Clinical Oncology

Sub-Speciality Training at ST3+

Specialty Schools of Medicine

Specialty Registrar (ST3) in Clinical Oncology on The East Midlands Rotational Training Scheme

The Hospitals included in the East Midlands Rotational Training scheme in Clinical Oncology are Nottingham Leicester, Derby and Northampton. During this 5 year training programme at least 3 years will be spent at the larger centres (Nottingham and Leicester) and at least 1 year will be spent in Derby or Northampton.

Applicants considering applying for this post on a flexible training basis should initially contact the South Trent Postgraduate Deans office for a confidential discussion.

The training period is 5 years during which the Trainee’s work will be monitored for satisfactory progress. Progress will be reviewed after the first 6 months and once a year thereafter. This post attracts a National Training Number and provides training towards a Certificate of Completion of Specialist Training.

The post is approved for Specialist Registrar Training by the Royal College of Radiologists. The Postgraduate Dean has confirmed that this post has the necessary educational and staffing approval.

ROYAL COLLEGE ENTRY CRITERIA TO SPECIALIST REGISTRAR GRADE

Possession of MRCP or equivalent plus two years basic medical training is essential.

CONTRACTED HOURS

A contract will be held with the individual Trust that the trainee is working in as part of The East Midlands Rotational Training Scheme

Out of hours service will be paid according to the on-call rota in the Trust.

POST GRADUATE TRAINING

Trainees will attend the MSc course in Oncology at Nottingham University which covers all aspects of the basic science and clinically relevant topics in Clinical Oncology. Course information is available on request. Regular education sessions are held in each hospital and quarterly Regional Study days are organised across the region.

DESCRIPTION OF SERVICES/HOSPITALS

The Leicester Royal Infirmary

The Leicester Royal Infirmary provides a significant component of cancer services within Leicestershire. The Department of Oncology is based there and provides all chemotherapy and radiotherapy for the County (containing a population of approximately 1 million). The Cancer Centre (Osborne Building) at the Leicester Royal Infirmary was opened in October 1997 and contains inpatient and outpatient facilities for patients with both haematological and solid tumours. This is a purpose built unit with up to date facilities and contains:

1) Elekta SLI Linear Accelerator 6 MV with MLC and megavoltage imaging.

2) Eleckta SLI Linear Accelerator MLC and megavoltage imaging.

3) Elekta Synergy 6MV – 10V with a range of electron energies. It also has MLC and megavoltage imaging.

4) 300KV machine

5) 80KV machine

There are 2 Varian simulators with beam shaping facilities.

There is a Helax TMS planning system with facilities for 3D planning.

Helax Viser system for patient management.

Low dose rate Selectron for gynaecological work with purpose built Selectron suite.

The Leicestershire Cancer Centre comprises the Leicester Royal Infirmary, the Leicester General and Glenfield Hospitals. There is close integration between the 3 hospitals (which are geographically close) with non surgical oncologists attending all 3 centres to provide input to multidisciplinary meetings and clinics. There is a very strong scientific research base in Leicester with internationally respected scientists in the Departments of Biochemistry and Genetics and at the Medical Research Council laboratories. The UKCCSG is based in Leicester and there is a Department of Paediatric Oncology at the Leicester Royal Infirmary.

The Department of Oncology has grown rapidly in the past 3 years and the University Department was created in 1996. There is very close co-operation between the different sub-specialties within Leicestershire and most patients with cancer are treated or given an opinion by members of the Department of Oncology.

The availability of a large patient base, clinical trials infrastructure, large academic Departments of Radiology and Pathology and proximity of the Leicester Royal Infirmary to the University campus (10 minutes walking distance) provides excellent opportunity for trainees in Medical Oncology to gain experience in all aspects of the speciality. There are also several opportunities to undertake basic research programmes should this be appropriate and the major emphasis of research within the Department of Oncology is in chemoprevention, angiogenesis and new drug development.

Chemotherapy/Wards

There is a dedicated chemotherapy suite with specialist nurses trained in dealing with chemotherapy. There are two inpatient wards with a total of 36 beds. Medical staff are listed in Appendix B.

