Because cancer is such a varied and individual disease, using a one-size-fits-all approach to treatment is unlikely to yield good results. Particularly with breast cancer, which can have wide variations in the types of treatment available to individual patients based on the stage, location and other characteristics of the diagnosis, many differing medical disciplines may come into play to create the right treatment plan for you.
A 2010 study published in the Journal of Oncology Practice reports that using a multidisciplinary approach — in which multiple doctors from different specialties care for the same patient — has many advantages. “The most important reason to do a multidisciplinary clinic is that many people working together may reach more intelligent solutions than an individual working alone,” the study notes.
Laura Martin, breast care center nurse navigator at UF Health Cancer Center, Orlando, says her facility uses a multidisciplinary approach to treating cancer and “there are a lot of individuals involved in a patient’s care. It’s a big team, and sometimes it can be overwhelming to the patient because they meet a lot of people.”
[See: 7 Surprising Things That Age You.]
Radiologist
Martin says a radiologist is usually the first doctor most breast cancer patients meet. A breast cancer diagnosis typically “starts with the imaging work-up when an abnormality is identified.” The person who’s looking at the mammogram is a radiologist, and Martin says that doctor is also often the person who will perform the initial biopsy to determine whether the growth is cancerous. “Sometimes they’ll also do an image-guided biopsy,” she says, and “if it’s cancer, that starts the whole ball rolling.”
Pathologist
Once your radiologist has determined there could be a problem and a biopsy has been performed, your tissue samples will be sent on to a pathologist who examines the cells and provides additional diagnostic information about the type of cancer you have. Materials from the Memorial Sloan Kettering Cancer Center note that “some pathologists specialize in looking for genetic abnormalities that are associated with certain diseases or cancers. Pathology results are critical in determining the precise stage (extent) of disease or cancer.”
Navigator
Martin says she’ll often be looped into the patient’s situation early on, as soon as the diagnosis is made, so that she can help serve as a guide through the next series of appointments and procedures. Not all facilities have navigators on staff, but if your hospital does, the navigator may be a nurse like Martin, a social worker or even a layperson with knowledge of the facility’s process “who’s not clinical at all. They do more of the emotional support of accompanying patients to appointments and working with the patient’s family,” Martin says.
Breast Surgeon / Surgical Oncologist
For many patients, the next doctor on the list will be a breast surgeon. Although not every case of breast cancer requires surgical intervention, many do, and a breast surgeon will examine your situation and recommend either a lumpectomy or a mastectomy based on your specific diagnosis.
Also depending on your preferences, you may meet with a plastic surgeon early on, prior to surgery to remove the cancer, to plan for a subsequent breast reconstruction surgery. The surgical oncologist and the reconstructive surgeon are not usually the same person, and they will coordinate so you can achieve the best possible outcome from both procedures.
In addition to the surgeons who will perform the surgeries you may have, you’ll also be attended by an anesthesiologist during a mastectomy or reconstruction surgery. (Most lumpectomies are not performed under general anesthesia.)
Medical Oncologist
“The medical oncologist will determine what we need to do to systemically treat the rest of your body,” Martin says. Because cancer can spread, the oncologist will determine whether you need chemotherapy treatments. They may also prescribe anti-estrogen therapy to help starve certain cancers of the hormones they feed on. “If there’s a reason to have chemotherapy or endocrine therapy based on your diagnosis, that’s the medical oncologist’s forte,” Martin says.
The MSKCC reports that the medical oncologist is often the lead doctor who coordinates the patient’s entire treatment plan.
[See: A Tour of Mammographic Screenings During Your Life.]
Radiation Oncologist/Interventional Radiologist
In addition to chemotherapy and endocrine therapies, you may also need radiation therapy, and a radiation oncologist will determine the best plan of attack for these treatments. MSKCC reports that the radiation oncologist “works together with a medical physicist to create an individualized treatment plan for each patient.”
Clinical Nurses and Nurse Practitioners
In addition, each physician may well have a dedicated nurse or team of nurses that work with them, so you may be working with quite a few of these hands-on health care professionals, too. MSKCC reports that “clinical nurses will assist you when going for surgery, chemotherapy infusion or radiation treatment and in other procedural and diagnostic areas.”
You may also work with nurse practitioners along the way. These nurses “have completed advanced education in nursing. They work with physicians and other members of the patient care team to develop and implement a treatment plan that meets the needs of individual patients and their families,” MSKCC reports. Nurse practitioners can also write prescriptions, order treatments and diagnostic tests and perform some procedures.
Support Team
In addition to the doctors and nurses you’ll be working with, your care team will also likely include “a whole slew of supportive team members,” Martin says. These health care professionals may be brought into the process at various stages along the way and may include:
— A genetic counselor “to look at your family history and determine whether there’s any reason to suspect a genetic cause for your cancer,” Martin says;
— A financial counselor to help you figure out ways to pay for your treatment, especially if you’re uninsured;
— Psycho-social counselors to help you cope with the emotional impact of your cancer diagnosis and treatment. These counselors may make referrals to support groups or connect you with community resources that will help make living with cancer easier;
— A registered dietitian “to talk about the importance of nutrition and diet,” Martin says;
— A physical and/or occupational therapist to help you regain mobility and dexterity after treatment. A physiatrist may also be called in to work with you if you’re having trouble with mobility, lymphedema — swelling of the arm caused by build up of lymph fluid the body cannot clear because the lymph nodes have been removed — or neuropathy — nerve damage usually in the hands and feet that sometimes results from cancer treatment — after breast cancer treatment. MSKCC reports this doctor’s “goal is to improve patient quality of life and function,” and that may be achieved through the prescription of physical therapy, assistive devices or medication.
[See: What Not to Say to a Breast Cancer Patient.]
Teamwork
With such a large group of people involved in the care of a single patient, it’s important they all communicate with each other to make sure the patient’s treatment is progressing according to plan. To do this, Martin says the cancer team at UF Health meets every Tuesday morning to discuss what’s coming in the week ahead. “Our multi-discipline planning meeting gets them all around the table. We review new patients coming in and make recommendations and treatment plans. And we talk about their individual pieces [of the treatment puzzle] and the best approach for each particular patient.” She says this is also the time when the team will review information from outside the facility, such as pathology reports that could be coming from a lab, patient records received from another facility or clinical trial information that could be relevant to an individual’s treatment plan. In addition to the weekly meeting, Martin says the doctors all communicate directly as they go along, and they ask each other a lot of questions to coordinate care.
Martin says that patients can help themselves by doing some research on what multidisciplinary care is and how it works by asking lots of questions of the care team as they arise. She encourages patients to speak up and ask for a second opinion if they’re unsure about a decision or don’t have a clear understanding of what’s happening. Being a participant in your own care adds another strong and important voice to the conversation going on around you about how best to treat your cancer.
More from U.S. News
7 Surprising Things That Age You
A Tour of Mammographic Screenings During Your Life
What Not to Say to a Breast Cancer Patient
Who Will Be Caring for Me During Treatment for Breast Cancer? originally appeared on usnews.com
