A day in the life of a Clinical Oncology specialty registrar

8.30am: Urology multidisciplinary team (MDT) meeting alongside my consultant, urologists, radiologist, pathologist and nurse specialists. An interesting case was a patient with potentially curative prostate and lung cancers and the discussion focused on how to potentially treat both cancers successfully. Other cases included patients with medical comorbidities and we discussed which of several treatment options might be the most appropriate to discuss with the patients.

9.30am: Urology outpatient clinic, which was a combination of follow up and new patients. Most of the follow up patients were doing well and their prostate cancers appeared to be under control following radiotherapy or brachytherapy. It was great to see how pleased they were with the successful care that they had received. There were some patients with metastatic cancers receiving novel hormone therapies and chemotherapy and these discussions involved checking how they were tolerating their treatment and whether it seemed to be working. Finally we saw patients newly diagnosed with prostate and bladder cancers. Before each patient we reviewed their radiological imaging and tumour biopsy result and decided on what treatment options they potentially had available. These consultations focused on assessing the patients’ fitness for radiotherapy, hormone therapy and chemotherapy treatments and carefully explaining what the treatments would involve and the potential side effects.

12.30pm: Reviewed a patient receiving radiotherapy for bladder cancer who’s bladder appeared too large to fit in their radiotherapy treatment field because they were retaining urine as a side effect of their treatment. I reviewed the scan that had been done on the radiotherapy treatment machine and assessed the patient before deciding that they needed a catheter. This successfully drained their bladder and they could continue with their radiotherapy.

1.30pm: Radiotherapy planning session with my consultant. This involved using computer software to determine how best to deliver the patients’ radiotherapy treatment. There were several cases to plan including a patient with a painful bone metastasis in the hip that would likely be symptomatically improved with a single radiotherapy treatment and patients where radiotherapy had a great chance of curing their prostate cancer. For these cases I used their diagnostic imaging to create three dimensional radiotherapy treatment volumes that included the prostate gland and the cancer but excluded their bladder and rectum. We also prescribed radiotherapy treatments that had already been planned after checking that the doses that were to be delivered appeared appropriate.

3pm: Joined one of the other consultants in the brachytherapy suite to observe placement of radioactive seeds using image-guided needles into the prostate gland under general anaesthesia. After I have observed a few cases I will have the opportunity to train in this form of advanced radiotherapy.

4.30pm: Returned a telephone call to a patient having symptoms of hot flushes with their hormone therapy for prostate cancer and discussed the options they had to help manage this potentially distressing side effect.

5pm: On call this evening so I joined the on call consultant in reviewing the patients who had attended the oncology assessment unit and those who had been admitted to the ward. We were able to discharge some patients and made an appropriate management plan for a young woman with breast cancer and chemotherapy-induced neutropenic sepsis. She was unwell and we liaised with the critical care team to ensure she was appropriately managed. We also saw a patient with malignant spinal cord compression and put in place a plan for them to receive urgent radiotherapy the next day.

9pm: Home time after a busy, but varied, interesting and rewarding day!