I originally chose clinical oncology because I’m interested in multiple specialties and oncology is interesting because you really see a great spectrum of patients, you need to have knowledge about paediatric patients up into head and neck, ENT, gynaecology. In medical school and during my intern training I was in touch with multiple departments and I was interested in multiple aspects and this is really interesting. And I’m quite interested in palliative care as well and just improving the quality of life of patients. I think oncology really tries to improve the quality of life of patients and this, to me, is quite an important aspect.
In Hong Kong I’m part of the clinical oncology training, so it’s quite similar to the UK system. You have the basic science and now I’m learning about the cancer biology and physics aspects and also statistics and pharmacology, then later on we go into more clinical aspects. Day to day, in the day I would round in the mornings, I see my in-patients. Then afterwards we would go to clinic where we either have a chemo clinic or also our RT planning and quite a lot of follow-up patients as well. So the whole process is learning new things every day, learning things from my seniors, reading up on my own and also having the opportunity to attend these immuno-oncology conferences to really see the more cutting edge and the newer therapies as well. So there’s a lot to learn but it’s really, really exciting as well to be in this field.
What have been the highlights of this meeting?
Immuno-oncology is really interesting to a lot of patients. In Hong Kong and in China as well there’s almost like a traditional Chinese medicine mind-set to it as well, the whole yin and yang and then using your own immune system to help combat the disease. It’s actually very appealing to a lot of Chinese patients so actually learning more about this is interesting, both for the care of our patients but also because patients are really interested in knowing more about it. It’s definitely an incremental step in better treatment for our patients; it will be a good development but it’s not necessarily a complete cure. For example in lung cancer just comparing the immunotherapy to docetaxel, the chemotherapy, it’s definitely an improvement but it’s not as huge as improvement as, for example, the TKI therapy. So it’s definitely incremental and there will definitely be patient selection about which patients will benefit the most but it’s definitely a very interesting area.
Do you have access to the necessary lab tests when choosing treatment?
It is definitely because I’m working in the public setting so it would be limited by the lab. For example for colorectal cancer I don’t think our lab can actually do the microsatellite instability testing. They are still trying to develop getting the PD-L1 testing as well so it’s in development at the moment. Actually even if we do have testing for these aspects some patients can’t actually afford the treatment as well so that’s another aspect we need to think about.
How do you handle these difficulties with treating patients?
It’s our duty of care to really give them all the options but then at the same time giving all our treatments we talk about the efficacy, the side effects but then there’s also this other aspect we need to talk about of the cost. It’s an unavoidable issue and some patients really do feel that sometimes we’re almost denying them a treatment because of the cost. Unfortunately that’s the thing we need to try to overcome and we would need help from NGOs, from getting funding resources to try to help get our patients the best care we can.
Are patients incentivised to join clinical trials?
I think so. Sometimes if patients are in that aspect we would offer a clinical trial to them so that they could have opportunities to try newer treatments, so that they could try the drug for free.
Do you see imaging becoming a prognostic factor?
As imaging techniques get better and definitely getting more and more access to PET-CT. I heard about the biologically guided radiotherapy which was really interesting. Actually I saw one of my radiotherapy colleagues in there saying that this is probably going to be the latest development so this is another thing we’ll have to learn. So it’s definitely really interesting and as the techniques get better we would see which parts of the tumour are getting treated and we can actually target those places where we’re progressing with the oligometastasis so it’s definitely a really interesting aspect.
What is your take-home message?
I’ve just starting doing oncology and we definitely have a lot of new treatments we can offer to patients. But at the end of the day the most important, and what I get the most job satisfaction, is actually not necessarily the most heroic things but is actually seeing our in-patients and, for example patients who come in in a lot of pain, and actually a lot of what we do, the basics of palliative care, pain control, those are really important aspects that are integral to our job and also really do help the patient. So actually for most of us that, quite a lot of the time, gives us quite a lot of job satisfaction. So I just wanted to reiterate that, I really enjoy that aspect of our job.
