Question 1

Why do you want to work in clinical oncology?

Accepted Answer

The honest answer is that one patient changed my plans. As a foundation-level doctor I looked after a man in his sixties who came in unable to walk properly because of back pain, and it turned out to be spinal cord compression from prostate cancer he didn't know he had. I was part of the team that got him scanned, started on steroids and referred that night. What struck me was what happened next. The clinical oncologist saw him the following morning, sat on the edge of his bed and explained radiotherapy in a way he could actually follow, and within a few days he was planned and treated. A couple of weeks later his pain had settled enough for him to go home. That was the first time I understood how much one specialty could hold together. Clinical oncology isn't only radiotherapy. It's systemic treatment, acute oncology, palliative care, long relationships with patients, and some very technical work with physicists and radiographers. I like that mix. I enjoy anatomy and imaging, so the planning side genuinely interests me, but I also find I'm good in the quieter conversations, the ones where someone needs time to understand what's happening to them. Since then I've tried to test that interest properly. I've spent time in on-treatment review clinics, sat in on planning sessions, and worked on the acute oncology rota. I've seen patients whose cancer we cured and patients whose last few weeks were made more comfortable by a single fraction of radiotherapy. Both feel worthwhile…

Question 2

You are asked to see a patient with painful bone metastases referred for palliative radiotherapy. How would you approach the consultation and treatment decision?

Accepted Answer

I'd start before I meet the patient by reading the referral, the imaging and the most recent clinic letters, so I know the primary, what systemic treatment they're on and what the MDT has said. With bone metastases I want to know exactly where the pain is coming from and whether the imaging actually matches it. In the room I'd take a proper pain history: where it is, how it affects sleep and walking, what analgesia they're taking and whether it's working. Then I'd be specifically looking for red flags. Any back pain that's new, band-like or worse lying flat, any weakness, numbness or change in bladder or bowel function makes me think about cord compression, and that changes the urgency completely. I'd also think about fracture risk, especially in a weight-bearing long bone, because a lesion that looks at risk of breaking may need an orthopaedic opinion before radiotherapy rather than instead of it. If it's uncomplicated bone pain, the evidence supports a single fraction being as effective for pain relief as longer courses, with a slightly higher chance of needing retreatment later. For most patients one visit is a real advantage, particularly if they're frail or travelling a long way. I'd plan in line with our departmental protocols and check with my consultant if anything is unusual, such as previous radiotherapy to the same area. Consent would cover what we hope to achieve, which is pain relief rather than cure, how long it takes to work, and the common side effects,…

Question 3

Tell me how you would break the news to a patient that their cancer has progressed despite treatment.

Accepted Answer

I'd prepare first. I'd read the scan report myself and look at the images with a radiologist or my consultant if I'm unsure, and I'd know what the realistic options are before I go in, whether that's a change of systemic treatment, palliative radiotherapy, a trial or a focus on comfort. I'd ask the clinical nurse specialist to join me if possible, book a quiet room, and hand my bleep to a colleague. I remember a woman with lung cancer whose scan after several cycles of treatment showed new liver disease. I started by asking how she'd been feeling and what she thought the scan might show. She said she'd been more tired and was worried. That told me she was partly expecting it, so I gave a warning shot: 'I'm afraid the scan hasn't shown what we'd hoped.' Then I paused. I explained in plain words that the cancer had grown and spread to the liver, and that the treatment wasn't controlling it. I didn't rush to fill the silence. She cried, and her daughter held her hand. When she was ready, she asked whether this meant she was dying. I answered honestly that we couldn't cure the cancer, but that there were still things we could do to try to control it and keep her comfortable, and that we'd talk about time if and when she wanted to. We then talked through options in outline and agreed not to make any decisions that day. The specialist nurse arranged to phone her later in the week, I gave her a contact number, and I documented the conversation carefully, including what she'd been…

Question 4

What are your responsibilities under IR(ME)R as a doctor working in clinical oncology?

Accepted Answer

The Ionising Radiation (Medical Exposure) Regulations 2017, IR(ME)R, set out who is responsible for each step of a medical exposure. Northern Ireland has its own equivalent regulations, but the principles are the same. The key idea is that every exposure must be justified and optimised, and that everyone involved has a defined duty holder role and is entitled by the employer to carry it out. The duty holders are the employer, the referrer, the practitioner and the operator, with the medical physics expert advising. In radiotherapy, a clinical oncologist will often act as referrer and practitioner, because we decide that treatment is indicated and we justify the exposure. Practical parts of the process, such as outlining target volumes or signing a prescription, are operator functions. What matters to me is that I only carry out the roles I've been formally entitled to do in that department, and as a new Clinical Fellow I'd expect my scope to be defined clearly and to grow with training and sign-off. Justification means I'm satisfied the benefit outweighs the risk for that individual, considering alternatives and previous radiotherapy. Optimisation is a shared job with physics and radiographers, keeping dose to normal tissues as low as reasonably practicable while treating the target properly. Then there are the specific checks. I make sure the correct patient is identified, that pregnancy status has been established for anyone of childbearing potential in line with the…

Question 5

You are on call and receive a phone call about a patient with known breast cancer who has new back pain and leg weakness. What would you do?

