The Healthcare Team
Posted 4/14/2010
Posted in
As it takes a village to raise a child, it takes a team to care for cancer. It is often overwhelming and confusing, in the beginning, to sort how who ARE all these people and what are their jobs and who do I call for what. It may be difficult to choose the right doctors, to make careful decisions about institutions and office practices and teams. We had a long and thoughtful conversation in my group for women with Stage IV cancer this week about the importance of being with the right medical oncologist.
Women who are first diagnosed with breast cancer usually spend the early days with a surgeon. It seems then that the surgical choice is the most important one, and most certainly it is vital to have a competent and caring breast surgeon. S/he often will be the conduit to your other doctors, so her affiliations and professional networks matter, too. What becomes clear over time, over years, is that the medical oncologist is the person who will be driving the course of your total care. Without trying to minimize or insult anyone, one way to think about this is that the medical oncologist is the contractor. S/he asks for help with particular parts of the task (surgery, radiation, neurology, other specialists if needed) as a contractor would hire an electrician and a plumber. It is the medical oncologist who is the central figure and will be your primary cancer relationship. You likely will be seeing your medical oncologist for the rest of your life. Therefore, it is vitally important that you trust and respect this person, that you can communicate easily with one another, and that you are comfortable with her care. If you are not, consider finding another doctor.
Anyway, all of this is prologue to this handy guide from ASCO's Patient Site listing the likely members of an oncology care team. You may not have all of these people involved in your treatment, but it is still helpful to know they exist and aree available if needed.
Onology Team
Last Updated: April 02, 2010
This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/10
Key Messages:
A medical oncologist, surgical oncologist, radiation oncologist, and pediatric oncologist are the doctors who treat people with cancer.
Other members of the oncology team may include a diagnostic radiologist, pathologist, oncology nurse, physician assistant, oncology social worker, rehabilitation therapist, dietitian, and chaplain.
The process of diagnosing and treating cancer is complex and often involves a team of doctors, nurses, and other health care members. A team approach combines the skills of several different disciplines to provide the best possible care. With many specialists on the team, it can be difficult to understand each person's role. You will find more information about these professionals below.
The education of doctors
All oncologists (doctors who treat people with cancer) begin their education with four years of premedical education at a college or university, followed by four years of medical school where they earn an MD (medical doctor) or DO (doctor of osteopathy) degree. After medical school, a doctor must pass an examination to become licensed to practice medicine and complete a three- to seven-year residency, such as general surgery or internal medicine. In the United States, each state has its own standards for licensing doctors.
Many oncologists have additional training (called a fellowship) after their residency in a specific subspecialty, such as breast surgery or medical oncology. Independent specialty boards certify doctors in each specialty and subspecialty to ensure a professional level of competence for all who earn certification.
Types of oncologists
Medical oncologist: A doctor who specializes in treating cancer with medication. Medical oncologists complete a three-year residency in internal medicine, followed by a two-year fellowship in oncology. (Note from Hester: at BID, and some other institutions, Fellows spend three years in training.) They may give chemotherapy (the use of drugs to kill cancer cells) and work with primary care physicians and other medical specialists. Often, the medical oncologist is the coordinator of the treatment team and keeps track of the various tests results and follow-up exams performed by other specialists. A person with leukemia, lymphoma, or other blood-related cancer may be cared for by a hematologist (a doctor that specializes in the treatment of blood disorders). A hematologist also completes a three-year residency in internal medicine followed by a fellowship in hematology, oncology, or hematology/oncology.
Surgical oncologist: A doctor who specializes in treating cancer using surgery. Surgical oncologists complete a five-year residency in general surgery and a two-year surgical oncology fellowship. They may choose to specialize even further and devote training to one type of cancer, such as breast or lung cancer.
Radiation oncologist: A doctor who specializes in giving radiation therapy to treat cancer. Radiation oncologists complete a five-year radiation oncology program. The first year focuses on internal medicine, while the rest focus on radiation oncology. Unlike medical and surgical oncologists, a fellowship is not required to be a certified radiation oncologist.
The American Society of Clinical Oncology (ASCO) also recognizes pediatric oncology and gynecologic oncology as distinct disciplines within the field of oncology.
Pediatric oncologist: A doctor in one of the three primary oncology disciplines above who specializes in the treatment of children and adolescents with cancer. Pediatric oncologists are trained as pediatricians (doctors who specialize in the treatment of children and adolescents) and then receive additional training in oncology.
Gynecologic oncologist: A doctor who specializes in diagnosing and treating cancer in a woman's reproductive system. Gynecologic oncologists obtain training in obstetrics/gynecology and then complete two to four years of formal training in all forms of treatment of gynecologic cancers, which include surgery, radiation therapy, chemotherapy, and investigational treatments. They also study the biology and pathology of gynecologic cancer.
