Oncology (Medical)

The common oncologic emergencies are:

• Febrile neutropenia (FN): FN is a common complication of systemic therapy. Relevant patients have been briefed on the detection and action required, if they suspect they have FN
• SVC obstruction
• Malignant hypercalcaemia (Serum Calcium over 3.0 mmol/l)
• Tumour lysis syndrome and malignant spinal cord compression

Malignant spinal cord compression may be the initial presenting symptom for some people with undiagnosed malignancy. In any adult with new onset back pain (particularly if it is not relieved by rest) and even subtle neurological symptoms in the lower limbs should undergo urgent MRI of the entire neuraxis and/or referral to the Emergency Department of the Royal Hobart Hospital.

Medical Oncologists are also involved in multi-disciplinary diagnostic workup and overall care planning in concert with other relevant hospital-based specialists, particularly surgeons and radiation oncologists.

Exclusions: Early stage non-melanomatous skin cancers.

Lymphomas and myeloma are principally managed within Haematology Services although there is some overlap.

Long term survivors of multimodality cancer treatment with complications from this, or their cancer, may benefit from referral to Oncology Late Effects Clinic.

In most instances referral to Medical Oncology is a secondary referral from another specialist discipline in the RHH who are primarily responsible for the management of the condition.

A referral is required for all new appointments and must conform to the Referral Standards as outlined on For Clinicians.

eReferral is now the preferred method of referral for this service and is available in all THS regions. Please refer via HealthLink SmartForm eReferral through your software system (either Best Practice, or Medical Director). For instructions, see Quick Guide: Creating an eReferral.

All referrals, regardless of origin, are triaged by the Medical Oncologist on call and presented to a weekly meeting of all Medical Oncologists. The patients are allocated in order of clinical priority to the Medical Oncologist with the earliest available appointment, usually over the ensuing one – three weeks.

This process ensures timely medical oncological input and shares the workload.

Where the on call Medical Oncologist judges there is a possibility of an oncological emergency or need for urgent therapy, the patient will be either seen within that week, or admitted to the RHH under the Medical Oncology Unit.

While each Medical Oncologist has interests in certain types of malignancies, it is not appropriate, at this time, to confine our clinical input to only those tumour types; therefore, we are all responsible for the management of the entire spectrum of adult malignancies (excluding early skin cancers and haematological malignancies for the most part).

• Northern Cancer Service
• Tasmanian Health Pathways