Accepted Answer

This is suspected metastatic spinal cord compression until proven otherwise, and it's an emergency because the neurological outcome depends on how quickly we act. The single most important predictor of whether someone walks after treatment is whether they're walking before it. First I'd get the key facts: where the patient is, how long the weakness has been there, whether it's progressing, and whether there's any numbness, a sensory level, urinary retention or bowel change. If they're at home or in another hospital, I'd advise urgent assessment in an emergency department. If they're on our ward, I'd go and see them myself straight away. On examination I'd do a full neurological assessment and document it clearly, because that baseline matters. I'd check for a palpable bladder. Until spinal stability is assessed, I'd follow local guidance on positioning and log rolling, especially if the pain is severe or mechanical. Then I'd arrange an urgent MRI of the whole spine, because there can be more than one level involved. I'd contact the MSCC coordinator, as most cancer centres have a single point of contact. I'd start dexamethasone in line with our local MSCC protocol if there's a neurological deficit, with gastric protection and blood glucose monitoring, and make sure they have adequate analgesia. Once the MRI confirms compression, the decision about surgery or radiotherapy is made quickly with the spinal surgical team, the oncology consultant and the patient. Factors include…

Question 6

Which of the NHS values matters most to you in clinical oncology, and how have you shown it?

Accepted Answer

The six NHS values are working together for patients, respect and dignity, commitment to quality of care, compassion, improving lives, and everyone counts. In oncology the one I come back to most is respect and dignity, because patients with cancer can very quickly lose control over their own lives. Their week is built around appointments, they're examined by lots of different people, and they can start to feel like a diagnosis rather than a person. I saw this with a man in his seventies having a course of radiotherapy for head and neck cancer. He'd been a teacher, quite private, and by the third week he was struggling to eat and losing weight. In the review clinic he was quite short with me. Rather than going straight through my checklist of side effects, I asked him what had been the hardest part. He told me he hated being weighed in the corridor and being talked about as 'the feeding tube conversation' before anyone had asked him what he wanted. That was fair. So I slowed down. I explained honestly why the dietitians were worried and what a feeding tube would and wouldn't mean for him, and I asked what he was worried about. It turned out he thought a tube meant he'd never eat normally again. Once we'd talked that through with the dietitian, he agreed to it on his own terms. I also mentioned to the radiographers and the clinic nurse that we could weigh him somewhere more private, and they changed it straight away. It was a small thing, but it reminded me that respect…

Question 7

How do you work with therapeutic radiographers and medical physicists, and can you give an example?

Accepted Answer

Radiotherapy is one of the most team-based things a doctor does. I might outline a target and sign a prescription, but the plan is produced by dosimetrists and physicists, checked independently, and then delivered every day by therapeutic radiographers who see the patient far more often than I do. If I treat any of them as a service rather than as colleagues, the patient is less safe. One example stays with me. I'd outlined a target volume for a palliative pelvic treatment and the plan came back from planning with a note from the physicist. The dose to a nearby area of bowel was higher than she'd expect for that technique, and she asked whether my volume was meant to extend that far. When I looked again with fresh eyes, I'd included more of a nodal area than the clinical picture justified. I thanked her, discussed it with my consultant, and we tightened the volume. The revised plan was better for the patient. Another time, a radiographer bleeped me because a patient on treatment looked much more breathless than at the start. It would have been easy to say 'I'll see him in review clinic on Thursday', but I went down. His oxygen saturation was low and he needed admission. She was right to flag it. What I try to do day to day is simple. I answer bleeps from the treatment unit promptly, I make sure my prescriptions and notes are clear and complete so nobody has to chase me, and I ask radiographers what they're seeing because they often notice a skin reaction or a change in mood…

Question 8

Tell us about a time you made a mistake or were involved in a near miss. What happened and what did you learn?

Accepted Answer

As a junior doctor on an oncology ward I prescribed a patient's regular medications on admission and missed that she'd stopped one of her oral anticancer tablets a week earlier on her oncologist's advice. I'd copied it from an older clinic letter. The pharmacist picked it up during medicines reconciliation the next morning, before any dose was given. My first feeling was a horrible jolt, because oral SACT isn't something you get casually wrong. I went straight to the pharmacist, thanked her, checked the most recent letter and confirmed with the patient what she was actually taking. I amended the chart, told my registrar and completed an incident report, even though no harm had happened, because a near miss is still useful learning. I also spoke to the patient. I explained there'd been an error on her drug chart that had been corrected before she received anything and apologised. She appreciated being told, and it felt like the right thing to do. When I reflected afterwards, the problem wasn't just my lapse. The latest letter wasn't easy to find, and oral anticancer medicines on that ward were being prescribed on the general chart rather than through the SACT prescribing system. I raised that at the ward's safety meeting, and the team agreed a simple rule that oral SACT on admission is held until confirmed by the oncology team or pharmacy against the electronic SACT record. That later became part of a short teaching session for new doctors. Since then I never rely on a…

Clinical Oncology Interview Questions & Answers

About this NHS interview question bank

Free NHS interview questions and model answers

Question 1: Why do you want to work in clinical oncology?

Question 2: You are asked to see a patient with painful bone metastases referred for palliative radiotherapy. How would you approach the consultation and treatment decision?

Question 3: Tell me how you would break the news to a patient that their cancer has progressed despite treatment.

Question 4: What are your responsibilities under IR(ME)R as a doctor working in clinical oncology?

Question 5: You are on call and receive a phone call about a patient with known breast cancer who has new back pain and leg weakness. What would you do?

Question 6: Which of the NHS values matters most to you in clinical oncology, and how have you shown it?

Question 7: How do you work with therapeutic radiographers and medical physicists, and can you give an example?

Question 8: Tell us about a time you made a mistake or were involved in a near miss. What happened and what did you learn?

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