Additional members of the medical team
Diagnostic radiologist: A medical doctor who specializes in performing imaging tests to diagnose disease. A diagnostic radiologist is responsible for reviewing requests for x-rays, ultrasound tests, magnetic resonance imaging (MRI) tests, and magnetic resonance angiography (MRA) tests, performing procedures, and interpreting results.
Pathologist: A medical doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. A pathologist is responsible for interpreting the results of biopsies (removal of tissue for examination under a microscope) and laboratory tests. A pathologist's recommendations provide the final diagnosis of cancer. Although a pathologist usually works directly with the treating oncologist, a person with cancer may never meet their pathologist. (Note from Hester: Everything follows from the pathology. All treatment decisions are, at least partly, based on the pathologist's report. This job is critical.)
Oncology nurse: A health care professional who helps care for a person with cancer. Nurses serve in many roles depending on their experience, advanced education, and specialized certification. A nurse's role ranges from giving chemotherapy to coordinating care between the clinic and home, as well as conducting research. To be certified as a registered nurse (RN), a person must graduate from a state-approved school of nursing.
The program may be a four-year university program, a two-year associate degree program, or a three-year diploma program. An RN must also pass a licensing examination to begin practicing nursing. Nurses need additional experience to specialize in the area of oncology, and many choose to obtain certification in oncology. Certification as an oncology nurse (OCN) requires a minimum of one-year experience as an RN, a minimum of 1,000 hours of oncology nursing practice, and completion of at least 10 contact hours of continuing education in the specialty of oncology nursing. Another certification is the Certified Pediatric Oncology Nurse (CPON). Learn more about the role of an oncology nurse.
Oncology nurse practitioner: An advanced practice nurse educated at either the Master's- or Doctoral level. Oncology NPs see patients independently and work in collaboration with and under the supervision of an oncologist to enhance the care of people with cancer. Responsibilities of an oncology NP may include performing health assessments and physical examinations, ordering and interpreting diagnostic and laboratory tests, prescribing medications, and ordering chemotherapy. In addition, they are experts in helping patients manage side effects of cancer treatments. Some advanced oncology NPs perform procedures such as a bone marrow aspiration, biopsy, and intrathecal chemotherapy (chemotherapy that is injected into the fluid-filled space between the layers of tissue that cover the brain and spinal cord). Oncology nurse practitioners (NPs) begin training as family or adult NPs; if they choose to focus in oncology, they take a national exam to become certified as an Advanced Oncology Certified Nurse Practitioner (AOCNP).
Physician assistant: A health care professional educated at a Master's- or Doctoral-level who has been certified by the National Commission on Certification of Physician Assistants. Physician assistants (PAs) work with and under the supervision of a doctor, delivering a broad range of services. Responsibilities may include performing regular cancer screening tests, conducting physical examinations, ordering and interpreting tests, diagnosing and treating cancer, assisting in surgery, helping mange side effects, prescribing medications, and ordering chemotherapy. In addition, PAs educate and counsel people about their disease. Meanwhile, some PAs perform procedures, including lumbar puncture (the process of taking a sample of cerebral spinal fluid to look for cancer cells, blood, or tumor markers), paracentesis (the removal and analysis of fluid from the abdomen with a needle), and biopsy.
Oncology social worker: A professional who provides a variety of services, which may include counseling patients and families in discharge planning (transferring care from the hospital to home) and home care, helping with coping skills and lifestyle changes, and facilitating support groups. Social workers are also trained to help people living with cancer cope with financial concerns and provide links to community resources.
Social workers often possess a Masters in Social Work (MSW) degree. The MSW program is typically two years in length and includes course work in human growth and development, social policies and programs, methods of practice, and social research. Most programs require at least 900 hours of supervised fieldwork. Oncology social workers receive specialized training in cancer care through continuing education and onthe-job experience. Read more about how an oncology social worker can help.
Dietitian: A food and nutrition professional who answers questions about nutrition and helps people with cancer plan menus to cope with special needs. For example, a dietitian may teach a person with head and neck cancer how to prepare liquid food after surgery. In hospitals and other health care facilities, the dietitian provides medical nutrition therapy. A registered dietitian (RD) has completed an accredited practice program (usually six to 12 months) and passed a national examination.
Rehabilitation therapist: A physical, occupational, speech, or recreational therapist who helps patients return to their highest level of independence. For example, rehabilitation therapists may help people with brain tumors regain speech and independence or help women with breast cancer learn exercises to regain strength after a mastectomy.
Chaplain: A trained member of the clergy who offers spiritual support and rituals for patients and their families, facilitates support groups, and offers support in health crisis situations. Most hospitals have clergy on staff who work with people of all faiths. Some people may prefer to work with their own clergy person.
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