How Your Oncologist's Experience Shapes Your Cancer Treatment
The same cancer, the same stage, a different treatment plan. Why does this happen? The answer may lie not just in the disease, but in the individual experiences of the oncologist crafting the cure.
A cancer diagnosis sends a patient on a complex medical journey, one navigated with the help of an oncologist. While we trust that treatment follows a standard, evidence-based path, a growing body of research reveals a surprising variable: the treating oncologist's own clinical experience. This article explores how an oncologist's professional journey—from years in practice to their personal views on treatment benefits—creates a hidden layer of variation in cancer care, influencing the very decisions that can determine a patient's quality of life and survival.
Medical decisions, especially in high-stakes fields like oncology, are not made in a pure vacuum of objective data. They are filtered through the lens of a physician's individual judgment. A pivotal qualitative study that interviewed medical oncologists in England uncovered that a significant amount of variation in end-of-life cancer treatment could not be explained by clinical differences or patient preferences alone 1 3 .
Each oncologist holds a personal, and often subjective, interpretation of what constitutes a "meaningful" treatment benefit 1 .
The number of years and cases an oncologist has managed shapes their approach to aggressive versus palliative strategies 1 .
A study of nearly 18,000 patients revealed the treating oncologist was a major predictor of end-of-life treatment 7 .
This qualitative insight helps explain the findings of a powerful quantitative analysis of U.S. healthcare data. A study of nearly 18,000 patients who died of cancer revealed that the identity of the treating oncologist was a major predictor of whether a patient received systemic therapy in their last 30 days of life 7 .
To understand the real-world impact of this phenomenon, let's examine the crucial experiment based on the analysis of Medicare SEER data.
To determine how much the individual treating oncologist influences the rate of systemic therapy administration in the last 30 days of a patient's life.
The research team analyzed Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare claims from 2012 to 2017. They identified 17,609 patients who died from lung, colorectal, breast, or prostate cancers and traced them back to their 960 treating oncologists. Using multilevel models, they estimated the rate at which each oncologist provided end-of-life cancer therapy and ordered these rates into percentiles for comparison 7 .
The core results, summarized in the tables below, highlight the dramatic variation in practice patterns.
Source: Adapted from George et al. Analysis of SEER-Medicare data 7
4.5x
Greater odds of receiving end-of-life treatment when cared for by a high-prescribing oncologist (75th+ percentile) compared to a low-prescribing oncologist 7 .
The scientific importance of this experiment is profound. It moves beyond simply identifying variation in care and pinpoints the treating oncologist as a significant independent factor. This suggests that the quality of end-of-life care—specifically the avoidance of potentially futile and toxic treatments—is not solely determined by the cancer's biology or the patient's wishes, but also by the practice patterns of the doctor they happen to see 7 .
The challenges of variable treatment decisions and the explosion of complex medical data have necessitated new tools and team structures in oncology. The following details the essential components of a modern, Multidisciplinary Team (MDT) and Precision Oncology Program, which are designed to standardize care and leverage specialized expertise 5 9 .
A multidisciplinary meeting where experts review complex genetic data from a patient's tumor to recommend targeted therapies or clinical trials 5 .
Works at the intersection of inherited and acquired mutations; counsels patients on the implications of genetic test results for them and their family 5 .
Advises on treatment selection and dosage adjustments based on how a patient's genes may affect their response to specific drugs 5 .
Often an oncology nurse practitioner or physician assistant who plays a key role in patient communication, symptom management, and survivorship care 4 .
Critical for seamlessly embedding genomic test results and clinical decision support tools into the oncologist's workflow 5 .
Recognizing the problem of individual variation is the first step toward a solution. The field of oncology is actively evolving to create systems that mitigate unwarranted practice pattern differences while simultaneously personalizing care for each unique patient.
Single oncologist making treatment decisions based primarily on personal experience and training.
Collaborative approach with multiple specialists reviewing cases to develop consensus treatment plans 1 9 .
The discovery that cancer treatment varies with the experience of the treating oncologist is not an indictment of the profession, but a reflection of its human element. Medicine, particularly in complex fields like oncology, involves navigating uncertainty and making difficult judgment calls.
The future of high-quality, patient-centered cancer care lies in creating structures—like multidisciplinary teams and precision medicine protocols—that support these decisions. By combining advanced data with collective clinical wisdom, we can ensure that every patient receives the most consistent, effective, and personalized care possible, no matter which oncologist they see.
I hope this article has provided you with a deeper understanding of the complexities of cancer care. If you have personal experiences or thoughts on this topic, please share them in the comments below.