MD2B - Cancer Care Team

Introduction

Below is just a brief look at some of the key players of a comprehensive cancer care team. One must not forget, however, the undeniably crucial role of the patients' families, as they are often the truly "primary" caregivers. The needs they provide are an integral supplement to the care given by health care professionals.

Primary care providers

Primary care providers are often the patient’s first point of contact within the medical system, typically practicing in outpatient clinic settings. They play a crucial role in providing preventative care, screening for cancer and other diseases, handling non-urgent sick visits, and maintaining health. There are several pathways to becoming a primary care provider in the United States. These providers may refer patients to an oncologist or another specialist to investigate suspicious findings from cancer screening exams or if patients develop new symptoms concerning cancer.

• Family Physician: Primary care providers that treat patients from childhood to adulthood, offering a wide breadth of care primarily in outpatient settings. They receive training in many areas of medicine including inpatient medicine, obstetrics/gynecology, pediatrics, and geriatrics.
  • Training: Four years of undergraduate, four years of medical school, and a three-year family medicine residency.
• General Internist: Also known as an internal medicine doctor, these physicians provide inpatient and outpatient care of adults. Therefore, they see a wide variety of patients in various states of health. Unlike family medicine, trainees generally spend more time in inpatient hospital settings and are exposed to and may specialize in several subspecialties such as hematology/oncology and cardiology.
  • Training: Four years of undergraduate, four years of medical school, and a three-year internal medicine residency.
• Nurse practitioner: A nurse practitioner has advanced nursing training and can diagnose and treat patients. They are integral members of both the primary care and specialized care settings and work closely with physicians to manage patients.
  • Training: Nurse practitioner training can include a Bachelor of Science in Nursing (BSN) and either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP). They may also complete additional training and certification to specialize in oncology care.
• Pediatrician: Physicians who specialize in the care of infants, children, and adolescents. Pediatricians may work in primary care, or they can specialize to take care of specific populations such as oncology patients.
  • Training: Four years of undergraduate, four years of medical school, and a three-year pediatrics residency. Pediatric oncologists finish an additional three-to-four-year hematology/oncology fellowship.
• Obstetrician/ gynecologist: Ob/Gyns specialize in the female reproductive system and are essential to screening and diagnosing gynecologic malignancies. Ob/Gyns who specialize in oncology also manage the treatment of such malignancies with both surgery and chemotherapy.
  • Training: Four years undergraduate, four years of medical school, and a four-year Ob/Gyn residency. Gynecologic oncologists finish an additional three-year oncology fellowship.

Oncology care team

In the realm of clinical cancer management, there are numerous professionals who serve as patient caregivers and function as members of a diverse, multidisciplinary team. They collaborate on a regular basis to provide the best care for cancer patients at every stage of their disease course, from diagnosis and treatment to nutrition and symptom management. These providers often work in close collaboration to ensure the best possible management of their patients. One way they do this is through “tumor board” meetings, where they share patient cases and receive input on the treatment plans.

