Health Education England, working across the East of England: Clinical Oncology
Welcome to the East of England Clinical Oncology website.
Clinical oncologists administer radiotherapy, systemic therapies including chemotherapy, immune modulators and endocrine therapy, radioisotopes and a wide range of medical modalities to treat cancer with both curative and palliative intent.
The treatment of cancer patients requires co-operation between members of a multidisciplinary team in cancer centres and units. In Britain, the doctors in the team include surgeons, clinical oncologists, medical oncologists, palliative care physicians, haematologists, radiologists and histopathologists.
Treating patients with cancer is challenging and rewarding. The prognosis and quality of life of a good proportion of cancer patients is better than those with other chronic medical problems. Improving quality of life for patients with incurable disease remains an important goal for oncologists, and is equally as important as cure.
The specialty is predominantly clinical rather than technical, although an understanding of the technical aspects of radiotherapy is essential. Clinical oncologists sub-specialise by tumour site and the proportion of radiotherapy to chemotherapy given by each clinician depends on the site specialty. For example, specialists treating breast cancer deliver more chemotherapy than radiotherapy, whilst the opposite is true for those treating tumours of the head and neck.
The specialty is predominantly outpatient based, with an emphasis in the following areas:
- Planning and prescribing of radiotherapy and chemotherapy
- Management of medical, oncological and psychosocial problems
- Support to allay the fear of patients
The East of England training programme typically has 21 in programme trainees at any given time. This will increase to 25 by 2020. There may additional supernumerary academic trainees. Training occurs at Cambridge University Hospital, Norfolk and Norwich University Hospital, Southend University hospital, Colchester Hospital and Ipswich Hospital. Mount Vernon Hospital will be joining the rotation from 2019. Trainees rotate to up to 3 centres within the region during their training. The rotation is split into Northern, Western and Southern axes for convenience with all rotations rotating through Cambridge (See fig 1.) There is usually scope for flexibility within this, if trainees’ needs dictate. Together the centres offer the latest in radiotherapy techniques, with three dimensional treatments planning; intensity modulated image-guided radiotherapy, stereotactic radiotherapy and brachytherapy, as well as a broad experience of systemic treatments for common and rare solid tumours.
The early part of each rotation consists of training in basic oncological principles in the context of common tumour types. Higher training takes place at Addenbrookes in Cambridge and will encompass the rarer more specialised tumour sites as well as higher training in common tumours and other higher training competencies. The final part of training is directed according to trainees’ needs. In all of our posts trainees participate in a non-resident on call rota. The frequency of duties varies between centres. None of our trainees participate in General Medical Take or ‘Hospital at Night’.
Each centre runs a combination of teaching sessions dependent on the needs of their trainees which may include basic sciences teaching, clinical sessions, journal club, and exam preparation. All trainees have free access to the Cambridge Cancer Medicine online e learning programme.
All of our trainees have the opportunity to complete the ICR MSc in oncology. This 3 year course is fully funded and weekly attendance is protected. This course allows preparation for the FRCR and if trainees wish to complete the 3rd year modules will enable them to gain an MSc in Oncology.
Our trainees receive a fully funded place on a locally run advanced communication skills course during their training.
We have a rolling program of regional study days which are funded and protected to facilitate attendance. We also run study days in conjunction with the medical oncology trainees to broaden learning opportunities and to foster excellent interdisciplinary relationships.
Trainees at a recent regional study day.
Our trainees are supported and encouraged to complete projects suitable for presentation at national and international meetings.
Past and present trainees enjoying ESTRO 2018
Many of our trainees (including those in non academic posts) choose to undertake a period of research and then often go on to complete an MD or PhD. We have close links with the Cancer Research UK Centre in Cambridge and the Universities of Cambridge and Norwich to facilitate project development. Other trainees choose to take time out of programme for clinical activities including time in centres abroad which we actively support.
Work Life Balance:
We believe that work life balance is important. We support and encourage less than full time training for trainees that request it. Splitting our training programme into northern and southern axes has allowed us to limit commuting and relocation. We endeavour to provide details of your rotation well in advance but like to keep a degree of flexibility to accommodate trainees whose circumstances require a change to their planned rotation.
The East of England is a varied region with the opportunity to live rurally or within large towns or cities. There is a wide range of entertainments outside of work including but not limited to beaches, flat and undulating countryside, arts, culture, shops and many sporting activities. It has excellent transport links to other parts of the country.
Our trainees enjoying the sights of Cambridge!
- Completion of a core medical training programme or equivalent.
- Documented evidence of achievement of level 1 competencies in general internal medicine (acute) and generic curricula.
- Documented evidence of completion of full MRCP(UK) Examination.
