Identifying the Right Medical Professionals for you
Cancer Care Takes a Village
Cancer is a group of complex diseases that require a comprehensive whole-person approach, and you'll likely encounter many different medical professionals during treatment and survivorship. Some cancer centers offer multidisciplinary care (MDC) or operate with multidisciplinary teams (MDT)—professionals from multiple medical disciplines (oncology, radiology, radiation oncology, interventional radiology, surgery, pathology, nursing, etc.) coming together to collaborate on your care. Larger cancer centers may have all of these various professionals under one roof, making it easy to gather expertise from multiple perspectives. This is what happens in tumor board meetings: oncologists, radiologists, surgeons, pathologists, nurses, and others come together to discuss individual patient cases as a group, taking into consideration the many factors involved in creating personalized, effective treatment plans. If your cancer clinic doesn't offer many "in-house" professionals, you will have to work a bit more to develop your MDC team, but it is certainly possible. Plus, being able to select your ideal professionals a la carte, from a list of all in-network providers can be quite nice if you are someone who likes to have a bit more control.
It’s important to know who/where to go for the best guidance for various needs throughout cancer treatment and beyond. Thinking about how medical professionals are educated and what/how they are taught can help us better understand their expertise and limitations, so we can then choose the right medical professional for specific health and medical needs.
Your main go-to provider will likely be a medical oncologist/hematologist, and if you're a candidate for surgery or radiation therapy then you'll also work with a surgeon or interventional radiologist/radiation oncologist. What's important to remember as you move forward from diagnosis to treatment is that the medical needs you'll have will likely stretch beyond the care of a single oncologist. Side effects from cancer and cancer treatment can impact virtually any organ or body system from the liver, kidneys, and brain to the immune system, endocrine system, cardiovascular system, and more.
When you're in need of medical advice or side effect relief, seek out the right medical professional for your needs.
- Do you want to know if your cancer can be surgically removed? Meet with a surgeon.
- Do you want to know if radiation is an option for you? Speak to a radiation oncologist.
- Do you want to know if you're eligible for immunotherapy? Talk to a medical oncologist.
- Do you want to improve your diet? Schedule a consultation with a registered dietician.
- Do you want to discuss and work through fear, anxiety, stress, depression, coping skills, or other mental health concerns? Seek out a psychologist, counselor, social worker, or behavioral health specialist.
- Do you want help with sexual side effects or do you need to consider freezing eggs, sperm, or embryos before treatment? Set up an appointment with a gynecologist, urologist, or reproductive endocrinologist.
Medicine, for the most part, is siloed and specialized. Medical professionals are divvied up into categories based on their expertise and must operate within their scope of practice. If it's not in their wheelhouse, then it's incumbent upon them to refer you to someone who is better equipped to help you. However, identifying the right expert is not always that obvious and the referral process is not always that smooth. If you have specific concerns and questions about your health and you receive vague or oversimplified responses, that may indicate that you're not speaking with the right medical professional.
In the next section, we'll discuss who all of these medical professionals are and how they can help you.
Are all of you here for me? You betcha!
Let's take a quick look at each of the following professionals and how they may assist you following a cancer diagnosis:
- Medical Oncologist-Hematologists: Manage your diagnosis, treatment options, and uses chemotherapy and other approved medications (hormone, targeted, and immunotherapies) to treat cancer; see patients across all cancer types. Hematology focuses on cancers of the blood or lymph system (liquid tumors).
- Specialty Oncologists: Do everything a Medical Oncologist/Hematologist does but they are focused on one or a few subspecialties. Oncological Specialists are often found in academic settings, metropolitan areas, or at major cancer centers. Rural patients or patients who don't have easy access to a subspecialist will likely see a general Medical Oncologist/Hematologist to manage their care.
- Surgical Oncologists or Specialty Surgeons: Perform surgery to remove cancer from the body
- Plastic Surgeons: Reconstructive Surgery
- Interventional Radiologists: diagnose and treat conditions using minimally-invasive techniques, often as an alternative to surgery or more invasive procedures. Examples of procedures include RFA (radiofrequency ablation), chemoembolization, and port-a-cath placement.
