Consultant physicians working with patients - Royal College of ...

2 Specialties Medical oncologyaround standardised ‘prescriptions’ of information andthe process and documentation of consent. The NCIGceased to exist in 2013 but medical oncologists now leadand participate in the Chemotherapy Clinical ReferenceGroup, which has taken on many of the roles of NCIG.Over the next 2 years, in collaboration with Macmillan,standardised national consent forms will be introducedto ensure higher standards of consent for systemiccancer treatment. This work, including patient nursingand pharmacy staff, has been led by medical oncology,initially through the NCIG and now through the JointCollegiate Council for Oncology (JCCO). Medicaloncologists are key members and often leaders of MDTsin which the patient is at the centre of any managementdecision. Adherence to national guidelines, the IOG, 5ensures high-quality services. All patients should beoffered participation in appropriate clinical trials, whichmay facilitate access to drugs that are not otherwiseprovided by the NHS. Medical oncologists arerepresented(oftenaschairpeople)onallrelevantNCRIclinical studies groups on which patient representativesensure that patients’ voices are heard as early as possibleduring the planning stages of clinical trials.Increasing importance is paid to provision ofpsychological support and to access to informationabout financial support. With more patients survivingthrough cure or prolonged control of cancer, survival isbecoming an important issue for many. Medicaloncologists are increasingly involved in identifying,monitoring and treating late effects, both of cancer andof its treatment.Patient support groupsLocal self-help groups within hospitals and thecommunity can improve patient education andsupport. Medical oncologists provide staff educationwithin the specialist oncology team, the general hospitaland the community services that provide much of thepatient care. The expert patients’ programme provideslay-led, group-based support for patients, empoweringthem to improve their quality of life despite living witha long-term condition. The National Awareness andEarly Diagnosis Initiative (NAEDI) is coordinating aprogramme of activity to raise public awareness of signsand symptoms of early cancer to encourage people toseek help sooner.Patients may wish to explore complementary therapytogether with standard treatment. This need has beenrecognised in a paper published by the JCCO. 74 Interspecialty and interdisciplinary liaisonand opportunities for integrated careMedical oncology is by design, and by national guidance,an integrated specialty through MDT working.Multidisciplinary team workingAll newly diagnosed patients are discussed in a relevantMDT meeting and a recommended treatment plan isagreed in accordance with tumour site-specificguidelines and protocols. Often medical oncologists arethe coordinators of these treatment plans, working withother specialties to create defined care pathways bothfor elective care and within acute oncology.Working with other specialtiesWithin the MDT, medical oncologists work closely withsurgeons, physicians, clinical oncologists, radiologists,pathologists, specialist nurses and the palliativecare team. The MDTs are required to communicateeffectively with those in primary care who, in turn, havetargets to ensure prompt referral of new patients. 2,3An RCP/RCR working party has recently published adocument, Cancer patients in crisis – responding to urgentneeds, which was produced by specialists in medicaloncology, clinical oncology, palliative care, emergencymedicine, intensive care, acute medicine, together withpatient representatives in recognition of the complexitiesof acute cancer management in emergency situations. 8Working with GPs and GPs with a special interest(GPwSIs)Communication with GPs is vital to provide seamlesscare at all stages of a patient’s illness. Patients in remissionrequire a coordinated follow-up strategy. Palliativetreatments require excellent communication andcoordination between oncologists and the community.Medical oncologists are frequently the non-surgicaloncology leads for trusts, providing input into themanagement and planning of services and workingclosely with trust management and primary care trusts(PCTs) on commissioning issues.Other specialty activity beyond local servicesMost medical oncologists will be based in a cancercentre and provide a number of direct clinical care(DCC)-programmed activities (PAs) in a peripheralcancer unit within their network. For some, theprincipal site of activity is within a cancer unit and theywill visit their cancer centre for audit, research andcontinuing professional development (CPD).C○ Royal College of Physicians 2013 155