Considering a career in radiation oncology?
Radiation oncology is a highly specialized field that many medical students will not be exposed to directly during their standard curriculum. Therefore, this section has been crafted to answer basic questions about this fascinating field of medicine.
As of summer 2013, CROF is offering a CARO-CROF Pamela Catton Summer Studentship in Radiation Oncology for medical students – this is an opportunity for medical students to gain clinical exposure to radiation oncology.
What is radiation oncology?
Radiation oncology is a high-tech branch of medicine that primarily deals with the skillful application of ionization radiation for the treatment of cancer. Although radiation has been utilized to kill malignant cells for over 100 years, continued innovations in technology have allowed radiation to be delivered with increasing precision, safety, and effectiveness for the purpose of cure as well as palliation. Nearly two-thirds to three quarters of all cancer patients will receive radiation treatment at some time during their illness. Although there is a strong technical component to radiation oncology, it is first and foremost a clinical specialty that focuses on providing compassionate care for cancer patients through all parts of their disease journey, including diagnosis, treatment, and surveillance.
How is radiation delivered?
Radiation treatment can be delivered to a patient through a variety of techniques. The most common method is external beam radiation, which uses focused high powered x-rays generated by a machine called a linear accelerator (LINAC). Photons, electrons, and even more exotic particles such as protons, are delivered into tissue to cause damage to the DNA of cancer cells, which causes their death. Another common method of delivering radiation is brachytherapy (Greek “brachys” = short distance), where a radiation source is placed within or close to the tumour for highly localized treatment, often used in prostate, gynecological, and breast malignancies.
Where is radiation oncology practiced in Canada?
Due to the complexity of delivering radiation treatment, and the equipment and resources involved, radiation oncology in Canada is currently only practiced at specialized cancer centres across the various provinces. Although traditionally thought of as an academic specialty, the opening of many new regionalized cancer centres has led to increasing numbers of radiation oncology working in “community” settings. This differs from the United States, where a large number of private community practices exist.
How does you become a radiation oncologist?
In Canada, graduating medical students directly match to a 5-year Royal College of Canada Radiation Oncology residency training program. At the end of five years, residents must pass a written and oral Royal College board exams to obtain their FRCPC designation, which allows for independent practice. Although radiation oncology shares roots with diagnostic radiology, these fields are now quite separate and different specialties.
What subspecialities in radiation oncology exist?
Academic radiation oncologists will frequently subspecialize, focusing on treatment of one or two ‘disease sites’ that divide up the body (such as CNS, Head/Neck, Thoracic, GI, GU, Gynaecology, Hematology, Sarcoma, Skin, Breast and Paediatric). Many graduating residents will pursue further training through a one or two-year clinical and/or research fellowship which allows for further specialization in a variety of areas, examples of which include treatment of specific disease sites, application of highly focused (stereotactic) radiation techniques including radiosurgery, and brachytherapy (placement of radioactive sources within body cavities for close treatment of tumours). Treatment with radioactive labeled compounds, such as radioactive iodine and samarium treatments, is more often the domain nuclear medicine specialists and not radiation oncology.
What is the radiation oncologist responsible for?
Radiation oncologists are responsible for seeing patients in consultation and ensuring that their patients fully understand their diagnosis and all the care options that they may choose from. They help patients decide which treatment(s) are valuable and reasonable option(s) for them and explain this to the patient. Should a patient elect to pursue radiotherapy, they decide what area of the body to radiate, how much dose to deliver, and how to devise a plan to safely achieve this (treatment planning). The radiation oncologist will monitor for toxicity and treat patients accordingly to get them through their treatment. Following treatment, radiation oncologists will often see patients in routine follow-up visits for up to 5 years or longer for surveillance of cancer relapse. When cancer relapses, Radiation Oncologists are involved in salvage care and palliative care. Radiation Oncologists also liase with others in the medical community to ensure that all cancer patients receive optimal oncological care throught the spectrum from prevention to end of life care.
Who do radiation oncologists work with?
One of the rewarding aspects of a career (and residency) in this field is that radiation oncology is truly multidisciplinary, and require the skills of many individuals to provide optimal care. In addition to individuals such as nurses, social workers, dieticians, and other allied health workers, radiation oncologists work commonly with some unique specialities to provide care. These include: oncologic surgeons and medical oncologists (to decide optimal treatment plans), radiation therapists (specially trained individuals whom provide the daily radiation treatments to patients), and physicists and dosimetrists (design and delivery of optimal and safe radiation plans).
What is typical workweek like for a radiation oncologist?
Although it will vary by individual, a typical radiation oncologist work week consists of two days of clinics for new patient consultations and follow-up visits. A half-day is typically spent on a rapid patient review clinic for that consultant’s 20-30 patients on active treatment at any given time. Those who practice brachytherapy will have procedural time in the operating room. One day of the week is used entirely for the complex process of treatment planning, while another day is often set aside as academic time. Individuals often use their academic time for teaching of trainees, research, or administrative duties. Since radiation is generally outpatient treatment on a Monday to Friday basis.
Are there any radiation emergencies?
Radiation is generally delivered during typical weekday business hours, and reasons for emergency treatment are limited but typically include spinal cord compression and superior vena cava syndrome which can necessitate treatment after hours or on the weekend by the on-call team. Other reasons for urgent treatment can include brain metastases, painful cancer metastases, and to stop uncontrolled bleeding.
Is it safe to work as a radiation oncologist?
Yes. Radiation oncology has advanced dramatically over the years, and modern radiation treatment is delivered in very safe and highly controlled settings that do not pose a significantly increased risk to the oncologist. With the exception of brachytherapy, radiation oncologists do not have significant opportunity for increased exposure to radiation as all daily external beam treatments are delivered by the radiation therapists. Furthermore, all radiation oncologists wear monitoring badges to track exposure to radiation.
With all the new chemotherapy, isn’t radiation oncology a dying art?
Quite the opposite. While it is true that there have been significant advances in chemotherapy over the years, radiation oncology has also advanced leaps and bounds. Countless studies have demonstrated the continued benefit of radiation treatment before, during, or after other treatments such as chemotherapy. As mentioned above, a majority of patients will get radiation treatment as part of their cancer care. Furthermore, significant advances in radiation technology and imaging have kept the specialty evolving, allowing the ability to do even more precise and radical treatments that were not possible just a few decades ago. This advancement of the field, especially with technologies such as IMRT (intensity modulated radiotherapy), IGRT (image-guided radiotherapy), SABR (stereotactic ablative radiotherapy) to name a few, has only increased the indications and demand for radiation treatment.
What is residency like?
Radiation oncology residents typically spend their first year doing relevant medical and surgical rotations, with senior years spent in radiation oncology training working with radiation oncology consultants to deliver clinical care and design radiation treatment. As residents often shadow a specific consultant or two during a block rotation, their typically workweek schedule can mimic the radiation oncologist schedule detailed above. This includes time spent designing treatment plans and attending various rounds. In addition to clinical duties, many residents will choose to pursue other interests during residency that can include education (teaching of clerks, etc), advocacy initiatives, and research projects.
Do you have to know a lot of physics to get into residency?
Although the physics aspect of radiation oncology treatment can seem very daunting to the outsider, you do not have to have a physics background to succeed in radiation oncology residency. Training programs incorporate formal teaching on radiation physics and radiobiology to give trainees a general foundation and provide the basic knowledge required to safely deliver radiation treatment. Residents and radiation oncologists work with physicists who provide expertise beyond our basic training.
Are there international opportunities?
Many radiation oncology residents are becoming increasingly involved in international opportunities which can include electives, internships, as well as initiatives in areas with limited cancer resources. Those interested in learning more should visit the CARO International Communications (CIC) Workgroup website: http://cicworkgroup.org/
Are there concerns about finding a job once residency is done?
As with most specialties, opportunities and job opening will vary from year to year in radiation oncology and can be difficult to predict. Often times, this is exacerbated by the fact that radiation oncology is a resource intensive specialty that requires access to highly specialize equipment. With the aging population, demand for cancer services including radiation is only expected to continue to grow, but it can take governments time to respond with the opening of new positions. Despite the periodic uncertainty that this can cause for trainees, the future of radiation oncology appears to be very bright (see below for link to a report that illustrates this point).
Why choose radiation oncology as a residency (and career)?
Radiation oncology is a unique and exciting field of medicine that is continuously evolving with the development of state of the art technology and the rapidly changing landscape of cancer care. Caring for oncological patients as they navigate the difficult journey of their illness can be challenging, but ultimately most radiation oncologists find this to be the most immensely rewarding part of their chosen career. Do an elective, and discover for yourself what possibilities this career might hold.
How do you apply to radiation oncology residency in Canada?
Through the Canadian Residency Matching Service (CaRMS). For details including specific program requirements, visit the CaRMS website (www.carms.ca).
Other interesting links:
- Introduction to Radiation Oncology (link from Queen’s University)
- Radiation Oncology career profile (CMA)
- What to learn more about LINACs? http://www.radiologyinfo.org/en/info.cfm?pg=linac
- An article from the MD Anderson Cancer Centre about radiation oncologist supply and projected growth in demand (from a US perspective): http://jco.ascopubs.org/content/28/35/5160.full
- CARO International Communications (CIC) Workgroup website: http://cicworkgroup.org/