Presentations (including but not limited to)
- Cardiovascular:
- Gastrointestinal and nutrition:
- abdominal distension or pain
- abdominal mass
- altered bowel habit
- anorexia and reduced intake
- hepatosplenomegaly
- mouth ulceration
- nausea and vomiting
- Genitourinary:
- Haematological:
- anaemia
- bleeding, bruising, and petechiae
- lymphocytosis, lymphopenia, and neutropenia
- pallor
- thrombocytopenia and thrombocytosis
- Lymphatic system:
- Musculoskeletal:
- bony mass
- pain
- soft tissue mass
- Neurological:
- headache
- impaired conscious state
- seizures
- visual loss
- Ophthalmologic:
- loss of red reflex
- proptosis
- Respiratory:
- chest pain
- cough
- dyspnoea
- Skin:
- Systemic / General:
- acutely unwell
- allergy symptoms and anaphylaxis
- fever
- pain
- weakness and fatigue
Conditions (including but not limited to)
- Cardiovascular:
- cardiac tamponade
- cardiotoxicity from anthracyclines
- superior vena cava syndrome
- Gastrointestinal and nutrition:
- constipation
- malnutrition
- mucositis
- Genitourinary:
- Haematological:
- anaemia
- bleeding due to thrombocytopaenia
- coagulopathy
- hyperleucocytosis
- Immunologic:
- cytokine release syndrome
- immune-related complications of cellular / immunotherapy, and grading of these
- Infectious:
- febrile neutropenia
- sepsis
- pneumonia:
- atypical
- bacterial
- fungal
- pneumocystis jirovecii
- viral
- Metabolic:
- adrenal insufficiency
- tumour lysis syndrome
- Neurological:
- posterior reversible encephalopathy syndrome (PRES)
- raised intracranial pressure from intracranial lesion or drug toxicity
- spinal cord compression
- Respiratory:
- anterior mediastinal mass / airway compression from upper airway mass
- Systemic / General:
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Adrenal insufficiency and acute adrenal crisis
- Coagulopathy related to acute promyelocytic leukaemia
- Disseminated intravascular coagulation
- Horner syndrome
- Immune effector cell-associated neurotoxicity syndrome (ICANS)
- Opsoclonus myoclonus ataxia syndrome
- Paraneoplastic syndromes
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Acute toxicities and complications of treatment on different organs and systems
- Anatomical compression from masses on:
- airway
- bowel, such as Burkitt lymphoma
- spinal cord
- vascular systems
- Haematological complications
- Immunosuppression and infectious complications
- New oncology diagnoses presentations
Assessment
- Full examination and history, such as height and weight
- Grading of toxicities, such as by Common Terminology Criteria for Adverse Events (CTCAE)
- Mucositis score
- Pain score
- chest x-ray
- CT scan
- others as clinically indicated
- Immediate IV access, with aim of central venous access
- Inflammatory markers as appropriate
- Referral to other speacialist teams as appropriate
Investigations
- As indicated by presentation and suspected diagnosis
- Basic observations
- Blood cultures (as per local guidelines) and other microbiological investigations as indicated
- Blood work as indicated:
- biochemistry
- coagulation studies
- full blood examination (FBE)
- Imaging:
- chest x-ray
- CT scan
- others as clinically indicated
- Immediate IV access, with aim of central venous access
- Inflammatory markers as appropriate
- Referral to other specialist teams as appropriate
Procedures
- Cardiorespiratory resuscitation
- Central line / IV access
- Conscious sedation
- Indwelling urinary catheter
- Insertion of intraosseous needle
- Intradermal, intramuscular, intravenous, and subcutaneous injections
- Nasogastric tube insertion
- Needle thoracocentesis for pleural effusion
General management considerations
- Consider goals of therapy
- Consider patients’ demographics, including geographic location, socioeconomic status, ethnicity, and cultural background when managing and following up patients, such as travel from rural to metropolitan areas
- Consider timing of decisions and risks for individual patients:
- advance care planning and referral to palliative care for patients with advanced stage disease, recurrent / relapsed disease and known poorer outcomes
- compliance with treatments
- complicating premorbid conditions or those related to treatment, such as:
- cognitive impairment
- fatigue
- mood changes
- neurological impairments
- vision and hearing loss
- consideration of stresses related to body changes and subsequent altered social and peer interactions due to cancer and treatment, such as amputation, hair loss, and weight changes
- Impact of comorbidities on diagnosis and management
- Multidisciplinary care in management and treatment
- Tailor communication according to patients’ age, developmental stage, and psychosocial circumstances
- Unique requirements of adolescents and young adults (appropriate language and setting)
Specific management considerations
- Emergencies require prompt assessment and management, including escalation of care as required
- Goals of care
- Monitoring and managing side effects during treatment