Integrated academic training programme
Our academic training programme opened in 2010 and we have appointed 7 ACF posts and one CL post since this time, and we are recognised as an emerging centre of excellence for radiation oncology research. The clinical fellowship posts offer 25% protected research time and the opportunity to work with world class research groups in cancer biology and translational research, imaging, and computational radiation therapy. We also have an excellent track record in obtaining funding for PhD and MD students, and the same research opportunities are offered to both NTNs and ACFs alike.
Clinical fellowship posts are usually advertised on the CATO website ( see below ) and also on Uni Jobs, Job Centre Plus, Reporter, Jobs.ac.uk and the BMJ
Our Academic Supervisors:
Dr Charlotte Coles is a Reader in Breast Radiation Research at the University of Cambridge Department of Oncology. Her research interests include clinical and translational studies in breast radiation therapy.
Dr Raj Jena is a Principal Research Associate at the University of Cambridge Department of Oncology and academic training lead for clinical oncology. His research interests include glioma imaging and computational radiotherapy.
General information about ACF posts can be found here: https://gcat.medschl.cam.ac.uk/clinical-academic-training-office/academic-clinical-fellowships/
Information about available posts can be found here: https://gcat.medschl.cam.ac.uk/clinical-academic-training-office/academic-clinical-fellowships/acf-applications/
Please contact Dr Raj Jena Rajesh.email@example.com for additional information.
Some of our academic trainees
Dr Deborah Gregory
Consultant Clinical Oncologist Addenbrookes Hospital.
Chair of STC & Training Programme Director
Please contact me if you are core medical trainee and would like to try to arrange a taster session in Clinical Oncology
Dr Raj Jena
Consultant Clinical Oncologist & Principle Research Associate Addenbrookes Hospital
Academic Training Lead for Clinical Oncology.
General information regarding a career in Clinical Oncology may be found on the Royal College of Radiology website here:
Detailed information regarding the recruitment process and eligibility criteria may be found on the Royal College of Radiology website here:
Information on Academic clinical fellow posts:
NTN applications to Clinical Oncology are made through the oriel website : https://www.oriel.nhs.uk/Web/Account/LandingPage
CLINICAL ONCOLOGY FROM A TRAINEE PERSPECTIVE by Dr Sarah Lightowlers (Trainee Representative)
What Is Clinical Oncology?
Clinical oncology involves the treatment of cancer with a range of different treatment modalities, including radiotherapy and systemic treatments such as chemotherapy. Clinical oncologists are the only specialists to be trained in the use of radiotherapy - this is the main difference between medical and clinical oncologists.
A typical week for a clinical oncologist working in full time clinical practice might involve:
- Outpatients clinics in either a tertiary centre or a district general hospital, or both.
- Radiotherapy planning sessions. This usually involves using imaging to decide where the radiotherapy should be targeted, and can be fairly simple or highly technical depending on the tumour site and setting.
- Review of patients currently having radiotherapy treatment. Most patients, especially those undergoing longer courses of radiotherapy, will be seen at least once by a supervising oncologist during the course of their treatment. Often they will have acute side effects that need to be managed.
- Review of patients on inpatient wards. Depending on the hospital, this might be on a specialist oncology ward, or on a general ward under the care of a medical or surgical team.
- More specialist clinical activities, such as brachytherapy procedures.
- Administrative sessions.
- Lots of clinical oncologists are also involved in other activities, such as education, management or research. More about that below…
Why Do Clinical Oncology?
If you’re reading this page then you probably are already thinking about whether clinical oncology could be the right specialty for you… Here are a few factors we think might help make up your mind:
Clinical oncology involves curing people of cancer - the contribution of radiotherapy to cancer cures has been estimated at 40%, compared to 49% of for surgery, and 11% for systemic treatments. Radiotherapy can also be used in very palliative settings, for patients who would be too unwell for surgery or chemotherapy.
Clinical oncology can be very holistic - you have the chance to be involved in all stages of cancer care for many patients. This involves a wide range of different activities that may form a part of your day to day work, and development of a range of skills, both technical and conceptual.
Oncology is a fast-moving field, with new drugs and radiotherapy techniques coming into clinical practice all the time. Whilst it is sometime challenging to keep abreast of the latest research, it’s also exciting to be working in a field in which treatments are constantly improving and there is always something new to learn.
Oncology is friendly! We’ve found the departments we’ve worked in in East Anglia and beyond welcoming and helpful - not just the other oncologists, but radiographers, physicists, specialist nurses, dieticians, surgeons, palliative care physicians, and many others.
