Career: Facing the big C

CANCER 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: have good communication skills

• enjoy practising evidence-based medicine by analysing and adapting the results of research to optimise patient outcomes

• are interested in a broad spectrum of academic research, including basic and translational science and clinical trials

• can work as part of a multidisciplinary team.

Entry and training

Entry into training follows successful completion of both a foundation and core training programme. The two core training programmes for medical oncology are: core medical training (CMT) or acute care common stem (medicine; ACCS). Both lead to the attainment of MRCP(UK). This is followed by specialist medical oncology training leading to CCT. The minimum training period from ST1 is six years. Trainees must register for specialist training with the Joint Royal Colleges of Physicians’ Training Board (JRCPTB) at ST3.

Medical oncology is seen as an academic specialty and a significant proportion of trainees will take time out during training to do an MD or PhD, but this is not mandatory.

Entry into medical oncology is competitive and candidates should be able to demonstrate some specific interest in oncology. F1 and F2 and CT1 and CT2 posts are available in hospitals with oncology departments, and rotation through one of these posts during training gives an excellent insight into the specialty. It would also be useful to undertake a project pertinent to medical oncology, either an audit, publication or presentation at a local or national meeting. It is also helpful to speak with current medical oncology trainees and be aware of some of the research that underpins practice.

Sources/Further reading

• Medical Oncology. JRCPTB webpage

• The Association of Cancer Physicians

• Medical careers – medical oncology. NHS webpage

• Medical Oncology FAQs. Northern Ireland Medical and Dental Training Agency (NIMDTA).

• Specialty career profile. Payne, Sarah. RCP, 2011.

Q&A - Dr Adam Dangoor, medical oncologist at University Hospitals Bristol NHS Foundation Trust

What first attracted you to medical oncology?

I took rather a long time to make a career decision compared with current junior doctors. However, as early as house jobs, I found aspects of palliative care interesting and rewarding. Then I did an SHO job which included oncology outpatient clinics so gained an insight into what oncologists do, and enjoyed it. My subsequent experience as an SHO in oncology was not entirely satisfactory as the post was far too busy and disorganised; also on the ward you often see the patients who are doing less well. Fortunately it didn’t put me off!

What do you enjoy most about the job?

You get to know your patients well, as there is more continuity of care than in some specialties. They have a serious diagnosis but you can help to ease their symptoms and hopefully support them. You can sometimes cure, or at least prolong life, and really make a difference to patients and their families, which is very satisfying. Academically it is interesting with new advances that you can help bring to the clinic.

What do you find most challenging?

Obviously you are often dealing with patients with terminal illness and that can be tough but to a certain extent you get used to it. Unlike more sessional specialties, you have more irregular calls on your time – maybe review of patients on the ward, organising treatments and answering queries from patients, families and other doctors, outside your timetabled clinics. In addition of course you have to stay up to date in your field, which can be fairly fast moving. There are new treatments being developed all the time.

Has anything surprised you about the specialty?

I had quite a lot of exposure as a junior so knew basically what to expect. My period in lab research took me out of my comfort zone, and although I had a mixed experience, there are a variety of opportunities and many find it adds another facet to their career.

What do you consider the most important attributes of a good medical oncologist?

An interest in people, empathy, good communication skills, organisation and conscientiousness, an enquiring mind and positive attitude.

What advice could you offer to a final year or FY trainee considering medical oncology?

I always think people need to find a specialty that suits their personality. You should certainly try and get along to an oncology outpatient clinic or do a relevant post so you get an insight into the job. If you want to apply you need to try and make aspects of your portfolio relevant and show a genuine interest, as well as aptitude.