Physics Department

3 principal physicists

5 physicists

Mould room with trained technicians

Therapy Radiographers

30 Radiographers

1 quality assurance radiographer

Clinical Department

Approximately 3,000 new cancer patients are registered per year. Site specialisation has now been achieved. There are well established multidisciplinary clinics in head and neck, gynaecology, urology, breast cancer, lung cancer and lymphomas. Care pathways have been developed for all major tumour sites and protocols are being established for all the common tumours. Breast cancer and lung cancer services are sited at Glenfield Hospital and Urology is based at the Leicester General Hospital.

The Academic Department of Oncology has established a Cancer Trials Unit. Patients are entered into several national and international multi-centre studies of chemotherapy. There are also several phase I and phase II trials being conducted. The Trials Unit consists of a Trials Co-ordinator, two Clinical Research Assistants and four Research Nurses.

Patients are also entered into national radiotherapy trials in testicular tumours and the new MRC prostate cancer trial.

MEDICAL STAFFING at The Leicester Royal Infirmary

Consultants:

Medical Oncology - Professor W P Steward, Dr Anne L Thomas,

Paediatric Oncology - Dr D Heney

Clinical Oncology - Dr A Benghiat, Dr S Khanna, Dr I Peat,

Dr S Vasanthan, Dr P Symonds, Dr Gill Thomas

Dr I Boiangiu

Palliative Care - Dr N Rudd

Staff grade - Dr A Osman

6 SpRs Clinical Oncology

3 SpRs Medical Oncology

1 Research Fellow

4 CMT trainees and 1 Foundation Programme Trainee in Oncology

Duties of the post

Broad experience of the management of patients with cancer will be obtained from attendance at Outpatient Clinics and involvement with the care of inpatients. During the first two years, attendance at an approved training programme (MSc in Oncology) in Nottingham will occur with one days attendance per week. During the subsequent higher phase of training, a research project can be undertaken on this day. A formal in-house-education programme will be arranged on Thursday morning and a list of the specialities that will be involved is appended. The close integration of medical, radiation, and haematological oncology together with palliative care and pain management in the Leicestershire Cancer Centre will provide a broad base of clinical experience from attendance at Clinics and multidisciplinary team meetings.

At Leicester the post is based mainly at the Leicester Royal Infirmary with clinics at the Leicester General Hospital and Glenfield Hospital. The Specialist Registrar will rotate between various Departments to get all round training in clinical oncology and will be expected to maintain the log book as recommended by the Royal College. Yearly assessment will be made locally as well as at the Trent Regional level.

Weekly Timetable for Trainees

The weekly timetable will vary every 6 months with attendance at different clinics being arranged to provide experience of all tumour types and radiotherapy. An example is shown below.

DRAFT TIMETABLE

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

Attendance
All day at

Study Time

New Case Clinic LRI

(GT)

Emphasis on Lung and Lymphoma

Oncology
Lecture Series
_________

Chemotherapy Clinic

Lung MDT at GH

MSc Course
In Oncology
at
Nottingham

Ward Round
(GT)

Lymphoma MDT - LRI

Follow – up Clinic - LRI

Attendance at lecturer series and training programme, Dept of Oncology, LRI

TEACHING

The Specialist Registrar will be expected to contribute to teaching of medical students, Pre-registration House Officers and Senior House Officers. This will involve a commitment of one to two hours per month. See an example of teaching programme in Appendix A.

MEETINGS

There is a weekly Oncology/Diagnostic/Radiology meeting conducted by Professor Cherryman. There is a weekly planning meeting arranged by clinicians/planning physicists. There is a fortnightly Friday meeting with a guest speaker where recent developments are presented. Each Specialist Registrar would be expected to undertake an audit project and present the results during one of these meetings each 6 to 12 months.

ADMINISTRATION

There will be no formal administrative duties during the first two years but subsequent years may involve assistance with the supervision of clinical trials research staff.

ON CALL EMERGENCY DUTY ROTA

The Specialist Registrar will take part in the on call rota at the Leicester Royal Infirmary, Osborne Building.

ACADEMIC DEPARTMENT

The Specialist Registrar will be attached to the University Department of Oncology. This Department was established in 1996 and currently comprises the Chair of Oncology (Professor W P Steward), Reader (Dr P Symonds), Senior Lecturers (Dr A Thomas and Dr D Heney) and non-clinical lecturer (Dr M Lee). The Department employs 2 Research Fellows and 5 Research Nurses.