One thing that is particularly fun about clinical oncology in East Anglia is that in the first and second years most trainees will have one day a week as day release, to go down to London for the Institute of Cancer Research Oncology MSc course. Registrars at the same stage from various different deaneries also go to this, so it’s a great opportunity to meet your peers from around the southern half of the country (more about that below).
The East of England deanery encompasses the whole East Anglian region, including Cambridgeshire, Norfolk, Suffolk and Essex. Training time is usually spilt between 3 centres. Either the Norfolk and Norwich University Hospital, Ipswich Hospital and Addenbrooke’s Hospital, Cambridge or Southend University Hospital, Colchester General Hospital and Addenbrooke’s Hospital Cambridge. The rotation details for academic trainees may be slightly different depending on the specific post they hold. There are currently around 25 registrars training in the deanery, 6 of whom are on the academic program.
Academic Training Programme
Academic Clinical Fellowship posts in clinical oncology in the East of England involve 25% protected research time alongside clinical training. The aim of this is for the trainee to develop academic skills and to prepare and compete for a clinical research fellowship to undertake a higher degree. Mentoring will be provided by a consultant academic oncologist for academic matters, together with a clinical supervisor in accordance with the Royal College of Radiologists guidelines.
There are strong links between the oncology department at Addenbrooke’s Hospital and the Cambridge University Department of Oncology, and with various research institutes based in Cambridge. Within Oncology, the department has a good record of securing funding for MD and PhD posts for trainees to continue their own research projects.
Requirements For Entry
The following are requirements for entry into a clinical oncology training programme:
Completion of a core medical training programme or equivalent before the date on which the post will begin.
MRCP (UK) Part 1 or EEA eligibility at time of application.
Documented evidence of completion of the full MRCP(UK) examination, or an ‘acceptable equivalent qualification’, before the date on which the post will begin.
Further details regarding eligibility are available on the clinical oncology national recruitment website and the Health Education England specialty recruitment person specification page.
Training structure and exams
Clinical oncology training starts from ST3; most people who are training in the UK start after completion of a Core Medical Training (CMT) or Acute Care Common Stem (ACCS) programme, and gain their CCT after finishing ST7. The Royal College of Radiologists (RCR) advises that training will usually be completed in five years of full time training and be adjusted pro rata for those undertaking less than full time training.
The training curriculum is divided into Intermediate Clinical Oncology Training (ST3, 4 and 5), which includes the Core Clinical Oncology Training module, and Advanced Clinical Oncology Training (ST6 and 7). Curriculum competencies will be achieved through work based experiential learning, self-directed learning, learning with peers, and formal postgraduate teaching. There are requirements for numbers of workplace based assessment to be completed per year, details can be found on the clinical oncology curriculum document on the RCR website.
During this time trainees must take the Fellowship Examination of The Royal College of Radiologists (FRCR). This consists of the First FRCR (a written exam in basic sciences), Final FRCR Part A (a written exam in clinical oncology) and Final FRCR Part B (a practical exam a bit like the MRCP PACES). More information about the can also be found on the RCR website.
Institute of Cancer Research MSc Course:
Clinical oncology trainees from the East of England are allowed day release one day per week to attend the part time Institute of Cancer Research Oncology MSc course, based in London. There are three parts to the course:
Postgraduate Certificate in Oncology: One academic year part-time.
Postgraduate Diploma in Oncology: Two academic years part-time.
MSc in Oncology: Three - four academic years part-time.
The first academic year (Part A) focuses on basic sciences relevant to oncology: cell and molecular biology of cancer, pharmacology, statistics and radiation science. It is a requirement for sitting Part 1 of the FRCR examination that trainees undertake a course of this sort, and the ICR course tends to be the most convenient for East of England trainees. Lectures take place over a period of 36 weeks, on Fridays at a venue near Barbican tube station. A certain amount of private study is also expected.
The second academic year (Part B) focuses on clinical management of cancer. There is no requirement to continue the course after the first year, but the majority of trainees continue to attend as the lectures in this section are very relevant to what we do on a day to day basis! Lectures take place on Thursdays in the second year.
Exiting the course after either the first or second year will mean that attendees receive the Postgraduate Certificate or Postgraduate Diploma in Oncology respectively. Some trainees chose to progress to the final part of the course, which involves production of a 10 000 word dissertation in order to graduate with the MSc degree. There are fewer contact hours (trips to London once a month rather than weekly), and a greater expectation of independent work in this final part.
Contact For Further Info
Training Programme Director - Dr Deborah Gregory (Deborah.firstname.lastname@example.org)
Academic Training Program Lead - Dr Raj Jena (email@example.com)
Trainee Rep - Daniel Holyoake (firstname.lastname@example.org)