Medical oncology is the specialty that cares for patients with solid organ malignancies including diagnosis and management. Treatment focuses on appropriate use of systemic therapy for malignancy (including chemotherapy, immunotherapy, targeted therapy and endocrine therapy) together with toxicity management with due regard for a patient's individual circumstances, preferences and treatment goals.
The majority of patient care in this setting is ambulatory (clinic based) with close attachment to an infusion suite for administration of anticancer therapies. Affiliation with a hospital that provides inpatient care is also required when caring for patients who are acutely unwell either from their condition or its treatment.
Cancer care is truly multidisciplinary in nature. In the course of a week oncologists may interact with many other health care professionals including general practitioners, physicians, surgeons, radiation oncologists, nuclear medicine specialists, imaging specialists, pathologists, psychiatrists and psychologists, palliative care practitioners, geneticists and genetic counsellors, nurses, allied health professionals, pastoral carers and interpreters. As such clinicians are quite connected with colleagues and peers and generally well supported.
Cancer care is challenging – patients are often fearful of their diagnosis and what it means for their survival, their present and their future. Medical oncologists need to be understanding and empathic while also maintaining health strategies to unwind from the stresses of the job. Good communication skills are central to delivery of care to patients’ and their supporters. Despite advances in cancer care many patients still die from their condition. Patients also have greater access to information about their diagnosis and care options and may challenge conventional medical opinions around their diagnosis and treatment.
Cancer care is complex – cancer is for the most part a condition of aging. The patients we are treating are often older and have increasing comorbidities that must be managed. The therapies that we prescribe can sometimes have unpredictable or significant toxicities. Care often requires coordination across different disciplines. Conversely, we also care for younger patients who have different concerns and priorities including longevity, survival, work, careers, family and fertility.
Cancer care is increasingly exciting – advances in medical science and drug development mean that many of our patients are now living longer, happier and healthier lives than before. The cycle of development and discovery means that some therapies are taking less than a decade to go from development to routine care. As such a medical oncologist needs an engaged and inquisitive mind to stay abreast of current best practice.
Adult medical oncology is a specialty discipline under the Royal Australasian College of Physicians. Entry to advanced training occurs after completing the three year Basic Physician Training course via the RACP. A minimum of 24 months must be undertaken as core training in accredited medical oncology registrar positions. A maximum of 12 months can be taken as non-core training (which can be undertaken in research, laboratory-based training, overseas training relevant and specific to cancer medicine or an additional year of clinical training (medical oncology, cancer genetics, palliative medicine, radiation oncology or malignant haematology).
At present in WA positions for core training positions for advanced trainees are offered at FSH, SCGH and RPH. Several fellowships are available towards the end of the advanced training, as well as the opportunity to take up specialist fellowships nationally or internationally to advance skills in a particular discipline of medical oncology. Several workshops (communications skills, cultural safety and competency) and a research project also form part of training.
Training jobs include a mixture of assessment of new patients, clinic based worked, pre-treatment reviews, inpatient care and involvement in departmental activities and multi-disciplinary team meetings. Trainees can join and be supported by the Medical Oncology Group of Australia - the specialty society that represents medical oncologists in Australia.
Medical oncology is a relatively young specialty and as such generational change and retirement of older specialists is a recent phenomenon. Coupled with this the incidence of cancer is rising as our population ages, and the number of patients requiring care is increasing as people survive for longer following diagnosis. As such more medical oncologists will be required over the coming years to deliver care.
A qualification in medical oncology also offers significant diversity in career paths including the prospects of:
