A Day In The Life: Radiation Oncology

I'm just over halfway through my four-week radiation oncology rotation. It's one I'm really enjoying...and not just because I get to sleep in until 6 am! The cancer institute is probably the most controlled environment I've spent time in this year. In other hospital-based specialties, consults are announced by pager beeps -- they crop up during the day and I find I'm always scrambling to get on top of them. In radiation oncology there is much less urgency.

Though a radiation oncologist may do several new patient consults back to back, for the most part they know which patients they will be seeing (which allows them time to review the charts ahead of time) and they generally have around 45 minutes to complete each consult. Any complicated case is discussed at multidisciplinary rounds in advance of the consultation, so that the best evidence-based treatment may be determined and presented to the patient. The cases are all interesting and even though I'm starting to get the hang of some of the treatment protocols, there are always little things to consider that individualize each patient's management.

Here's what my typical day looks like:

0800 - 0900 h: I often start the day by attending multidisciplinary rounds. These are attended by the radiation oncologist, medical oncologist, general surgeon (if they are available), radiologist, pathologist, and nursing staff. New patients are discussed and their optimal management is determined. These kinds of rounds are super for learning and help to ensure that everyone is on the same page.

0900 - 1200 h: I usually spend the morning in a new patient clinic, where we see on average three new consults. Each clinic is specific to a site (e.g. breast). We're fortunate to have the luxury of around 45 minutes per consult.

1200 - 1300 h: Every day there is some sort of noon rounds (lectures, quality assurance rounds, grand rounds, physics rounds, etc.). I usually have lunch before or during rounds.

1300 - 1400 h: In the afternoon I may attend another multidisciplinary round session to discuss new patients.

1400 - 1700 h: I may spend the afternoon in another clinic (e.g. seeing follow-ups). Alternatively I may join the staff to work on radiation planning. If there is no clinic or planning, I use the time to read or familiarize myself with the charts of the patients whom I'll be seeing the following day.

(http://cancer.ucsd.edu/care-centers/radiation-oncology/breast/Pages/default.aspx)

Study Resources:
In terms of radiation oncology study resources, here are some that I've found helpful:

• Alberta Health Services Cancer Guidelines -- Clear treatment protocols, organized by site.
• BC Cancer Agency Cancer Management Guidelines -- A similar thing from BC.
• Manual of Clinical Oncology by Dennis Casciato (2012) -- This is a well-organized pocket guide that provides a good overview of each site.
• Handbook of Evidence-Based Radiation Oncology by Eric Hansen (2010) -- Though a bit outdated, this point-form pocket guide is good for quickly finding information and provides summaries of important studies. I have a PDF version on my phone.

I'd encourage anyone who has the opportunity to do a radiation oncology elective, even just to appreciate how the cancer institute operates (and to figure out what radiation oncologists do, as it's one of those mysterious specialties that medical students and residents seldom get much exposure to!). Have you done a radiation oncology elective?