Medical Oncology Rundown

Ward 64

General

Overall this is a really interesting job with a very supportive group of registrars and consultants, there are good opportunities for learning about a speciality that medical students and junior doctors usually get very little exposure to previously. However it can get very busy and stressful, this is a combination of the challenges that the patients can bring (often very ill and at times quite stressed and demanding) as well as the organisation of the ward and rounds which can make things inefficient at times.

Service and team structure

The ward is divided into two tumour streams. One team consists of GI, lung and head & neck cancer patients. This team is usually the busiest. The other team consists of melanoma, breast, GU and sarcoma patients. There is one registrar per tumour stream.

There tends to be only one house officer on this job (despite the department requesting a second house officer for at least the last 6 years!). The house officer usually goes with the busiest team.

There tends to be one consultant per cancer group. This means each tumour stream usually has at least 2 consultants on at one time. Consultants can spend anywhere from one week to one month at a time on the ward.

Each will usually round twice a week. A sheet is placed at the start of every week by the whiteboards; this shows the days each consultant will be rounding. There are unfortunately no house officer (or reg) phones available, so your personal phone will be called.

Daily routine

0750 Prepare the list. The inpatient list code on RCP is 39. Print the list and mark which tumour stream each patient is in, and their room number.

0815 MDT meeting. The charge nurse and registrar go through all the patients with the MDT. It is a good opportunity to mention tasks such as PT/OT/SW review or hospice referral to ensure these are done to facilitate D/C as soon as possible.

Consultant rounds are slotted in alongside their clinics and other commitments. It is a good idea for the registrar to contact the SMO in the morning to gauge what time they plan to round, so that you can plan the day ahead. Make sure that you get any known jobs (eg. confirmed discharges, referrals and prepping discharge summaries) done in the morning to make the afternoon easier.

Clinical tips

Many of your patients will be on regular opioids. Ensure that patients have anti-emetics and laxatives charted.

When a patient is admitted for inpatient chemotherapy, they will be consented and chemo charted by a reg or consultant. These prescriptions are then faxed to the cytotoxic pharmacy. You do not need to add the chemotherapy to the regular chart. Check the chemo prescription as many regimens require adjunct prescribing (such as regular domperidone) that you will need to prescribe on the regular chart.

The palliative care page on HIPPO is a great resource for the charting of end-of-life medications, and for the conversion of opioids from oral/IV to SC form and vice-versa.

If a patient is placed on the LDL (last days of life pathway), ensure that you hand over to the on-call house officer (OCHO) to sight the patient and also document the cause of death (as decided by the team). This increase the chance that the death certification will be done by the OCHO should the patient die after hours, and saves delays for the patient’s families in getting the body released from the morgue the next day.

You will often have patients who are receiving oncology treatment (eg immunotherapy) in the private sector. Ensure these patients’ most recent imaging is present on our public system. You can ask the ward clerk to call the private oncology practice and ask them to transfer any scans to the public system. Oncologists who refer private patients to hospital tend to be very good at handing over plans and monitoring patients’ progress with the team.

Take the opportunity to practice procedures such as paracentesis and chest drains with supervision.

On call

After hours you will cover the medical specialties. There will be specialty-specific registrars on in the evenings and one registrar covering medical specialties on overnight.