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Oncology as a career

• Managing and treating patients with cancer

• Two distinct career pathways – medical and clinical oncology • Medical oncology – use of chemotherapy and targeted agents + involvement clinical trials
• Clinical oncology – radiotherapy mainly but also some chemotherapy and trial involvement • Don’t forget other specialties: haem/surgery/pall care

Good points to the job
• High degree of patient involvement and management
• Interesting and changing medical field – new developments occurring continually • Multidisciplinary approach • Research opportunities • Rewarding

Lung cancer: 2003
Advanced NSCLC

Platinum doublet chemotherapy

Best supportive care

Median survival 7.9 months

Lung cancer: 2013
Wild-type EGFR NSCLC Advanced NSCLC
ALK rearranged NSCLC

Squamous NSCLC

Non-Squamous NSCLC



Platinum doublet Chemo: not pem or bev

Pem-cisplatin doublet Chemo / carbo/taxol± bev


Docetaxel monotherapy Erlotinib monotherapy

Erlotinib monotherapy

Pemetrexed monotherapy


Best supportive care

Median survival 24.3 months

Difficult points to the job
• High degree of patient involvement and management – can be intense!

• Can be emotionally stressful • Hard work
• Limited experience as junior doctor

Personal qualities which make it enjoyable
• Good communication skills

• Interest in academic medicine
• Enjoyment of working in multi-disciplinary teams • Commitment to the specialty including hard work, both clinically and academically • An ability to delegate and influence decisions as well as to make sound clinical judgements under difficult, emotional pressure

Average day as an oncology registrar
• Outpatient clinic – seeing new patients and patients undergoing treatment • Prescribing and planning new chemotherapy

• Ward based work – junior team + ward rounds / family discussions
• Managing queries on patients and treatment from day unit • On-call overnight (from home)

Average week
Monday Ward round Tuesday Journal club Lower GI clinic Lower GI clinic Wednesday Upper GI MDM Upper GI clinic Ward round Thursday Friday

Course/admin Ward round

HPB clinic




The Good News

The chart above shows an expansion in the workforce since 1997, at an increasing rate of change during the past five years, and the supply of Medical Oncology consultants is forecast to increase during the next decade

Core)Medical) Training)

Specialist)Trainee) a Years)3;6) or Academic)Clinical) Fellow) Cer4fic te)of) Consultant)Training)


Genome Analyser β6-1089

Aortic ring sprouts

Breast cancer cell line Genome Map Yap et al. Nature Reviews Cancer 10, 514-523 (July 2010)

Master) Clinician)

Clinical) Inves4gator)

Clinician) Scien4st)

The Association of Cancer Physicians

Academic training
2 pathways
Most medical oncology trainees complete a higher research degree (MD/PhD) - ‘normal’ training number, OOP for MD/PhD - NIHR Academic Clinical Fellowship (ST3 onwards for medical oncology)

Academic Training
• Academic training available in oncology in foundation years (FY1 and 2) • Then can continue from ST3 after completing core medical training • Designed to allow doctors to gain experience in research

• Involves 3 months each year during specialist oncology training - (~3 available in London/yr) • Designed to work up to starting a PhD

Building CV…
• • • • • • • FY/ST job in oncology/haematology Case reports Audit Poster presentations Clinics MRCP Trust oncology post


• • • • • • •

ARCP (yearly appraisal at deanery) Educational/clinical supervision WPA MSF Patient satisfaction surveys MRCP Specialist Exam Oncology course

My route
• Undergraduate training abroad • Moved to UK 2005 • 2004-2008 old style medical SHO rotation

• • • • •

– Oncology part of final SHO rotation 2008 unsuccessful in ST3 oncology interview… 2008 – 2009 clinical fellow med onc GSTT March 2009 – NIHR academic clinical fellow post med onc 3x3 months research blocks in 2 different labs KCL March 2013 - MRC/Prostate Cancer UK Clinical Research Training Fellowship

Related links
– Joint Royal Colleges of Physicians Training Board

– London Deanery

– Association of Cancer Physicians

– Academic training Email: