Should You Become an Oncologist? An Honest Letter to Kenyan Medical Students

What our new study found — and what the numbers don’t tell you

A few months ago, in a clinic room in Garissa, I sat across from a man who had travelled two days to see me. He had been swallowing with difficulty for eight months. By the time he reached me, his oesophageal tumour had grown past the point where cure was possible. We talked, in Somali, about what could still be done — and what could not.

There are fewer than 100 practicing oncologists for more than 50 million Kenyans. That man’s two-day journey is arithmetic, not misfortune.

So when my colleagues and I set out to survey final-year medical students across Kenya, we were not asking an academic question. We were asking: who is coming?

The answer, now published, is complicated. And if you are a final-year student or a young medical officer weighing your options, I think you should know what we found — including the part that surprised us most.

We surveyed final-year medical students across Kenyan medical schools between April and May 2025 and analysed 88 responses. The headline number: 25% would consider oncology, 51% said maybe, and 24% said no.

That half-in-the-middle is the most interesting group in the entire study. Fifty-one percent of the next generation of Kenyan doctors have not ruled out oncology. They simply do not have enough information to decide.

And they are not deciding in the abstract. Seventy-seven percent had a close friend or family member diagnosed with cancer. Sixty-one percent said that experience shaped how they saw the specialty. This is not a cohort choosing between equally distant options — most of them have already sat in a waiting room with someone they love.

But look at what they knew:

• 53% were unsure how many cancer cases Kenya sees each year. (It is roughly 44,700, with about 29,300 deaths.)

• Only 42% knew that postgraduate oncology training exists in Kenya — despite 84% knowing oncology is a recognised specialty here.

• Only 30% had attended any oncology workshop or seminar, even though 73% had done a clinical rotation.

• 86% said undergraduate oncology training should be strengthened.

Read that again. A quarter of final-year students do not know they can train in oncology in this country. That is not a motivation problem. That is a signposting problem, and it is fixable this year.

Here is where the study got uncomfortable.

We tested which factors predicted interest in an oncology career. Clinical rotation? Not significant. Workshop attendance? Not significant. Personal experience with cancer? Not significant. Awareness of training pathways? Not significant.

Nothing we measured predicted whether a student wanted to become an oncologist.

What exposure did predict was competence. Students who completed an oncology rotation were significantly more confident managing cancer patients in the future. Students who attended workshops knew more. Students who rated their curriculum highly were far more confident.

So exposure builds capability. It does not build desire.

I have thought about this a great deal since. I believe the explanation is in the deterrent data: emotional burden (25%), patient suffering (22%), and lack of mentorship (16%) were the top three reasons students backed away.

A rotation shows you the suffering. It does not show you how anyone survives it.

If you spend six weeks on an oncology ward watching patients present at stage IV, watching families sell land for treatment, watching a consultant see forty patients in a day — and nobody sits with you afterwards and explains how they have done this for fifteen years without being destroyed by it — you will conclude, rationally, that this specialty will consume you.

The rotation is not the intervention. The mentor is.

Let me tell you what I would want to know at your stage.

You become useful faster than in almost any other specialty. Cancer medicine in Kenya is not saturated. There is no queue of people ahead of you doing what you want to do. When I started at Garissa, I was the first oncologist practising in northern Kenya. That is not a boast — it is an indictment of the system. But it means the distance between your training and your impact is very short.

The intellectual work is serious. Oncology sits where molecular biology, statistics, ethics, and communication meet. You will read trial data critically for the rest of your career. You will make decisions under genuine uncertainty. If you are the kind of doctor who finds algorithms boring, this is your field.

You can build things that do not exist. Registries. Screening pathways. Palliative services. A tumour board where there was none. In a mature system, you inherit structures. Here, you construct them. That is rare, and it is a privilege that comes disguised as a burden.

The relationships are unlike anything else in medicine. You will know some patients for years. You will meet their children. In a country where a cancer diagnosis is still viewed by roughly a third of the population as a death sentence, the person who explains, patiently, in the patient’s own language, what is actually happening — that person matters enormously.

The need is not speculative. It is here, it is growing, and it is currently unmet.

I will not soften this.

You will lose patients who were curable somewhere else. This is the hardest part and it does not get easier. A woman with early breast cancer who presents at stage IV because she could not afford transport, or was told to try herbal treatment first, or was misdiagnosed twice — she would have lived in Nairobi, or in Toronto. You will carry that.

You will ration. Openly. You will have conversations about what a family can afford that no textbook prepared you for. In our national benefit design, a single course of one targeted drug can consume close to a household’s entire annual health cover. You will make those calculations out loud, with the patient in the room.

The volume is punishing. Oncologists in Africa see a median of 325 new patients a year, against 175 elsewhere. Nearly a third see over 500. This is not a specialty where you drift.

Training pathways are thin and often require leaving. Local programmes exist and are growing, but the fellowship landscape is uneven and many people still train abroad. That has costs — financial, and personal.

Research is structurally hard. Our own multi-country survey of African oncology professionals found that funding difficulties were near-universal, most rated institutional research infrastructure inadequate, and the majority found publication difficult, largely because of article-processing charges. If you want an academic career, you will fight for it.

The emotional load is real, and largely unsupported. There is no institutional debriefing structure. There is no protected time for grief. Whatever sustains you, you will have to build yourself.

Find one oncologist and ask them a direct question. Not “can you mentor me” — that is a large request of a busy person. Ask something specific: how did you choose this? Most of us will answer. Our study found mentorship was simultaneously the second-highest deterrent when absent and the joint-highest suggested solution when present. The asymmetry is entirely in your favour: almost nobody asks.

Join AORTIC and KESHO (Kenya Society for Hematology and Oncology). Student and trainee membership is inexpensive and it connects you to the continental oncology community — conferences, abstract opportunities, collaborators, and people at every career stage. For an isolated trainee, a regional network is worth more than an institutional one.

Do one audit before you finish internship. An audit. Pull the last hundred cancer records at your facility and describe them: stage at presentation, time to diagnosis, treatment completion. This is publishable, it is genuinely useful, it costs nothing, and it teaches you more about your health system than any lecture.

Learn to publish without money. There are good journals that charge nothing at all. Waivers exist for many others. This is knowable information, and almost nobody tells students it exists.

Visit a regional centre, not just a national one. Kenyatta National Hospital will show you tertiary oncology. Garissa, Nakuru, and Mombasa cancer centres will show you what oncology actually looks like for most Kenyans. Both are worth seeing before you decide.

Do not decide alone at 3 a.m. after a bad ward round. The 51% who said “maybe” are not indecisive. They are under-informed. Go get the information.

The man or the elderly lady who travelled two days got a cancer diagnosis in his own language, from someone who understood why he had waited, in a town (Garissa) where — a few years ago — there was nobody to see him at all.

That is a triumphant story.

But there is a version of Kenyan oncology in fifteen years where he will present at stage I, close to home, and lives. That version does not build itself. It gets built by people who are, right now, in their final year of medical school, wondering whether this is too hard.

It is hard. Come anyway.

The full study is available open access on PubMed Central: Baseline knowledge, attitudes and perceptions on the oncology profession among final-year medical students in Kenya. My thanks to my co-authors and to the 88 students who responded.

If you are a Kenyan medical student or intern with questions about oncology training, my inbox is open.

About the Author

Dr Omar Abdihamid, Clinical oncologist and Research fellow.

Vice President of the African Organization for Research & Training in Cancer

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