How did you first get into medicine?
When I was at school I considered a range of careers, including engineer and pilot. My brother, who was a doctor, tried to persuade me to be a vet. In the end I decided that if I was going to be getting up at night on call I would rather be on a hospital ward than standing in a barn.
What inspired you to pursue your specialty?
Perhaps first I should explain what a 'clinical oncologist' does, because even other doctors often don't really know. Oncology, or cancer care, is covered by a range of specialties. Surgeons specialising in cancer operations may call themselves an oncologist - for example 'gynaeoncology'. For physicians there are two specialties, 'medical' and 'clinical' oncology. Medical oncology focuses on drug treatments for cancer including chemotherapy, hormones and biological agents. Clinical oncology involves giving the drug treatments but also using radiotherapy, often as a combined approach. Treatments might be curative, adjuvant or palliative.
A patient from my student days made me realise the importance of holistic care and inspired me to get my first job in oncology. She was a young woman with metastatic breast cancer. The ophthalmology consultant focused on the tumour deposit in her orbit but the patient also wanted better general symptom control so that her young children would have good memories of what I am sure she knew would be her last Christmas with them.
A patient from my student days made me realise the importance of holistic care
Most cancer patients need radiotherapy at some point, so choosing clinical oncology means you are there throughout their journey. Once I started planning radiotherapy, I realised I really enjoyed the practical, three dimensional thinking required to target tumours but spare normal tissue. I confess I'm also a bit into the science behind the radiobiology, physics and the technology.
How does it differ from other medical settings?
I used to say to my junior doctors on the ward that they got a 'jaundiced view' of the specialty and that they ought to come to clinic to see what it's really like. It is amazing to think that the vast majority of even quite intensive oncological treatment is given to outpatients, who will often remain at work during their chemotherapy and radiotherapy.
Photo credit: Science Photo Library
What additional skills have you learned as a result?
Communication skills are central to oncology. Talking with patients and their families about their diagnosis, treatment and prognosis is a big part of the job, but working well with colleagues is also really important. As a consultant you will probably focus on a specific cancer site (for me it was thoracic malignancy - lung, pleural and thymic tumours) and work in a multidisciplinary team (MDT).
You will liaise on a day-to-day basis with surgeons, pathologists, physicians, radiologists, nurses, radiographers and medical physicists. It's important to recognise your colleagues' expertise and know when to ask them for help.
What advice would you give to a student who is considering this specialty?
You may be able to get a taste of oncology as part of a medical rotation. The training involves doing your core medical training or acute care common stem in acute medicine (ACCS) and getting your MRCP.
At ST3 you would move over to specialist oncology training and embark on another set of exams, the FRCR. The commitment and studying is worth it though! I was privileged to work with a great bunch of colleagues in oncology, and indeed I still am here at the MDU.