Cancer Care Guide: Who Are the Doctors?

The diagnosis and treatment of cancer is complex and multiple healthcare professionals play a role in providing comprehensive care to patients.

Oncology physicians

Physicians are either medical doctors (MDs) or osteopathic doctors (OD) and many complete additional training in specific medical conditions, such as oncology. As cancer patients receive their diagnosis and then proceed through treatment, they may see more than one type of oncology physician. Often there are also other oncology specialists behind the scenes providing important services as well.

Medical oncologists are specialized internal medicine physicians and experts in treating cancer with chemotherapy. They care for patients from initial diagnosis through the course of the disease, discussing treatment options, managing pain and treatment side effects, and consulting with other physicians as needed.

Some oncologists specialize in specific types of cancer. The most common specialties are pediatric, gynecologic, and urologic cancers. Hematologists specialize in cancers of the blood (lymphoma and leukemia) and related tissues, such as bone marrow and lymph nodes.

Diagnosing cancer may require multiple diagnostic procedures. Radiation oncologists use x-rays or ultrasound, surgical oncologists remove tissue samples (biopsy,) and pathologists analyze results of lab tests and examine biopsy samples to determine the specific type and nature of a patient's cancer. Radiation oncologists and surgeons also treat cancer by administering radiation to kill cancer cells or surgically removing tumors when possible.

You should choose an oncologist who has experience caring for patients with your type of cancer. Specialists in less common cancers often practice in large cancer centers and medical teaching facilities, rather than community hospitals.

Multi-disciplinary teams

Cancer centers are moving towards a multi-disciplinary team approach to cancer care, which puts the patient at the center of a well-coordinated network of health professionals. A multi-disciplinary approach recognizes that cancer is more than a tumor; it's a disease that touches all aspects of patients' lives.

Multi-disciplinary cancer teams may include medical, surgical, and radiation oncologists; oncology nurses; a physician's assistant; oncology social worker; rehabilitation therapist; dietitian; and chaplain.

You'll likely interact most frequently with your oncology nurse. Oncology nurses provide patient education, coordinate and facilitate care, provide psychosocial support, and may administer chemotherapy. In fact, many cancer programs have designated specialists (who are usually nurses) called Patient Navigators. As the name implies, these professionals are there for patients (and their families) from diagnosis through post-treatment care, providing education, streamlining the process, securing additional patient resources when needed, advocating for the patient, and-most importantly-providing emotional support.

Sources:

National Cancer Institute. "How To Find a Doctor or Treatment Facility If You Have Cancer." Web.
29 June 2009. http://cancer.gov/cancertopics/factsheet/Therapy/doctor-facility

Cancer.net. "The Oncology Team." Web. April 2010.
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Find+an+Oncologist/The+Oncology+Team/The+Oncology+Team

Cancer.net. "ASCO Expert Corner: The Role of an Oncology Nurse." Web. 23 March 2010.
http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Feature+Articles/Expert+Information+from+ASCO/ASCO+Expert+Corner%3A+The+Role+of+an+Oncology+Nurse

Cancer.net. "Types of Oncologists." Web. May 2011.
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Find+an+Oncologist/Type

Full-Body Scans: Too Much of a Good Thing?

There's no question that advanced imaging techniques help us detect cancer and other serious diseases, allowing early-and potentially life-saving-intervention. However, is it possible to have too much of a good thing? When it comes to full-body scans, the answer may be yes.

Full-body scans (computed tomography, also called CT or CAT scans), create 3D x-ray images from the shoulder to the pelvis. CT scans take a detailed image of bone, soft tissue, and blood vessels, all at the same time. You can obtain full-body scans without a physician's referral.

Proponents of full-body scans say they provide peace of mind and are useful for detecting illnesses before they become symptomatic, particularly heart disease and some cancers.

However, full-body scans are controversial among radiologists and the broader medical community. The Food and Drug Administration (FDA) and the American College of Radiology (ACR) don't endorse them, referring to them as off-label (non-approved) use of CT scans. They are not a recognized standard of care nor do they meet generally accepted criteria for an effective screen procedure. The FDA and ARC say there is no scientific evidence that these scans provide more benefits than harms.

Full-body scans expose you to high levels of exposure. For example, the radiation in one full-body scan is approximately 150 times more than a chest x-ray and nearly 100 times more than a typical mammogram. In one analysis, researchers estimated the lifetime cancer risk mortality from a single full-body CT scan in a 45-year old adult at one in 1,250. As a point of reference, they said, in 1999, the odds of dying in an auto crash were roughly one in 5,900.

Results of full-body scans can cause needless worry or create a false sense of security if the scan fails to detect an existing problem. Imaging tests often uncover something that is not, or would not become, medically significant had it continued undetected. These false positives often lead to further testing or other potentially risky interventions.

In an article about unnecessary medical testing, author Martin Donohoe, MD, writes, "use of clinically unjustified tests also erodes the scientific underpinnings of medical practice and sends a mixed message to trainees and patients about when and why to use diagnostic studies. Such use also runs counter to physicians ethical obligations to contribute to the responsible stewardship of healthcare resources."

If you are considering a full-body scan, be sure you fully understand all the risks and benefits so you can make an informed decision.

Sources:
Pennachio, Dorothy L. "Full-body scans--or scams?" Medical Economics. Web. 9 August 2002.
http://medicaleconomics.modernmedicine.com/memag/Psychiatry+%26+Behavioral+Health/Full-body-scans--or-scams/ArticleStandard/Article/detail/116402

Querna, Elizabeth. "Full-body scan." US News and World Report. Web. 7 September 2004.
http://health.usnews.com/usnews/health/briefs/cancer/hb040907.htm

Food and Drug Administration. "Full-Body CT Scans - What You Need to Know." Web. 6 April 2010.
http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115340.htm

Brenner, David J., PhD, DSc, and Elliston, Carl D., MA. "Estimated Radiation Risks Potentially Associated with Full-Body CT Screening." Radiology 232 (2004): 735-738. Web. 23 July 2004.
http://radiology.rsna.org/content/232/3/735.full

Martin Donohoe, MD, FACP. "Unnecessary Testing in Obstetrics, Gynecology, and General Medicine: Causes and Consequences of the Unwarranted Use of Costly and Unscientific (Yet Profitable) Screening Modalities ." Medscape Medical News. Web. 30 April 2007.
http://www.medscape.com/viewarticle/552964

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