Nadine M. Tung, M.D.: Switching gears, Kristin, how do you explain multidisciplinary care to patients?
Kristin E. Fleischmann-Rose, NP: Multidisciplinary care is another way of saying that providers with different expertise are providing care to patients with cancer. The provider teams at our facility typically incorporate a medical oncologist who prescribes and recommends systemic treatments like chemotherapy; a surgeon; and a radiation oncologist. Now, if this is available at your hospital, I do believe that it is an asset. But certainly, this is not available everywhere.
Nadine M. Tung, M.D.: Are there other health care specialists or providers that you work with in your team?
Kristin E. Fleischmann-Rose, NP: Along with the medical oncologist, surgeon and radiation oncologist, I work with other nurse practitioners, nurse coordinators and treatment nurses. We work very closely with interpreters often, family members and of course patients. And all of these people make up the treatment team.
Nadine M. Tung, M.D.: What do you tell patients about complementary medicine? That’s a common question we get.
Kristin E. Fleischmann-Rose, NP: I do feel that there’s a role for complementary modalities in this type of treatment. Some of my favorites are massage, Reiki and acupuncture. I don’t feel that complementary treatments should take the place of recommended treatments such as systemic, either oral medications or chemotherapy, surgery, and radiation if they’re recommended, but I do think that they complement those treatments. Certainly, any time that you’re considering a complementary treatment, you should run it by your providers to rule out any treatment or medication contraindications.
Nadine M. Tung, M.D.: Kristin, any other specialists that you think are helpful for patients with breast cancer?
Kristin E. Fleischmann-Rose, NP: Very much so. I think that if you are considering a mastectomy or someone has recommended a large lumpectomy, you really should meet with a plastic surgeon to talk about reconstructive options. If you know that you’re going to have a large number of lymph nodes removed, this is a procedure called an axillary lymph node dissection, I would recommend that you meet with a lymphedema specialist or surgeon who specializes in reducing the risk of post-surgery lymphedema, which is swelling of the breast or arm. If you are somebody who already has lymphedema, I would strongly recommend that you meet with a physical therapist, preferably one who works with patients with breast cancer or patients who have had lymphedema. Here you could consider a role for lymphedema, or a compression, sleeve, which can help manage the symptom. They will also teach you massage and range of motion techniques to help lessen the severity of any discomfort associated with a lymphedema.