When you are diagnosed with cancer, you may be cared for by a battalion of medical professionals and support staff with titles that may be unfamiliar to you.
When Laura Hertzog was diagnosed with non-Hodgkin lymphoma in 2008, she chose treatment at a major New York City cancer center. There, she was cared for by a battalion of medical professionals, including her oncologist, a rotating cast of oncology nurses, administrative medical staff, technicians who took vitals and performed imaging scans as well as a pulmonologist and a cardiologist, to name a few.
“You deal with so many different people who are themselves dealing with so many different people,” says Hertzog, a 45-year-old attorney.
Hertzog is far from alone in her experience, which she describes as being put through a life-saving “cancer factory.” Today’s cutting-edge cancer care has become so complex that patients are typically treated by a multidisciplinary team of specialists, who themselves may be supported by specialists behind the scenes.
To help patients through the medical maze, some cancer hospitals and treatment facilities, such as Baylor Charles A. Sammons Cancer Center at Dallas, employ patient navigators like Cynthia Robinson-Hawkins, RN, herself a cancer survivor.
“We make sure the patient understands what to do, where to go next and what’s going to happen,” she says. If a patient navigator isn’t available to you, learning about the medical professionals you’re apt to encounter can make the treatment process less overwhelming.
When an abnormality, such as a lesion or mass, is first discovered, you may already know the drill: A sample is taken, usually by a radiologist, surgical oncologist or dermatologist, depending on where the questionable finding is located. Tissue is then sent to a pathologist, a doctor who reviews the tissue and cells in the lab to determine if it’s malignant and sends a pathology report to your physician. The pathology report indicates the type of cancer and special protein and genetic tests may be done on the tissue to help with treatment decisions.
With the possibility of a blood-related cancer, blood is drawn and sent to the lab for analysis. Further testing may be needed, such as more blood work, PET (positron emission tomography) or CT (computed tomography) imaging scans or an MRI (magnetic resonance imaging) to help the physician stage the disease.
Depending on your diagnosis—for example, if it’s a rare cancer—your physician may refer you to a major cancer center, which offers a specialized multidisciplinary approach to care. Here’s a rundown of who is likely to be part of your healthcare team and how to take full advantage of the expertise and personal attention available to you.
Medical oncologist: This physician, who specializes in treating cancer with systemic medical therapy, such as chemotherapy or biological therapy, will discuss your pathology report with you, including the stage of your disease, your treatment plan and its trajectory. You then may be referred to other specialists within the hospital or cancer treatment facility, depending on other medical conditions you have. If you have a history of heart disease, for example, you may need to be seen by the hospital’s cardiac service first before starting cancer treatment. If you require chemotherapy and radiation before having surgery, the medical oncologist will dictate the chemotherapy portion of your treatment plan. Post-surgery, you will continue to be monitored by the medical oncologist, to make sure the disease will not recur. Your treatment going forward will be based on your response to initial treatment.
Surgical oncologist: If surgery is appropriate for your situation, you’ll be referred to a surgical oncologist or other surgeon who specializes in the surgical procedure you need. In some cases, surgery will be the first phase of treatment and may impact further treatment.
Radiation oncologist: If radiation becomes part of your treatment plan, a radiation oncologist will manage the radiation portion. This physician has the expertise and training to prescribe radiation therapy treatments and determine the details of the area to be treated and the dose and schedule. In addition, you may encounter a number of technicians who operate the radiation equipment and are trained to support the radiation oncologist.
Fellow: After being called into the exam room, you may be seen by a fellow, a full-fledged physician in the process of specializing in a particular field of oncology, if you’re being treated at an academic medical center (teaching hospital).The fellow will do a physical exam and review your case with your physician.
Oncology nurses: Oncology nurses specialize in caring for cancer patients in several different settings, including inpatient and outpatient care. Nurses also may administer chemotherapy in the infusion room and assist the doctor during appointments. They may be a registered nurse (RN) or an Oncology Certified Nurse (OCN) or have received special training to become an Advanced Oncology Certified Nurse (AOCN) or an Advanced Oncology Certified Clinical Nurse Specialist (AOCNS). In some states, nurses can become Nurse Practitioners (NP), who may assist you instead of your physician. If you don’t know your oncology nurse’s role, ask about his or her specialization and the meaning of the letters after his or her name.
Patient Navigator: A patient navigator is typically a registered nurse, social worker or trained community member (sometimes a cancer survivor), who can help patients “navigate” the healthcare system, appointments and financial issues. Patient navigators won’t tell patients what to do but will suggest questions to ask their doctor and help them establish priorities. Being prepared can decrease stress and anxiety.
Social worker: If it’s determined that you may need social or financial support, a social worker may be summoned to determine what options might be available to you, such as a visiting nurse or enrolling in Medicaid or Medicare. The social worker can also meet with you for counseling or refer you to a psychologist or psychiatrist, a medical doctor who can prescribe psychiatric medication, if necessary.
Oncology clinical pharmacist: Before chemotherapy, an oncology clinical pharmacist, who specializes in providing pharmaceutical services to improve outcomes in oncology patients, might dispense medication to reduce the risk of nausea, pain and other side effects.
Depending on the type of cancer and other medical conditions you may have, your healthcare team may also include an internist and other specialists within the hospital or treatment facility, including a registered dietitian, who helps manage the nutritional aspects of cancer; bone marrow transplant specialists; pain management specialists (also called palliative care specialists); and pulmonologists—physicians specializing in lung conditions. You may also be referred to rehabilitation or to a support group.
At medical appointments, record the names and telephone numbers of key members of your healthcare team, such as your doctor, the physician's assistant and nurse. Find out who is the main coordinating physician that is organizing the overall care plan. Always ask as many questions as you need to, to understand what's happening to you, including: "Should I call you if I develop this symptom?"
If it's not clear who you should call if there's an issue, verify it before leaving your appointments, so you always feel you have a lifeline to your medical team. "We want patients to be well-informed about their disease and in agreement with the treatment plan that's determined," says Joanne Taylor, RN, a clinical nurse specialist at Memorial Sloan-Kettering Cancer Center in New York City. Moreover, a treatment plan is no good if you don't follow it. Expected side effects are less scary if you know they're a possibility, so make sure it's part of the discussion.
Despite the multitude of medical professionals you'll likely encounter, keep in mind that you are the most important part of your healthcare team. "The reality is that you're your own best advocate because no one is paying as much attention to your own medical care as you are," Hertzog says.