• Surgical oncologist: The surgical oncologist treats cancer by surgically removing tumors or performing procedures to manage cancer symptoms. They may also perform biopsies to diagnose cancer.
  • Training: Four years undergraduate, four years of medical school, and a five-year general surgery residency followed by a three-year oncologic surgery fellowship.
• Radiation oncologist: Radiation oncologists use radiation to treat cancer and manage symptoms related to cancer. They rely on imaging to create radiation plans and work within a team of radiation therapists, medical physicists, and dosimetrists to carry out the treatment plan.
  • Training: Four years undergraduate, four years of medical school, and a five-year radiation oncology residency. Fellowships are not required but are available if additional experience in specific areas such as pediatrics or proton therapy is desired.
  • https://cdn.agilitycms.com/applied-radiation-oncology/PDFs/issues/ARO_student-news_04-23.pdf for an interview with radiation oncologist, Dave Fuller, MD, PhD
• Radiation therapist: Radiation therapists work closely with dosimetrists, medical physicists and radiation oncologists to deliver the radiation therapy plan. They are responsible for positioning patients on the treatment machine, operating the machines, and administering the planned radiation dose.
  • Training: Typically, either a bachelor’s or associate degree in radiation therapy is required. Depending on the employer, additional certification may be required.
  • https://www.youtube.com/watch?v=cO-_EGF1tNE for interview with radiation therapist, Laurie Godwin
• Medical Dosimetrist: The medical dosimetrist specializes in creating a radiation plan that targets cancer cells and other high-risk areas while minimizing dose to the surrounding normal tissues.
  • Training: Bachelor’s degree followed by 1-2 years of a medical dosimetry program to become certified.
• Medical oncologist: Medical oncologists manage the medical treatment of cancer patients including chemotherapy, immunotherapy, and other targeted therapies. They manage side effects from these therapies and often coordinate the patient’s cancer care.
  • Training: Four years undergraduate, four years of medical school, and a three-year internal medicine residency followed by a three-year hematology/oncology fellowship. Additional fellowships are available for further specialization, such as bone marrow transplantation.
• Radiologist, (Diagnostic and Interventional): Radiologists are responsible for interpreting medical imaging in many different modalities including X-rays, CT scans, MRIs, and ultrasounds. They are critical members of the oncology team as routine imagine is completed throughout treatment to track progression or regression of the tumors. Interventional radiologists perform image-guided procedures to treat cancer or manage symptoms related to cancer, such as tumor ablation (for example, using heat or extreme cold to kill cancer cells) and embolization (cutting off the tumor’s blood supply).
  • Training: Training: Four years undergraduate, four years of medical school, and a five-year diagnostic radiology residency. Interventional radiologists complete a two-year interventional radiology fellowship after residency. Additional fellowships are available for further specialization if expertise in a specific anatomic site or imaging modality is desired.
• Oncology nurse: Oncology nurses are integral members of the cancer care team as they provide direct care and education to patients and their families throughout their entire treatment journey.
  • Training: An associate or bachelor’s degree in nursing is required as well as certification as a registered nurse.
  • https://cdn.agilitycms.com/applied-radiation-oncology/PDFs/other/ARO_student-scan_01-24.pdf for an interview with oncology nurse, researcher and educator, Deborah Bruner, RN, PhD, FAAN
• Social worker: Social workers help patients, and their families connect patients to numerous resources to assist with any number of challenges from financing treatment, arranging transportation services, and emotional support services.
  • Training: Social workers may either pursue a bachelor’s degree in social work or pursue a master’s degree in social work after completing undergraduate course work.
• Dietitian: Maintaining proper nutrition during and after cancer treatment can be a significant challenge. Dieticians educate patients on proper nutrition and provide resources and strategies for maintaining nutrition while undergoing treatment.
  • Training: Dieticians typically obtain a bachelor’s degree in nutrition from an accredited program followed by an internship or obtain a master’s degree to become a Registered Dietician Nutritionist (RDN)
• Physical therapist: Cancer treatments can take a toll on patients’ mobility, strength and coordination. Physical therapists help patients regain their strength, improve balance and flexibility through use of various exercises before, during or after treatment so patients can resume normal activities of daily living.
  • Training: Bachelor’s degree followed by a Doctor of Physical Therapy (DPT) program, which is three years long.
• Genetic counselor: Genetic counselors inform patients about their risk of inherited cancers based on family history or genetic testing. Deciding to be tested for genes linked to cancer often has implications for patients and family members, so genetic counselors help navigate the decision-making and testing process.
  • Training: Bachelor’s degree followed by a two-year master’s degree in genetic counseling and accreditation.
• Palliative care physician: Palliative care physicians help patients cope with both the physical symptoms and the emotional stresses of a cancer diagnosis. Palliative care may facilitate patient enrollment in hospice, but the palliative care and hospice teams are separate entities. While hospice providers see patients with 6 months or less to live, palliative care services can be integrated into management of any stage of disease.
  • Training: Four years undergraduate, four years of medical school, and a residency program (typically either internal medicine or radiation oncology) followed by a one-year palliative care fellowship. Palliative care can be integrated into many different specialties, so there are fewer restrictions on which residency program the physician completes prior to fellowship.