LIBRARY FACILITIES

The University of Leicester Medical Library is situated in the Leicester Royal Infirmary and is adjacent to the Osborne Building. Further library facilities are available within a 10 minute walk at the University of Leicester.

THE NHS IN LEICESTERSHIRE

The Leicestershire Health Authority is one of the largest District Health Authorities in England serving a population of over 900,000 and it is responsible for the whole of Leicester, Leicestershire and Rutland. The University Hospitals of Leicester NHS Trust, formed in April 2000, is composed of the three main teaching hospitals, the Leicester Royal Infirmary (1,096 beds), the Leicester General Hospital (771 beds) and the Glenfield Hospital (520 beds). The Leicestershire & Rutland NHS Trust was formed in 1999 by the merger of the Fosse Health NHS Trust and the Leicestershire Mental Health Services NHS Trust.

Oncology Sub-Specialisation at Leicester

Breast: Dr I M Peat Dr Khanna

Dr C Mulatero Dr Boiangiu

Lung: Dr C Mulatero Dr Gill Thomas

Colorectal: Prof. W Steward Dr S Khanna

Dr Anne Thomas

Upper GI: Prof. W Steward (esp pancreas & hepatobiliary)

Dr A Benghiat (esp oesophageal)

Dr Anne Thomas (esp oesophageal & gastric)

Urology: Dr S Vasanthan Dr R P Symonds

Germ Cell: Dr A Benghiat

Head & Neck : Dr S Vasanthan Dr A Benghiat

Gynaecology: Dr S Vasanthan Dr R P Symonds

Skin: Dr I M Peat

Melanoma Prof. W Steward and Dr Anne Thomas

Lymphoma: Dr Gill Thomas (inc TBI and myeloma)

Thyroid: Dr I M Peat

Brain: Dr Boiangiu (Dr R P Symonds – current patients only)

Sarcoma: Prof. W Steward Dr A Benghiat

Paediatric RT: Dr S Vasanthan

Miscellaneous: unknown primary, brain metastases, bone metastases,

SVCO, spinal cord compression

From GH: Dr I M Peat & Dr Gill Thomas

From LGH: Dr S Khanna & Dr S Vasanthan

From LRI: Prof. W Steward & Dr RP Symonds & Dr Mulatero

NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST

THE NOTTINGHAM CANCER CENTRE

The Oncology Department is sited within the Nottingham City Hospital (NCH), part of the Nottingham University Hospitals NHS Trust; this hospital has 1100 beds, employing around 5000 staff. Clinics are held at both NCH and the University Hospital Nottingham (UHN, at the Queens Medical Centre) 3 miles distant. The majority of in-patient beds, all radiotherapy and most chemotherapy for this cancer centre are based in the purpose-built oncology unit opened in 1993 at NCH. Additional clinics in a number of specialities are held at Mansfield, and Newark, Hospitals (Sherwood Forest Hospitals), where out-patient chemotherapy services are also offered.

Clinical Department

The Oncology Department serves a population of 1.1 million and currently sees around 3000 new patients each year. Site specialisation is well established. There are well established multidisciplinary clinics in breast cancer, lung cancer, colo-rectal, upper GI, head and neck, gynaecology, urology, skin cancers and lymphomas. In addition the MDTs for thyroid-endocrine cancers, CNS tumours, sarcoma, testicular tumours and hepato-biliary cancers are based at this centre for supra-centre populations. The department includes the Academic Department of Oncology and a Cancer Trials Unit. The Cancer Network offices and research group are integral to the oncology department at Nottingham. Patients are entered into local, national and international studies including Phase I, II and III and non-NCRN studies. There is an active NCRN portfolio of studies.

Chemotherapy facilities

The oncology department includes a dedicated out-patient chemotherapy suite with separate consulting, counselling and administration areas, a separate 4-bedded suite for day-case regimens extending up to 12 hours, and full in-patient facilities for longer treatments. The present computerised cytotoxic ordering and recording system is to be replaced soon by an integrated patient management and chemotherapy prescribing system.

Radiotherapy Equipment

There is a full range of modern radiotherapy equipment for the treatment of cancer, including 4 linear accelerators (two with multi-leaf collimators) fully networked with a simulator and treatment planning computer. There are facilities for stereotactic radiotherapy, gynaecological and other brachytherapy (Selectron and micro-Selectron, Iridium wires; 2 radiation protected beds for these and other interstitial therapies).

