Specialty spotlight – medical oncology

Medical oncologists are responsible for overseeing the treatment of patients with cancer. This involves discussing therapeutic options, supervising systemic treatments and supporting patients through their care. Patients are living longer with more complex treatments and therefore the specialty is one of the fastest growing. Most consultants will specialise in one to three tumour types, and acute oncology allows specialist input and advice to acutely unwell patients.

Dr Alison Jones and Dr Adam Januszewski discuss medical oncology, the training pathway, and what it is like to work in the specialty.

Medical oncologists are involved in the care of patients with cancer from first diagnosis through treatment to survivorship or transition to palliative care. It is therefore an extremely rewarding speciality where continuity of care means that medical oncologists are able to establish excellent relationships with their patients, often over many years.

Improving the survival of patients with cancer is a key role for medical oncologists and therefore patients will be on novel treatments and clinical trials. This makes clinical research an important feature and a significant proportion of trainees therefore undertake higher degrees. This can take many forms – including lab, translational or clinical trial-based research. As a result oncology is a dynamic and challenging speciality, which brings with it much variety.

Training in medical oncology involves rotating through and learning about the management of all the major types of cancer. This includes becoming competent in the supervision of systemic treatments, which incorporates chemotherapy, endocrine therapy and newer biological agents (such as antibodies and immunotherapy). Furthermore, with the multi-disciplinary approach of cancer care trainees learn the complex care pathways and multi-modality nature of treatments.

Dr Adam Januszewski 

National Institute for Health Research (NIHR) academic clinical fellow, specialist registrar in medical oncology

Training and working in medical oncology

Medical oncology resources

Consultant physicians working with patientsmedical oncology chapter (p153)

Clinical Medicine articles (CME sections in 2008 and 2014):

  • Berman R, Campbell M, Makin W, Todd C. Occupational stress in palliative medicine, medical oncology and clinical oncology specialist registrars. Clin Med 2007;7:235–42.
  • Payne S, Burke D, Mansi J et al. Discordance between cancer prevalence and training: a need for an increase in oncology education. Clin Med 2013;13:50–6.
  • Berger J, Cooksley T, Holland M. The burden of cancer on the acute medical unit. Clin Med 2013;13:457–9.
  • Neville-Webbe H, Carser J, Wong H et al. The impact of a new acute oncology service in acute hospitals: experience from the Clatterbridge Cancer Centre and Merseyside and Cheshire Cancer Network. Clin Med 2013;13:565–9.
  • Smyth E, Cunningham D. Gastrointestinal oncology – what you need to know. Clin Med 2012;12:575–579.
  • Ford A, Marshall E. Neutropenic sepsis: a potentially life-threatening complication of chemotherapy. Clin Med 2014;14:538–42.

CME oncology articles in Clinical Medicine (2008):

CME oncology in the emergency room articles in Clinical Medicine (2014):

Commentary article:

Future Hospital Journal article:

RCP resources

Ejournals and ebooks available online to members [email library@rcplondon.ac.uk for a password] include:

  • Ajithkumar T. Oxford case histories in oncology (Oxford : Oxford University Press, 2014)
  • Cassidy J (ed.) Oxford handbook of oncology (Oxford : Oxford University Press, 2011).

Books available by postal loan from the library include:

  • Bhattacharya, Madhumita (ed). Challenging concepts in oncology : cases with expert commentary (Oxford : Oxford University Press, 2015)
  • Ajithkumar T. Oxford case histories in oncology (Oxford : Oxford University Press, 2014)
  • Cancer patients in crisis : responding to urgent needs : report of a working party (Royal College of Physicians, 2012).
  • Ajithkumar T (ed). Oxford desk reference : oncology (Oxford : Oxford University Press, 2011).

The history of medical oncology through the library, archive and museum collections

An insight into the state of knowledge on cancer a century ago can be glimpsed in digitised items from the RCP library. These include Cancer of the Stomach by Mayo Robson AW (1907) and The natural history of cancer, with special reference to its causation and prevention by Williams W R (1908).

The RCP has a silver Comfort Crookshank Award for Cancer Research Medal that was presented in 1960 to Sir Charles Dodds FRCP (1899–1973). Sir Charles was a research based physician who dedicated himself to understanding the causes of cancer and its prevention. He was on many highly regarded committees such as the Cancer Research Campaign, and in 1962 he became president of the RCP.

In 1970 the Imperial Cancer Research Fund established a research unit in medical oncology at St Bartholomew’s Hospital and Gordon Hamilton-Fairley FRCP (1930–1975) was appointed its director; a year later the fund endowed a chair in medical oncology to be held at the hospital and he became the first professor in this specialty in the UK. His ability, his drive and his personality made the unit an immediate success. He rapidly acquired international status in his chosen field. He was a brilliant lecturer, capable of holding any audience spellbound, and his advice was sought by individuals, official bodies and governments.

Chemotherapy guidelines

Patient consent

The National Chemotherapy Board and Cancer Research UK have launched guidance on the consent for systemic anti-cancer therapy (SACT) and national SACT regimen-specific consent forms. The aim of the guidance and forms is to support clinicians to ensure that patients receiving SACT are fully informed when consenting to treatment.

Identifying side effects

The National Chemotherapy Board has also produced guidance in response to concerns that patients often delay reporting serious SACT side effects to dedicated help lines.

Mortality guidelines

The National Chemotherapy Board has produced a covering letter and template on 30-day SACT mortality.