First-of-Its-Kind Supportive Oncology Program Offers Unique Training Opportunity for Fellows

To fulfill the growing need for oncologists with expertise in providing supportive care for patients living with cancer and those who have achieved a cure for their disease, investigators at The Christie NHS Foundation Trust in Manchester, England, have created a first-of-its-kind program to train oncology fellows in this area and offer supportive oncology services to patients.1

First announced in October 2024, the supportive oncology program will support approximately 2000 patients annually at The Christie who are living with cancer for an extended period.2 The program combines offerings including psychological support, pain and symptom management, medication optimization, occupational therapy, and end-of-life care. The program also offers patients dietary advice, endocrinology services to address hormonal adverse effects (AEs) related to cancer treatment, cardio-oncology care, and access to a specialist senior adult oncology team for patients with high levels of frailty.

As of January 2025, 3 supportive oncology fellows have been recruited to the program.1 The fellowship takes place over the course of 3 rotational placements lasting 4 months each. The first rotation covers acute oncology, toxicity management, and inpatient care. During the second rotation, fellows work alongside a supportive care team in enhanced supportive care clinics and with the palliative and end-of-life care teams. The final rotation encompasses psychological medicine, endocrinology, and the senior adult oncology service.

During the first 3 days of each rotation, fellows will shadow experienced consultants and then will progress to work more independently with patients. After the training of the initial 3 fellows is complete, 3 new fellows will be recruited to take their places. The fellowship is part of a national pilot program in the United Kingdom (UK) that aims to develop core competencies in supportive oncology. The new national supportive oncology curriculum was developed by the UK Association of Supportive Care in Cancer with support from the Royal College of Radiologists.

“[The creation of this program] was not a hard sell,” Richard Berman, MBBS, MRCGP, FRCP, the leader of the new service, as well as a consultant in Palliative Medicine and Honorary Senior Lecturer at The Christie, said in an interview with Oncology Fellows. “Individuals who work in cancer centers get it. I believe the reason it has very quickly gained traction in the UK is that this is a simple initiative and people understand that it’s something that’s necessary now and in the future.”

In the interview, Berman discussed the rationale behind the creation of the supportive oncology program, it’s potential effect on patients, and what training for fellows in the program will look like.

Oncology Fellows: What inspired the creation of this supportive oncology program?

Berman: Cancer treatments are advancing; all the money that’s been spent [on cancer research] over the past few decades is paying off and these newer treatments are transforming lives. We are seeing more and more individuals [who] are now living longer with cancer and more individuals are surviving cancer.

In the UK there are approximately 2.5 million people living with cancer, but, because of these treatment advances, by 2040 that number is going to more than double to [approximately] 5.3 million. Services are not set up to be able to cope with that demand, and we don’t [currently] have the expertise to understand how to [care for] these people because traditionally cancer care has focused on diagnosis, treatment, and end-of-life care. But with this growing number of people living with and beyond cancer it’s becoming a concern that this tsunami of people who are going to be living with the disease won’t have care in place and [physicians] won’t be trained in terms of how to [care for] them.

As a palliative care physician, I have seen that the nature of the type of individuals who are referred to me has changed from end-of-life care to seeing more people who are living longer with the disease, sometimes for many years. [For example], patients with stage IV lung cancer would have died within a few months [of their diagnosis] 10 years ago. But now we’re seeing patients with stage IV lung cancer who in some cases are going into remission on some of these newer treatments, such as targeted treatments and immunotherapy, and living for years. There are two problems: the number of individuals that we’re going to have to [care for] and that we don’t understand how to [do so]. [One] may have been trained in how to address pain at the end of life, but I certainly wasn’t trained in how to [treat] pain in patients who are living for many years with incurable disease.

We’ve been guided by the Multinational Association of Supportive Care in Cancer and used their definition of supportive care, which is prevention and management of the AEs of cancer and cancer treatments across the whole cancer continuum. It doesn’t matter where you are in the cancer journey, [patients] have supportive care needs across the board, including cancer survivors.