Physics Department

There are 4 Physicists, 5 mould room technicians and 4 M.P.E. Physicists.

Strengths of the Department

The Nottingham Cancer Centre undertakes all types of Oncology treatments, and in addition receives referrals from across the mid-Trent region for specialist treatments (Paediatric tumours, high dose chemotherapy, CHART, endobronchial brachytherapy, stereotactic radiotherapy etc). The Nottingham hospitals include the regional centres for cardio-thoracic surgery and neuro-surgery. The City Hospital is a centre of international repute for the treatment of breast and bowel cancers.

The Academic Department of Clinical Oncology, including extensive laboratories, is based within the Oncology Department, and is linked to the Nottingham University Medical School.

The Oncology Department is linked with the Departments of Palliative Medicine and Clinical Haematology in the Cancer Services Division of the NCH Medical Directorate.

Sub-specialisation within the department of oncology is well advanced, and training of all Specialist Registrars, in both clinical and medical oncology, is integrated into tumour-site related teams.

Library facilities

General medical and a large number of oncology journals are available within the Department of Oncology and the Cancer Research UK Unit. The main City Hospital library, within the Post-Graduate Medical Education Centre, houses a wide range of general and specialist journals, and is linked to the University of Nottingham library at UHN, where all course literature for the MSc in Oncology is made available.

Medical Staffing at The Nottingham Cancer Centre

There are currently 9 Clinical Oncology and 5 Medical Oncology Consultants.

Breast: Dr D A L Morgan

Dr S Y Chan

Dr S Ahmed

Dr P Lawton

Lung: Dr S A Morgan Dr V Potter

Dr S Ahmed

Dr K Foweraker

Colorectal: Dr V Potter Dr E M Bessell

Dr I Hennig

Upper GI: Dr S A Morgan Dr E M Bessell

Dr Madhusudan

Hepato-biliary Dr Madhusudan

Urology: Dr M Sokal Dr S Santhanam

Germ Cell: Dr M Sokal

Dr S Ahmed

Head & Neck: Dr J Christian

Dr M Griffin

Renal cell: Professor P Patel

Gynaecology: Dr S Santhanam

Dr S Y Chan

Skin Dr P Lawton

Melanoma Professor P Patel

Lymphoma: Dr E M Bessell

Thyroid: Dr S A Morgan

Brain: Dr M Sokal

Dr K Foweraker

Sarcoma: Dr I Hennig

Dr M Sokal

Paediatric RT: Dr D Saunders

Dr M Sokal

There are 7 Specialist Registrars in Clinical Oncology and 3 Specialist Registrars in Medical Oncology, 1 Staff Grade in Clinical Oncology and 8 junior doctors.

Derby Cancer Centre

Description of Services

Derby is one of four Cancer Centres within Trent and received the only commendation in the region for its services during the regional accreditation visits held during 1998. The catchment for the Cancer Centre extends beyond Southern Derbyshire into neighbouring counties, particularly South Staffordshire and serves a population of approaching 810,000. Approximately 2000 patients are referred each year.


NHS CONSULTANTS	TUMOUR SITES

Dr P Chakraborti – Clinical Director	Urology, Colorectal, Breast
Dr R Kulkarni – Lead Clinician	Colorectal, Upper GI
Dr M Persic	Gynaecological, Lymphoma
Dr P Woodings	Breast, Skin
Dr D M Kumar	Lung, Urology
Vacant	Head & Neck, CNS, Upper GI

OTHER MEDICAL STAFF

Staff Grade (Chemo)	1
Clinical Psychologists	2

TRAINEE MEDICAL STAFF

Specialist Registrars	3
F2	3
F1	1

Chemotherapy facilities include a state of the art day unit, transfusion services, and 19 out-patient chemotherapy chairs. Treatment is provided by experienced chemotherapy nurses who are well versed in cannulation and administering chemotherapy. This is also provided peripherally at Ilkeston, Ripley, Ashbourne and Burton.

On Ward 11 at the DRI there are 25 dedicated oncology beds, provision of side rooms for neutropenic patients, and special need requirements.

Oncology services are well supported by five Palliative Medicine Consultants, Clinical Psychologists, interpreters and bereavement support staff.

Oncology services will be moving to a purpose-built site at DCGH with improved and comprehensive facilities in 2009, with four linacs, facilities for IMRT, IGRT, CT simulator and HDR brachytherapy services.

