safer and effective sufficient to increase adrenalin and be a significant morale booster despite their current workload and patient outcomes? I am not sure we can get an oncologist here on Medpedia, non-anonymously, to frankly tell us his emotions. ..Maurice.