Eight in ten young oncologists in Italy show signs of burnout, according to 2025 data from AIOM, the Italian Association of Medical Oncology. The problem is not purely organizational. Among the main contributing factors: difficulty managing communication with patients and families, and a lack of tools for handling the emotional weight of clinical practice. This is where psycho-oncology training becomes essential.
Psycho-oncology integrates psychological and medical expertise to understand and address the emotional, relational, and behavioral dimensions of cancer. It is quietly reshaping how future specialists are trained, not by adding another module to an already crowded curriculum, but by rethinking medical education around the therapeutic relationship itself.
We spoke with Prof. Valentina Di Mattei, Associate Professor of Dynamic Psychology at Vita-Salute San Raffaele University (UniSR), coordinator of the Clinical Health Psychology Service at IRCCS San Raffaele Hospital, and President of the Lombardy Order of Psychologists.
What psycho-oncology is and why medical training needs it
Psycho-oncology addresses the psychological impact of cancer on patients, families, and healthcare professionals. In Italy, the field has a well-established history: the Italian Psycho-Oncology Society (SIPO) has been active since 1985, and in 2019 the Presidency of the Council of Ministers formally recognized the psycho-oncologist as a member of the multidisciplinary team within the national oncology network.
Yet this dimension remains peripheral in most specialist training programmes. Medical residencies in oncology focus, understandably, on diagnosis, staging, pharmacological treatment, and follow-up. Psychological and relational skills are acquired mainly on the job, often without supervision or structured reflection.
«Psycho-oncology addresses the patient, the family, and the healthcare team, with the goal of improving quality of life and supporting the care pathway», says Prof. Di Mattei. The scope is wider than the phrase suggests: training in this field is not about learning to “communicate better.” It is about building a model of care that holds together the physical, psychological, and relational dimensions of the patient’s experience.
Communicating a cancer diagnosis as a clinical skill
One of the most concrete tests of psycho-oncology training is the communication of a cancer diagnosis. Research consistently shows that how this conversation is handled affects treatment adherence, the patient’s capacity to process what is happening, and their overall psychological wellbeing. AIOM’s updated 2023 guidelines on communication in oncology stress that this is not a skill acquired once during basic training, it must be continuously developed through structured engagement with real clinical experience.
In practice, communicating a cancer diagnosis is far more than conveying a test result. It requires calibrating language, respecting the patient’s pace, and managing one’s own emotional response to suffering. «It is essential to create a relational space that allows the patient to understand, ask questions, and begin processing what has been communicated», observes Prof. Di Mattei.
This is where clinical psychology in oncology directly enters the picture. The ability to read what is happening beneath the surface of the therapeutic relationship - defensive reactions, projections, family dynamics that shape treatment decisions - is what distinguishes a technically competent oncologist from one who can navigate the emotional complexity of cancer care.
Burnout in oncology: a problem that training can address
The data on burnout among oncologists is unambiguous. An ESMO survey of 737 professionals across 41 European countries found burnout signs in 71% of oncologists under 40. In Italy the picture is sharper: AIOM estimates that eight in ten young oncologists are affected, with symptoms including anxiety, loss of motivation, declining self-esteem, and (in 25% of cases) serious consideration of leaving the profession.
The causes are multiple: excessive administrative burdens, understaffing, time pressure. But one contributing factor is consistently underestimated: the absence of tools for managing the emotional impact of the work. Daily exposure to suffering, death, and high-stakes therapeutic decisions demands skills that cannot be improvised.
«Managing one’s own emotional involvement is not an optional extra, it is a clinical competency in its own right», says Prof. Di Mattei. The ESMO Resilience Task Force, in its 11 recommendations published in 2024, identifies training as one of the key levers for addressing the phenomenon. This is where psycho-oncology training shows its most tangible value: it creates space for supervision, team-based working, and structured case discussion, the conditions that allow clinicians to sustain their practice over time.
Dynamic psychology and oncology: reading the therapeutic relationship
The contribution of dynamic psychology to oncology extends beyond stress management. It is an approach that makes visible what is happening beneath the surface of the doctor-patient relationship: the defenses the patient activates after a diagnosis, the identification mechanisms that arise when a clinician confronts another person’s suffering, the family dynamics that influence treatment decisions.
In psycho-oncology training, this translates into concrete tools: clinical simulations, role-playing exercises, supervised case review. The goal is not to turn oncologists into psychotherapists. It is to give them a framework for reading relational dynamics: one that makes their clinical work more effective. «It is not only about learning what to say, but how to be present in the therapeutic relationship, especially when intense emotions are in play», observes Prof. Di Mattei.
This type of training also improves early detection of psychological distress signals in patients: social withdrawal, difficulty adhering to treatment, mood changes. Recognizing these signals early enough to refer to a specialist is what enables genuinely integrated care.
How quality standards in oncology are shifting
The growing attention to psychological dimensions is not simply a response to professional needs. It reflects a broader shift in how care quality is defined and measured. Alongside traditional clinical outcomes (survival, treatment response, toxicity) the quality of the therapeutic relationship and the patient’s psychological wellbeing are gaining traction as meaningful indicators.
«Care quality will be assessed not only in terms of clinical outcomes, but also in terms of relational quality», says Prof. Di Mattei. Several institutions are already moving in this direction: the Italian National Oncology Plan and SIPO guidelines both include the psychosocial dimension among the parameters of good oncological practice.
For those training in oncology today, this means that relational competency is no longer an optional enhancement for the personally inclined. It is a structural component of expected professional competence. This is also why psycho-oncology training is beginning to appear in the criteria used to assess specialist preparation. A physician who cannot manage the communication of a cancer diagnosis, who fails to recognize signs of psychological distress in a patient, who has no tools to protect their own emotional equilibrium… That physician is professionally incomplete, regardless of technical expertise.
A training model that puts disciplines in dialogue
The challenge of psycho-oncology training, ultimately, is bringing into conversation fields that academic tradition has kept apart: medicine and psychology, clinical practice and relational skill, technical knowledge and the capacity to listen. Investing in this direction is not following a trend — it is responding to a documented need. Professionals with stronger relational tools provide better care and remain longer in the profession.
«Psycho-oncology integrates psychological and medical expertise to understand and address the emotional, relational, and behavioral dimensions of cancer», says Prof. Di Mattei. That integration must begin in training, before clinical practice starts. UniSR, through the presence of Dynamic Psychology within its curriculum and the Clinical Health Psychology Service at IRCCS San Raffaele Hospital, is among the environments where this dialogue is already underway.
For anyone choosing a medical residency or continuing professional development in oncology, the question is no longer whether psycho-oncology training is useful. It is whether the programme they are considering has integrated it structurally or left it to chance.
