Acute oncology: A bona fide subspecialty or a distraction from the day job?

摘要

The concept of acute oncology and a clinical service to support it has developed rapidly over the past 5 years. It principally arose out of the publication of two reports. The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report in 2008 [1] and the National Chemotherapy Advisory group (NCAG) report in 2009 [2]. The NCEPOD report highlighted the process (or lack of process) of care of patients who died within 30 days of receiving systemic anticancer therapy (SACT). It made a number of wide-ranging recommendations, including better co-ordination of services for patients admitted as emergencies with SACT toxicity. As a result of these findings, the NCAG report went on to recommend the establishment of an acute oncology service (AOS) in relevant hospitals to improve the management of cancer patients admitted as an emergency. In parallel to these reports, there has been increasing awareness of a need to manage cancer-related complications, including better management of metastatic spinal cord compression [3]. Finally, patients who present acutely, usually as in-patients, with a new diagnosis of cancer and, in particular, malignancy of unknown origin, logically form a group who need oncological advice in the acute setting.