Northampton General Hospital – The Northamptonshire Centre for Oncology

Description of Services

Progressive expansion and rebuilding has been carried out since Northampton General Hospital was originally built on its present site in 1793.

The Hospital is a Cancer Centre with satellite units at Kettering General Hospital and Milton Keynes, and has invested in a major capital scheme to expand and up grade clinical and diagnostic services. The Hospital has a high dependency unit, acute stroke unit, three new linear accelerators, new library facilities and a student accommodation block.

In the past year an interventional cardiology centre, an inpatient renal unit, and new facilities for nuclear medicine have all been opened.

§ The Northamptonshire Centre for Oncology currently has 8 full time Consultant posts in Clinical Oncology. The Consultant complement is as follows:

§ Dr Christine Elwell (Clinical Director) Urology and skin cancer

§ Dr Craig Macmillan – Breast and gGastro-intestinal cancers

§ Dr Jill Stewart – Breast, Gynae and lower GI cancers

§ Dr Roy Mathew – Breast and Gynae

§ Dr. Hany Eldeeb – Lung, CNS, Head and Neck and upper GI

§ Dr Leo Houghton – Breast and Urology

§ Dr Philip Camilleri – Urology and Lung

§ Empty post awaiting interview

§ Clinics

Oncology has its own outpatient facilities at NGH, and further clinics and treatments are given at the Milton Keynes Macmillan Unit and Kettering Centenary Wing.

§ Chemotherapy Suite

The chemotherapy suite coordinates and delivers chemotherapy for patients in the outpatient setting. It also manages outreach and chemotherapy patients where there treatment is delivered at home. A new electronic Prescribing System is now being implemented across the local network.

§ Radiotherapy

The Radiotherapy Department currently has 3 Varian Linear Accelerators which were commissioned in 2004. A further agreed business case will increase this to 4 machines by 2010. All current machines are Intensity modulated radiotherapy (IMRT) capable with micro-leaf collimators. The new linear accelerator will also be image-guided radiotherapy (IGRT) enabled.

§ Brachytherapy

The centre has an HDR Microselectron which currently treats Gynaecological and Oesophagus patients. A business case is currently in discussion with specialist commissioners to perform HDR brachytherapy for prostate and rectal patients.

Prostate Seed Brachytherapy has been implemented since 2002, in conjunction with the Urologists, and treats patients from the local network and surrounding networks.

§ Inpatient Facilities - Talbot Butler Ward

Dedicated beds are centred in the adjacent Talbot Butler Ward. This is a specialist ward of 24 beds serving the Clinical Oncologists and the Haematologists. The Oncology quota of beds numbers 16, although overflow onto other wards is permitted throughout the hospital when necessary.

§ Palliative Care

There are palliative care nurses employed in the directorate who cover patients in the Trust, providing care and advice and a Palliative Care Consultant from Cynthia Spencer Hospice is in the Trust 3 days a week to offer advice.

§ Hospice Care

There are excellent hospice facilities with Cynthia Spencer House serving Northampton and Kettering, and Willen Hospice serving Milton Keynes.

§ Medical Physics

Medical Physics includes Radiotherapy Physics, Electronics, Radiation Protection, Nuclear Medicine and Supra regional Mammography Quality Assurance.

§ Research

The Centre has dedicated research staff who primarily coordinate the clinical trials. These posts are funded through the NCRN and comprehensive network. The consultants and the research team have been successful in increasing the recruitment of patients into NCRN recognised trials

§ Data Collection and Audit

The Centre also has its own dedicated clinical database system which provides electronic access to notes and data for audit purposes, and is available in Kettering and Milton Keynes

VISITING

Potential applicants are encouraged to contact:

Dr Pat Lawton

Training Programme Director

Department of Oncology

Nottingham University Hospitals

City Hospital Campus

Hucknall Road

Nottingham

NG5 1PB

Tel: 0115 969 1169 Ext 57298

Dr S Vasanthan

College Tutor

University Department of Oncology

Osborne Building

Leicester Royal Infirmary

Leicester

LE1 5WW

Tel: 0116 258 7632

Dr Philip Camilleri

College Tutor

Northampton General Hospital

Cliftoville

Northampton

NN1 5BD

Tel: 01604 634700

Revised: March 2009