Family physicians have long played a role in screening and diagnosing cancers, but have traditionally had little to do with the active management of cancers or survivorship care. Family physicians tend to receive minimal training in oncology, and feel ill-equipped to take on these roles. Increased uptake and efficacy of screening programs, coupled with an aging population and increasing five year relative survival rates, has resulted in a growing need for physicians skilled in the care of oncology patients. Cancer clinics throughout Canada are relying on family physicians to step into this care gap by involving more family physicians in acute and follow-up care of oncology patients.
Goals and Objectives
The PGY3 Family Practice Oncology training program is designed to educate family physicians in this expanding area of medicine. The FP oncology role is flexible, allowing physicians to function in primary or tertiary care settings. PGY3 oncology trained physicians have the skills to function as key members of an oncology team within the hospital setting or cancer clinic, or to act as a resource for their family practice, supervising chemotherapy administration in outreach centres and providing survivorship care.
The Family Practice Oncology program aims to prepare family physicians to:
- Assess and manage malignant disease in various stages;
- Be familiar with chemotherapy treatment and radiation therapy;
- Manage chemotherapy and radiation therapy treatment side effects;
- Recognize and manage oncologic emergencies including neutropenic fever, tumor lysis syndrome, spinal cord compression, SVCO and pain crises;
- Be proficient in diagnostic and therapeutic procedural skills (i.e. bone marrow aspirate, paracentesis and thoracentesis);
- Be skilled in symptom management and pain control;
- Be able to prognosticate based on diagnosis, stage of disease and functional status;
- Develop communication skills for interacting with patients and families affected by cancer; and,
- Maintain competency in Family Medicine through half-day back clinics.
The program offers six months of enhanced skills training with rotations in medical oncology outpatients, medical oncology in-patients, radiation oncology in-patients, gynecological oncology, palliative care and hematology oncology. Your rotations will take place at:
- The Élisabeth Bruyère Hospice;
- The Ottawa Regional Cancer Clinic;
- The Ottawa Hospital Civic Campus; and/or,
- The Ottawa Hospital General Campus.
Medical Oncology (Outpatient/Cancer Clinic)
The four-week medical oncology outpatient rotation will give you in-depth knowledge of the chemotherapy regimens used in different disease sites, as well as managing treatment side-effects. You will spend time in the clinic setting and get exposure to primarily lung, GI and breast cancers. You will also be involved in the triage service where you will learn about management of treatment reactions and emergent care of patients on treatment (who may require admission). You will provide palliative care and gain experience in pain management. You will attend educational rounds to enrich your experience.
Medical Oncology (In-patient)
For four weeks, you will be part of a multidisciplinary team providing in-patient care to patients receiving chemotherapy, suffering from chemotherapy-related side effects or complications of the disease. You will become familiar with diagnosis and treatment of common medical oncologic emergencies such as febrile neutropenia and sepsis. You will become proficient at treating chemotherapy-related mucositis, enteritis, nausea, vomiting, anemia, thrombocytopenia and neutropenia.
This rotation will give you opportunities to identify and manage disease complications including pleural effusions, biliary obstruction, ureteric obstruction, bowel obstruction and hypercalcemia of malignancy. Many patients on the in-patient service are making the transition from active cancer management to palliative or supportive care only. You will be expected to guide and counsel patients and families through this difficult transition.
You will take part in weekly multidisciplinary rounds, site-specific rounds (breast, GI, GU, lung) and special oncology rounds at the cancer clinic. You may also attend weekly internal medicine grand rounds.
You will be part of a multidisciplinary team of healthcare providers offering in-patient and outpatient care for this four week rotation. You will work with patients who are receiving radiotherapy or suffering from treatment side effects. You will become familiar with radiation oncology emergencies including acute cord compression and cauda equina, superior vena cava obstruction, acute deterioration secondary to brain metastases and impending airway compromise.
You will be exposed to common treatment side effects and complications including dermatitis, mucositis, esophagitis, pneumonitis, enteritis and radiation necrosis. You will also learn about the role of radiation for palliation of symptoms.
You will attend clinical rounds and weekly multidisciplinary rounds, along with treatment planning rounds, weekly lung and physics rounds, and head and neck rounds.
Over this four-week period, you will become familiar with the care of patients with gynecologic cancers (including ovarian, endometrial, cervical, vaginal and vulvar) across the disease continuum. The focus will be on post-operative care and perioperative medicine. You will learn about the management of chemotherapy-related side-effects for both ambulatory and in-patients.
You will gain exposure to complications of advanced gynecologic cancer and learn management strategies for pleural effusion, bowel obstruction, neuropathic pain, ureteric obstruction, hypercalcemia, vaginal bleeding, ascites and peripheral edema. You will become proficient in communicating with patients and families about treatment withdrawal, code status and palliation in the end-of-life setting.
You will do daily clinical rounds and attend weekly tumor board, chemotherapy and psychosocial rounds. You may opt to attend departmental rounds (Obstetrics and Gynecology).
This four-week rotation will offer you opportunities to develop expertise in symptom management. You will become proficient at identifying and treating physical, emotional and spiritual distress in cancer patients. You will work with a consult team of palliative care physicians and nurses.
You will develop a sound pharmacological approach to the management of pain and other cancer-related symptoms, such as: anorexia, nausea, vomiting, constipation, dyspnea, cough, delirium and depression. You will be expected to attend clinical rounds and monthly regional rounds.
You will spend four weeks becoming familiar with the in-patient management of hematologic malignancies including leukemias, lymphomas and myelomas. You will also gain experience with autologous and allogeneic stem cell transplantations and their complications.
You will participate in clinical rounds and be expected to attend weekly multidisciplinary, Bone Marrow Transplant (BMT) and leukemia/lymphoma rounds. On Fridays, you may also attend Special Hematology rounds.
Your time in the program will be evaluated using standardized forms available through the Department of Family Medicine’s one45 system. Field notes allow us to collect direct observation evaluations. Residents will also meet with the Program Director regularly throughout the residency period.