- Radiation Oncologists: Perform radiation treatments using high-powered targeted forms of energy to reduce or remove cancer from the body; these treatments may be curative or palliative in intent. Examples of treatments are SBRT (stereotactic body radiation therapy), brachytherapy, and proton radiation therapy.
- Integrative Oncologists "trained in conventional medicine, with additional training in integrating conventional and complementary approaches." (source)
- Radiologists: Read, interpret, and makes diagnoses based on imaging studies (these are the specialists who will perform and read all of your scans in partnership with radiation techs)
- Radiologic Technicians: Perform imaging studies like CT scans, MRIs, or PET scans.
- Radiation Therapists: perform radiation treatments on patients under the guidance of a radiation oncologist or interventional radiologist.
- Pathologists: Analyze body tissues/cells on a microscopic level, runs lab tests on tissue specimens and interprets tests; plays a significant role in determining malignancy, cancer stage, spread/invasion, aggressiveness, and identifying targetable biomarkers that may impact your treatment plan
- Registered Dieticians or Nutritionists: Provide food and nutrition recommendations for improved health
- Therapists (Physical, Occupational, Speech, Physical Medicine & Rehabilitation, etc.)
- Primary Care Physicians, Internal Medicine, Family Medicine
- Disease-State Specialists (pulmonologist for lungs, urologist for bladder, prostate, testes, gynecologist for ovaries, cervix, uterus, gastroenterologist for colon, stomach, pancreas, cardiologist for heart, dermatologist for skin, endocrinologist for hormone-related concerns, ophthalmologist for eyes, nephrologist for kidneys, neurologist for brain and central nervous system, etc.)
- Oncology Nurses: Provide education, conduct physical exams, administer chemotherapy treatments, and uncover what a cancer patient needs and how to meet those needs
- Advanced Practice Providers (Nurse Practitioners (ARNP) and Physician Assistants (PA-C)): These specialists provide education, conduct physical exams, diagnose and treat, prescribe medications, interpret test results, perform procedures, assist with surgery, and guide patient care.
- Oncology Social Workers "Oncology social workers are licensed professionals who counsel people affected by cancer, providing emotional support and helping people access practical assistance. Oncology social workers can provide individual counseling, resource navigation, support groups, locate services that help with home care or transportation and guide people through the process of applying for Social Security disability or other forms of assistance." (source)
- Patient & Nurse Navigators: Offer guidance, support, and resource connection on topics like medical expenses/health insurance, understanding your diagnosis and treatment options, clinical trials, community and broader cancer resources, support groups, mental health, communicating with your providers, transportation, food assistance, etc.
- Community Health Workers: Offer patient guidance, support, connection to community medical care and resources, remove barriers to care; have a close tie to and understanding of their community, may mirror the diversity that exists within the community, and serve as liaisons between healthcare systems and the community.
- Mental Health Specialists (psycho-oncology specialists, psychiatrists, psychologists, family counselors, behavioral health)
- Cancer Exercise Specialists & Exercise Physiologists (CETI-Cancer Exercise Training Institute; CES- cancer exercise specialist; DPT- doctor of physical therapy; ACSM-ACS Cancer Exercise Specialist- American College of Sports Medicine & American Cancer Society; CET- cancer exercise trainer or certified exercise therapist; CPT- certified personal trainer) offer specialized cancer exercise guidance for people diagnosed with cancer, going through cancer treatment, and during survivorship and post-treatment
- Pharmacists Provide education and guidance on prescription medications
- Dentists Provide dental and oral health services, oral cancer screenings, and guidance for good dental hygiene and care during and after cancer treatment
- Palliative Care providers: Offer symptom and side effect support at any cancer stage and in any phase of treatment; help with pain, appetite, neuropathy, GI distress, mental health, coping with stress, etc.
- Genetic Counselors: Provide guidance and expertise in understanding hereditary cancer, your personal risk, your family history, inherited mutations, and how to speak with your family about hereditary conditions/risks
- Hospice Care providers: Offer specialized care at home or in a facility for patients in the last 6 months of life; pain management, preservation of quality of life, safety, medication management, family/caregiver support, bereavement resources, etc.
