Is the time right for an acute oncology predominant job plan for oncologists?

Dr Caroline Wilson PhD FRCP Medical Oncology Consultant @The Christie

Reflections on my consultant experience

As a breast and acute oncologist for 10 years, I have always defined my site-specific interests in that order – AO a side helping on a breast predominant job plan. Throughout my junior doctor training the work I thrived on was ward based, dealing with acutely unwell patients on medical take and in A&E. Fast forwards 20 years and I find myself in a predominantly out-patients based speciality of Oncology and slightly far removed from the passion of my youth.

2023 was a turning point in my perception of what was the side helping in my job plan. A piece of transformational AO work was needed across an entire cancer alliance, and I needed more dedicated AO time to achieve this. My job plan became AO with a side helping of breast……….. and I have never looked back. The weekly job plan was 2 long days on the cancer centres assessment for admission unit dealing with the acutely unwell predominantly type 2 AO admissions. The third day was the breast side of my job and consisted of a breast clinic and a breast MDT. I also had a PA for AO clinical lead for the trust and the cancer Alliance on the 4^th day of my working week.

What did I gain from this opportunity to have an AO predominant job plan?

1. The headspace to re-design AO services across a cancer centre and 5 acute trusts in the Cancer Alliance by developing a daily acute oncology MDT to support AO CNSs across an entire geographical region. In addition, supporting a trial of an SpR ran oncology same day emergency care (SDEC) clinic in the cancer centre as a model to take out to all medical SDECs across the Alliance. I led a QiP to review the cancer centre cancer triage line to enable streamlining of calls to the right professional at the right time.
2. I returned to by the bedside teaching of oncology SpRs, Juniors doing membership exams and ANPs and CNSs in AO – investing in teaching and development of the next generation of clinical staff who will need to be AO savvy whatever speciality they find themselves working in as the lifetime risk of cancer increases to 1 in 2 people.
3. I was able to support the acutely deteriorating inpatient on the oncology wards enabling quick decisions on escalation or de-escalation to palliative care when site specific oncologists were in peripheral clinics and not able to attend the wards. A junior doctor review of that time demonstrated 100% felt more supported and patient care improved with the presence of an acute oncologist in these situations.
4. I updated my general medical knowledge. I realised although I am not GIM accredited (no oncologists are) my diagnostic ability to recognise not only the complications of SACT/cancer but also general medical issues i.e., infective exacerbation of COPD, ischaemic heart disease was still there. I needed help from consultant colleagues on the most up to date management of these but was very well supported by all…… especially when leading the oncology take during the junior doctor strikes.

CPD in an AO predominant job plan

Acute oncology is a rapidly developing multidisciplinary speciality. The number of patients living with cancer and needing cancer treatments and dealing with their toxicities is set to near double in the next 6 years. The AO services set up over 15 years ago, before immunotherapy/antibody drug conjugates/cell cycle inhibitors are not future proof. There is now a recognition that senior decision makers in AO are imperative to transform, lead and drive services to make them fit for purpose. This will require an expansion of AO consultants drawing on skills from oncologists, acute medics, haematologists and nurse consultants. The UK Acute Oncology Society (UKAOS) consultant subgroup is currently working on a project to define an AO job plan for senior decision makers working at national, regional and local level supported by the royal colleges. Jobs with a predominant AO component are now being advertised - Jobs with Sheffield Teaching Hospitals NHS Foundation Trust | BMJ Careers .

CPD opportunities in AO are extensive. The Society of Acute Medicine (SAM) is a partner of UKAOS with AO featuring in their national conference in 2023. UKAOS is an extensive resource with the first national conference since the charity’s inception in Sept 2024. Pharmaceutical partners are coming on board recognising the need to consider the impact of new SACT on acute services as well as oncology services. UKAOS is now an invited stakeholder in NICE treatment reviews.

Do oncologists need a site-specific interest as well as AO?

Opinions on this will vary and I know several national oncology trainees keen on an AO only job plan. Personally, as an established site-specific oncologist in breast, I would not want to lose that site specific specialist interest. I have been able, through my breast national contacts, to engage pharmaceutical companies in acute oncology. The new SACT pathways in breast have increased my acute oncology knowledge of management of immunotherapy toxicity, pneumonitis from non-IO SACT. I believe AO in a job plan can be the predominant sub-speciality and I will continue to define myself as an acute oncologist with a side helping of breast!

You can download a PDF of this paper at this link