What is Clinical Oncology?
Clinical Oncology is the non-surgical management of malignant disease, using both radiotherapy and systemic therapy (chemotherapy, immunotherapy, hormone therapy and biological agents). Managing cancer in all its various forms requires an enquiring mind, excellent communication skills, a secure general medical background, good practical skills and a real commitment to patient care.
Clinical oncology is a clinically focused specialty, with much of the working week spent in direct patient contact in outpatient clinics and on the wards. However, the challenging nature of the diseases that are treated means that using and contributing to research through clinical trials or translational research is integral to patient management. A period of time in research or other out of programme experience during training is actively encouraged and may lead to a higher degree. Teamwork is crucial; all clinical oncologists work in multidisciplinary teams which may include specialist nurses, radiographers, radiation physicists, surgeons and other clinicians, all of whom must integrate and communicate effectively. Good communication skills are essential, both to patient management and to teamworking.
During specialist training, success must be achieved in the Fellowship Examination of The Royal College of Radiologists (FRCR). The First FRCR Examination covers the basic cancer sciences of medical physics, medical statistics, radiobiology, cell biology and clinical pharmacology. It is usually taken after the 1st year of specialist training. Most trainees are ready to sit the Final FRCR Examination two years later having learnt the basic management of most common and some less common malignant diseases. The final phase of training after the FRCR Examination allows the trainee to broaden and deepen his or her experience, and also provides time for research and gaining the management skills that are so important to a career as an NHS consultant. The indicative total duration of training is five years (or the whole-time equivalent if training is undertaken on a less than full-time basis).
Clinical Oncology is a fantastic specialty that is varied, interesting, rewarding and exciting.
It involves close multidisciplinary team working with surgeons, physicians, radiologists, pathologists and nurse specialists to determine the best treatment plan for each patient.
There is further collaboration with medical physicists, radiographers, chemotherapy nurses and palliative care teams to administer radiotherapy and systemic anticancer therapies, and supportive measures to manage symptoms of the patient’s cancer and side effects of their treatment.
Most clinical oncologists sub-specialise in two disease sites and the work is predominantly outpatient-based and utilises general medical and surgical skills alongside interpretation of radiological imaging and laboratory investigations. Passing the exams to become a Fellow of the Royal College of Radiologists provides a framework for specialty registrar training and delivers the skills and confidence to take up a consultant role.
Radiotherapy is an essential anticancer treatment that can cure many different cancers in itself and also as part of a multimodality treatment strategy alongside surgery and chemotherapy. It is also a crucial treatment used in the control and palliation of incurable disease. There are currently exciting developments in the field of technical radiotherapy including MRI-based radiotherapy planning, advanced brachytherapy and new methods of delivering radiotherapy including highly-focused stereotactic treatments and proton beam therapy.
There are also new developments in systemic anticancer treatments including harnessing the patient’s own immune system against the cancer using immunotherapy, as well as novel therapies targeted specifically against cancer cells.
Clinical oncologists really get to know their patients throughout the course of their treatments and develop excellent communication skills used to discuss complex information about the management of their cancer, which may involve breaking bad news. There is the support of excellent colleagues including nurse specialists for these difficult conversations, and most clinical oncologists find that managed well these interactions can be a very rewarding part of the job.
Many clinical oncologists combine their clinical practice with research, medical education and roles in medical leadership in departmental management and on national committees, which further contributes to the variety of the job.
Clinical oncologists tend to be friendly and helpful doctors who contribute to a pleasant working environment and who prioritise the needs of patients and the support of their colleagues.
If you chose to train in Clinical Oncology, you will not be disappointed!