In the UK, there’s a lot of interest from the government and NHS England in supportive oncology because there’s research that has shown that by providing this type of care for patients, they have better outcomes in terms of symptom burden and quality of life. [Patients] who are going through cancer have enough stress and are upset, so if they have a problem related to their cancer or treatments, they need to be able to quickly access the right person.

Supportive oncology [also] benefits the health economy. Many studies have demonstrated that it helps to reduce costs because we see patients in a timely, proactive way, meaning that their problems don’t escalate to needing to be admitted to the hospital. There was a large national analysis of supportive care this past year which showed significant savings. In that study, across 8 cancer centers over 12 months, there was an 8.5-million-pound savings through supportive oncology. If you [scale] that up across all cancer centers in the UK there is a [potential] savings of 500 million pounds to the NHS. We are working with the government and NHS England to get this rolled out nationally and an important part [of that rollout] is that we need to train clinicians on how to [deliver supportive care].

What will training in the supportive oncology program entail?

These clinicians will provide care across the whole cancer pathway, irrespective of disease stage. They’ll need training in the main areas of cancer care practice, such as acute oncology and managing pain and symptoms in a way that’s consistent with disease stage. How you manage a patient’s pain at the end of life, often using opioid therapy, is not the same as how you might manage pain in a patient who is living for many years with the disease and is not the same as how you manage pain in an individual who has survived cancer.

We’re all conscious of the opioid crisis, and we don’t want to have millions of people on high doses of opioids for years and years. We need to do the research and then train our clinicians on how to manage pain in people living for longer with the disease [and do the same] for other symptoms too. How you manage sickness at the end of life is not the same as how you prevent and manage sickness in people who are undergoing chemotherapy.

[Clinicians] will also need to understand endocrine problems, because many cancer treatments cause endocrine problems, and they’ll need to understand how to manage other treatment toxicities, particularly those associated with the newer treatments. One of the challenges is that there are new treatments coming out all the time and these doctors will need to be kept up to date. Our fellows [will also receive] psycho-oncology experience and will undergo training in how to [care for] older patients with cancer [with higher levels of] frailty.

[Clinicians] will be able to deliver care across the board and they’ll receive palliative and end-of-life care training too. It’s not too complicated, we’re doing this to make sure that we’re [ready for the] future and understand how to [care for] these patients. If we don’t do this, there’s going to be a public health crisis in the not-too-distant future.

What makes a fellow a good fit for this program?

[Potential fellows] need be a member of one of the Royal Colleges. We’ve [chosen to also include] general practitioners because whilst it’s important that supportive oncology is delivered in the cancer centers, it’s also important that general practitioners and community [clinicians] can continue to provide that care at home. Now, they don’t have much expertise in these areas. [We hope] that this will become a standard part of oncology and palliative care training.

Have there been any challenges in terms of launching the program?

One of the biggest challenges has been making it clear to the palliative care community what supportive oncology is because the terms supportive and palliative have always been put in the same box. Supportive oncology is a much wider [scope] than palliative care. The world is changing and there are these new cohorts of patients who need a different type of care.

The second challenge is that there needs to be some national driver for change. Without that, [cancer centers] are not going to [offer supportive oncology services] unless they’re interested. Cancer centers need to deliver supportive oncology because it’s needed. This care is essential alongside treatment.

What are the next steps for further implementing and expanding the supportive oncology program?

It’s encouraging that the Royal Colleges in the UK are hugely supportive of it. The hope is that supportive oncology becomes a recognized medical specialty in the future; it’s going to have to be because there will always be individuals who need this type of care.

References

1. A new type of cancer care doctor is born. News release. The Christie NHS Foundation Trust. January 13, 2025. Accessed February 10, 2025. https://www.christie.nhs.uk/about-us/news-at-the-christie/latest-news-stories/a-new-type-of-cancer-care-doctor-is-born
2. New supportive oncology service launched at The Christie. News release. The Christie NHS Foundation Trust. October 8, 2024. Accessed February 10, 2025. https://www.christie.nhs.uk/about-us/news-at-the-christie/latest-news-stories/new-supportive-oncology-service-launched-at-the-christie