- Sexual Medicine specialists, Reproductive Endocrinologists (fertility), Urologists, Gynecologists, pelvic floor therapists, pelvic pain specialists, certified sex therapists: For sexual side effects resulting from cancer or cancer treatment (erectile dysfunction, inability to reach orgasm, loss of desire, loss of sensation, etc.), fertility preservation prior to treatment, fertility treatments after therapy, etc.
- Home Health professionals: A team of nurses, home health aides, CNAs, and therapists who provide in-home care and education for patients recovering from a procedure or injury, or who are at risk for falls, have mobility limitations, need help managing medications, and assistance performing ADLs (activities of daily living like bathing, toileting, preparing meals, and dressing)
- Naturopathic providers "emphasizes prevention, treatment, and optimal health through the use of therapeutic methods and substances. Naturopathic oncologists with a “FABNO” designation are licensed in naturopathic medicine as well as certified in naturopathic oncology care. They are skilled at collaborating with conventional oncologists to bring an integrative approach to your cancer care. These practitioners can prescribe natural therapies and lifestyle approaches as well as recommend and coordinate your use of other complementary therapies within their areas of training in collaboration with your primary oncologist." (source)
- Substance Misuse Specialists
- Pain Management Specialists
- Oncology Acupuncturists "Acupuncture is an integrative medicine therapy that has been proven to help with pain, improve well-being, and reduce the side effects of cancer treatments such as chemotherapy, radiation and surgery." (source)
- Oncology Massage Therapists "Improve quality of life, Reduce anxiety, Help with the management of pain, Improve quality of sleep, Reduce fatigue, Reduce unpleasant sensation from chemotherapy-induced peripheral neuropathy (CIPN), Increase function in areas affected by scar tissue resulting from surgery and radiation, Reduce post-surgical swelling and support rehabilitation and recovery, Support the lymph system and assist with lymphedema management, and Improve body awareness and image." (source)
- Reiki Practitioners "Reiki is a Japanese energy-based therapy. It may be used to help reduce certain symptoms related to cancer and its treatment, including fatigue, pain, and sleep issues. While research on its effectiveness is not considered conclusive, reiki is considered safe and a potentially helpful complementary cancer therapy—so much so that many major cancer treatment centers now offer it." (source)
- Spiritual Advisor, Chaplain, Clergy, or other religious leaders
- Patient or Healthcare Advocate "In the complex world of healthcare decisions, a patient or healthcare advocate is the supportive companion everyone needs. They ensure the client, patient, or family fully grasp the crucial issues, understand their rights, and feel emboldened to voice their own perspectives." (source)
- Family & Friends Support System
What am I looking for in a cancer care center and medical oncologist?
- In-network for your insurance plan. Call your insurance plan and ask for a list of all medical oncologists and cancer centers who are in-network and within a reasonable distance from your home (10 miles, 20 miles, 50 miles). Options for cancer care include community cancer centers, academic medical institutions, and NCI cancer centers.
- Easily accessible for regular appointments
- Be sure that the surgeon you choose has hospital privileges at an in-network hospital
- Access to a multidisciplinary care team, if possible (medical oncologist, radiation oncologist, surgeon, oncology nurses, social workers, etc.)
- NCI-designated cancer center, if conveniently located for you. If there is not one close to you, consider reaching out to one for a virtual second opinion. "There are 72 NCI-designated cancer centers in 36 states and the District of Columbia that are funded by the institute. A 2009 Dartmouth study suggested that patients who receive care at an NCI-designated cancer center can improve their long-term survival rates by up to 25 percent." (source)
Throughout your cancer journey, you can turn to a wide variety of medical professionals for guidance, recommendations, and support. Your needs should not be ignored. Your concerns should not be dismissed. Your side effects and quality of life should not be minimized. And at no point should you have to suffer in silence or grin and bear it. Solutions, relief, and support are out there. Build a care team that addresses your individual needs, works with you, and fights for you.
Cancer affects all of you, and all of you deserves proper, quality medical care and attention, not just your tumors.
