What is inpatient hematology/oncology?

[Jason110]

Hey all,

I'm a 4th year medical student. For my 4th year acting internship, I got assigned to the Inpatient Hematology/Oncology service, and will be starting in a month or so. I'm still unsure what exactly "inpatient heme/onc" is and have been unable to find it online.

What sort of pathology should I expect to see on this service? Solid organ tumors ? Myelodysplasia? Leukemia/Lymphoma?

I want to know because I'd like to (and maybe need to) do some reading up on the topic before starting.

Thanks.

Jason

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[gutonc]

The pathology to expect depends on what your program does. In general, if you have a BMT service, you'll see a lot of transplant patients, both during the txplant and the inevitable disasters afterwards. (Here's a fun fact, BMT patients who get intubated have a 3% 30-day survival...whip that one out on rounds for a good time.)

You'll also see a bunch of acute leukemics and blast crises (although depending on your program, a lot of these may initially go to the ICU) there for induction chemo. You'll also see a ton of neutropenic fevers and chemo complications like dehydration. Most solid-tumor chemo is done as an outpt these days but there are still a few continuous infusion regimens that need to be done in-house so you'll see some of them.

As with your IM clerkship, just read about the conditions that your patients have, no need to kill yourself reading all of Williams' Hematology or the MD Anderson Med Onc Guide. UpToDate will be more than enough for most things. If you've got a patient on experimental therapy, try digging up background, pre-clinical trial data. And always remember the NCCN treatment guidelines to help you figure out what the chemo regimens are and why they're being used: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp?button=I+Agree.

Good luck.

 

[TommyGunn04]

Inpatient oncology services vary quite a bit from hospital to hospital. Some are combined services with both solid and liquid tumor patients, while others are compartmentalized into separate liquid, solid, and transplant wards.

If you're on a liquid tumor service, as the last poster said you'll see lots of febrile neutropenia, some acute leukemias, maybe some tumor lysis syndrome, and other complications of chemotherapy. On the other hand, a typical solid tumor service is more like a general medicine service for patients who happen to have cancer. There you'd see pneumonias, GI bleeds, pleural effusions, volume overload, dehydration, renal failure, UTIs/urosepsis, etc etc. You'll also periodically see other complications of their diseases too, such as spinal cord compression from bony mets, SVC syndrome, malignant effusions and ascites, strokes from brain mets, carcinomatous meningitis, etc.

That said, no matter what service you're on, the most important thing about your AI is that you learn general medicine, not oncology. I'd encourage you not to focus too much on chemo regimens and the specific diseases, but more on the inpatient management of sick patients, with attention to antibiotic choices, lab interpretation, radiologic interpretation, pain management, and the treatment of common conditions like PNA, UTI, bacteremia, GI bleeds, renal failure, volume overload, CHF, DVT/PE, catheter infections, etc. You're likely to see most of this stuff on your AI, even on an oncology ward.

A general medicine type of text is probably your best bet, such as the "Current" book, or even just UpToDate articles on these general topics as you see them.