Why choose a career in clinical oncology?
Authors: Sally Appleyard, Samantha Cox
Publication date: 28 Nov 2017
Sally Appleyard and Samantha Cox explain what clinical oncology involves and consider why trainees might want to choose to specialise in this evolving branch of medicine
Clinical oncology is the non-surgical management of cancer. It encompasses patients with potentially curable disease through to those receiving palliative treatments aimed at improving symptoms. Clinical oncologists use both radiotherapy (x rays targeted at the tumour) and systemic treatments, including chemotherapy, endocrine treatments, and the more novel immunotherapies and small molecule drugs. They are distinct from medical oncologists who use only drug treatments. Clinical oncology—which requires excellent communication and team working skills—focuses on the holistic care of each patient.
Clinical oncology is an exciting, rewarding, and rapidly evolving branch of medicine. State-of-the-art radiotherapy technologies and the increasing use of new drugs specific to the patient’s tumour are resulting in better clinical outcomes. The specialty is evidence based, which means a commitment to continued learning as well as a good grounding in general medicine. There is ample opportunity to attend stimulating and motivating meetings and conferences.
As the number of patients being diagnosed and living with cancer increases, there is a growing need for clinical oncologists. Oncologists are members of a number of multidisciplinary teams in a variety of clinical settings, which makes for an interesting and diverse working week with the majority of work taking place in the outpatient setting.
Clinical oncologists must assimilate large amounts of information to make appropriate management plans. Decisions to withdraw treatment and breaking bad news are challenging aspects of the job, requiring compassion and empathy. But there is a strong network of support within teams and a healthy work-life balance.
Career pathway, training, and exams
A national central recruitment process takes place twice a year. Clinical oncology is a five year training programme, running from the third year of specialty training (ST3) to the seventh year, following 24 months’ experience in medical specialties (core medical training or acute care common stem). Membership of the Royal College of Physicians (MRCP) is a prerequisite. Six monthly rotations offer experience in the major cancer subsites. A significant proportion of trainees work less than full time for all or part of their training. On-calls tend to be non-resident and include managing oncological emergencies and complications of treatments.
Clinical oncologists are fellows of the Royal College of Radiologists. The part 1 membership examination is usually taken at the end of ST3 and is similar to the MRCP part 1 examination with multiple choice question papers covering cellular and radiobiology, physics, pharmacology, and statistics. It is achievable following completion of a recognised course, a variety of which are available around the UK. Part 2 is taken after the fifth year of specialty training and includes two single best answer papers covering clinical cases, followed by a viva and objective structured clinical examination. Although the exams do require a lot of work, good local and regional training is provided and the curriculum is relevant to day-to-day clinical practice.
Out of programme opportunities
Clinical oncology trainees are encouraged to take advantage of out of programme opportunities. This may be laboratory or clinically based research (clinical trials, drug or radiotherapy development, or quality of life studies), potentially leading to an MD or PhD. Most oncologists are regularly exposed to research by recruiting patients into trials but time out of programme allows the development of more specific skills. Trainees can also undertake fellowships elsewhere in the UK or overseas—in order to learn specific radiotherapy techniques, for example. Academic clinical fellowship posts are available and follow a separate application process, but research opportunities are by no means restricted to them.
How to maximise your chances of success
The person specification offers a detailed description of the desirable and required attributes of potential candidates. Use it as a checklist to identify areas of knowledge or skills that you may need further experience in.
Although a post in oncology is desirable, there are many ways to demonstrate specialty commitment. For instance, voluntary presence at multidisciplinary team meetings, arranging a taster week, or completion of a cancer related audit will be recognised. Even for those with a senior house office job in oncology, the experience as a specialty registrar and consultant is very different (and generally less depressing) and so making the effort to attend clinic is essential. Experience in teaching and management is also important.
In 2016, there were 116 applicants for 62 national training numbers and two locum appointments for training positions. Of those 116 applicants, 98 were deemed appointable. In total 56 posts were filled (79% of those available).
You can speak to oncology specialty registrars to find out who the local college tutor is, as they are likely to be the best person to arrange a taster week. Academic clinical fellows can apply through their deanery, but it is worth looking at the Royal College of Radiologists website for advice on academic careers.
A day in clinical oncology
8.00 am Regional upper gastrointestinal multidisciplinary team meeting: discussion of patients being considered for neoadjuvant therapies before definitive surgery for oesophageal/stomach cancers
9.00 am Radiotherapy planning meeting: review of radiotherapy outlining cases with consultants before submission to physics team for planning; planning of new cases using diagnostic investigations and computed tomography simulation to create radiotherapy volumes
12.30 pm Local multidisciplinary team meeting, followed by lunch: discussion of patients under investigation with possible upper gastrointestinal malignancies
2.00 pm New patient and follow-up clinic
5.00 pm Final jobs of the day: chasing of bloods, requesting chemotherapy or radiotherapy for new patients, return telephone call to a GP about a patient on chemotherapy
5.15 pm Home
Useful further information
Person specification: [Link]
Royal College of Radiologists: [Link]
London and South East recruitment (coordinators of national recruitment): [Link]
We have read and understood BMJ’s policy on declaration of interests and declare that we have no competing interests.
Sally Appleyard clinical research fellow in clinical oncology
Brighton and Sussex University Hospitals NHS Trust
Samantha Cox specialty trainee year 6 clinical oncology South West Wales Cancer Centre, Singleton Hospital, Swansea