08 FYi • Career


FACINGBIG C C


THE


Medical oncology is a dynamic and evolving specialty, ever responsive to a changing evidence base


ANCER RESEARCH UK reports that nearly 331,000 people were diagnosed with cancer in 2011, an average of around 910 new cases a day. More than one in three people in the UK will develop some form of


cancer in their lifetime with more than a third diagnosed in patients aged 75 and over. A growing elderly population leads to one


obvious conclusion – the burden of disease represented by cancer poses a major challenge to the NHS in the future. And this has, in turn, led to high levels of government funding for clinical and research posts in medical oncology. Medical oncology deals with the diagnosis, assessment, treatment and management of cancer patients. It is a dynamic and rapidly evolving specialty focused on systemic therapies such as chemotherapy, endocrine therapy, biological therapy, immunotherapy, hormonal therapy and other novel approaches designed specifically to target “dysregulated” pathways in the cancer cell. The specialty is distinct from clinical


oncology which also covers the therapeutic administration of ionising radiation (radiotherapy) and whose practitioners are members of the Royal College of Radiologists. Medical oncologists are members of the Royal College of Physicians (RCP) and the specialty arose originally at academic centres where


medical oncologists were often involved with translating advances in the laboratory to the clinic. Latterly, the two specialties have moved closer together and there are academic clinical oncologists and medical oncologists at district general hospitals. Treatment aims in medical oncology may be


curative but can also involve palliation and prolongation of good quality life. Medical oncologists will discuss treatment options with patients, supervise therapy and manage any complications of both the disease and treatment. Often patients will have undergone surgical treatment but require further therapy to improve their prognosis. The job involves close team working with surgeons, specialist physicians, clinical oncologists, radiologists, pathologists, clinical nurse specialists, research practitioners and palliative care physicians. Medical oncology as a specialty encourages


development in both clinical and academic medicine and because it is such an active area of research there is the necessity to regularly assimilate a changing evidence base.


The job


Most medical oncologists will be based in a cancer centre where patients commonly receive care in outpatient settings, such as clinics and day care wards. They will see new and follow-up patients for the organisation


and prescription of treatment and will also participate in inpatient ward rounds. Medical oncology consultants often specialise in the management of patients with specific tumour types and work in close liaison with site- specific medical and surgical teams. Medical oncologists are found primarily in


secondary care settings but there will likely be more direct liaison with primary care services in future if increasing numbers of patients are treated in the community. Acute oncology has recently emerged as a facet of some posts where oncologists get involved early in the management of patients recently admitted and diagnosed with cancer. This has led to an expansion of jobs in smaller hospitals and district general hospitals, previously only visited by oncologists from larger centres. Dealing with patients who have potentially


terminal illnesses can be challenging. A combination of empathy and sensitivity, coupled with a certain psychological “robustness” (which can be developed with experience) is necessary but helping such patients and their families can be extremely rewarding. An enquiring interest into the developments in the field is also essential to advance and optimise outcomes for patients. The RCP on its ST3 recruitment web page


states that medical oncology particularly suits trainees who:


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