Acute Oncology – Managing patients presenting with treatment or cancer-related complications
Ask an expert:
My name is Katie Fleming, and I am an acute medical consultant working at North Tees Hospital, in Stockton (North East England). I have recently got married, and live with my husband Mark, and cocker spaniel puppy Phoebe. I love to get outdoors hiking in the Lakes or Scotland, and am partial to a bit of DIY/home décor!
I studied at Peninsula Medical School, qualifying in 2013, and then moved up to the North East for my Foundation Programme placement at James Cook University Hospital, Middlesbrough.
I have trained in the North East for 10 years, progressing through foundation and core medical programs, in which I have undertaken rotations within oncology and haematology. I took some time out in 2017 to do a trust grade registrar position in acute medicine and intensive care, whilst deciding my next training step. I obtained my acute medical training number in 2018 in the North East and qualified as a consultant in April 2023.
What got you interested in Acute Oncology?
I was lucky enough to do a few rotations within oncology and haematology, in tertiary units during my foundation and core medical training, which really inspired me to look at oncology. I very much enjoyed the inpatient experience rather than attending clinics, and preferred being able to treat and support patients when they were feeling at their most vulnerable, either to get better, back onto treatment, or achieve a good death when suffering disease progression. I like to learn about new and innovative treatments, but on balance, I am just more acute-minded. It is a perfect combination of acute medicine, oncology, and palliative care.
How did you train in Acute Oncology?
When I started there was no one else who had actually done this specialist interest before, and I think it had only just been released as a specialist skill. As I already had very good contacts within the oncology team at my nearest tertiary centre, I was able to make my own timetable pretty easily. Rather than doing a four-month block, I did mine via sessional exposure. As oncology can be so fast changing, it meant I was able to be kept up to date with evolving treatments. I would take half a day a week, or a full day every two weeks to attend clinics, oncology ward rounds, referrals, or radiotherapy sessions, rotating throughout the different specialist areas e.g breast, renal, neuro etc. It would sometimes mean traveling to the hospital when I was not based there for rotations, but thankfully the distance was manageable.
Were there any challenges?
As acute oncology was only just starting to come into the curriculum for oncology trainees, it was a bit difficult to know exactly what I should be spending time doing. However, for me, I had already had inpatient oncology experience dealing with acute issues, so my knowledge needed to be expanded in the area of treatment regimes, common side effects and immunotherapy, so this is what I focused on, alongside seeing inpatient referrals that the oncologists would receive.
How does/will this fit into your consultant working?
Currently I am the Acute Oncology Lead for our trust, as well as Cancer of Unknown Primary. I have a wonderful team of three very experienced Acute Oncology Specialist (AOS) nurses who I support. My sessions are mainly on Emergency Admissions Unit (EAU) with our unselected take. During this time I may see oncology patients, admitted with issues such as suspected neutropenic sepsis or cord compression. Our acute medicine department also look after a medical ward which homes most of our oncology patients, which I do a week on every six weeks. As part of Cancer of Unknown Primary (CUP) , I attend the MDT once a week, and see patients in clinic who are undergoing diagnostic investigations.
As part of the AOS team, I am involved in developing pathways to help patients remain as “ambulatory” as possible and prevent admission, as well as ensuring we keep to national audit targets. Alongside my experienced nurses, I provide education to the junior and nursing staff about acute oncology presentations, complications, and treatments.
Do you have any tips for trainees who may be interested in Acute Oncology?
I think if you are like me, and enjoy acute medicine, love the variety of patients, but also enjoy oncology (but not necessarily the outpatient clinic work) this would be a brilliant option. We have an ever-expanding population of oncology patients attending our admissions units/SDECs and to have that expertise on board, will not only make their patient journey better and safer but will add expertise to your unit and build confidence in your staff.
This skill is so incredibly flexible, and whilst working with oncologists during your placement, you will be able to network and discuss possible job options for your future. Whether that’s working in a tertiary centre and doing sessional exposure in oncology, or leading on an acute unit, and developing pathways within SDEC or AOS services to prevent admissions. Like me, you will become a “niche” entity!
So I would suggest networking with local oncologists, explore their “acute oncology” curriculum that’s been developed, spend some time on an acute oncology ward if you can, and if you have any questions, please do just get in touch!
