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

Can Surgery Fix Asthma?

When common treatment methods aren't enough to manage your persistent asthma symptoms, it may be time to consider a new surgical technique.

Bronchial thermoplasty was approved by the U.S. Food and Drug Administration (FDA) in 2010 for use in people whose asthma doesn't respond to other less invasive measures. This asthma surgery is performed with a special device that delivers heat to the lining of the airways in order to shrink any inflammation there. By opening up the airways, the discomfort that typically occurs with an asthma attack is minimized.

The surgeon guides a long flexible tube called a bronchoscope that has a light and camera at the end through the nose and throat down into the lungs. The bronchoscope also contains a special thermoplasty device that has electrodes on the end. The electrodes are heated using radiofrequency waves and then are applied to the airway walls. The heat shrinks the inflamed tissue, helping to prevent the spasms and tightening, which frequently occurs during an asthma attack. While this may not completely eliminate asthma, it can certainly minimize the symptoms.

Since all of the airways need to be treated for the best results, bronchial thermoplasty is usually performed in a series of three separate surgical procedures, with each surgery addressing a different part of the lungs.

The clinical data on bronchial thermoplasty has been quite encouraging, although only a handful of hospitals currently have staff trained to perform the procedure. In addition, this technique isn't appropriate for all asthma sufferers. It's only meant for people who have severe asthma that isn't controlled by other methods and who meet certain lung function criteria to ensure the best results.

If your doctor thinks that bronchial thermoplasty is an appropriate option for your situation, you'll need to understand that like any type of surgery, there are some possible risks involved. This can include a collapsed lung or other respiratory complications.

Many insurance companies aren't yet covering bronchial thermoplasty, so if you're considering undergoing this procedure, you may need to be prepared to pay for it yourself. Just keep in mind that in return for the cost, once you get a better handle on your asthma, you'll probably improve your productivity at work and also reduce your medical costs. Better yet, you can expect an enhanced quality of life overall, making this quite a promising investment.

Sources:

"Medical Devices. Asthmatx, Inc. Alair Bronchial Thermoplasty System - P080032." US Food and Drug Administration. FDA.gov, 19 May 2010. Web. 16 May 2011.

"New Severe Asthma Treatment: Bronchial Thermoplasty." El Camino Hospital. Elcaminohospital.org, n.d. Web. 16 May 2011.

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Bypass Surgery or Angioplasty

If you or a loved one suffers from heart disease, there are a variety of treatment options available. The trouble is, which one is the best? Which is most effective?

New study findings released this fall have found that coronary artery bypass surgery is more effective than coronary angioplasty and stenting in patients with severe heart disease.

The study, a joint European and American effort, compared the surgery benefits after three years of 1,800 patients who had undergone the two procedures. The study researchers found that patients who had undergone angioplasty had a 28 percent higher chance of developing a major cardiovascular event, such as a stroke or heart attack; were 46 percent more likely to need a second procedure to reopen the blocked blood vessels; and had about a 22 percent greater chance of dying due to complications than the bypass patients.

During coronary artery bypass surgery, a section of healthy blood vessel, usually taken from inside the chest wall or the lower leg, is attached above and below the blocked artery, allowing blood to bypass the blocked area and flow to the heart muscle. Coronary angioplasty is a much less invasive procedure in which a tiny balloon is inserted and expanded at the site of the blockage to widen a clogged artery. A small metal coil called a stent is then implanted to help keep the artery open.

 The reason bypass surgery may be more effective than coronary angioplasty is that, because it replaces a much longer section of the affected artery, it can treat both the current and emerging blockages of a blood vessel, whereas angioplasty only treats the existing lesion.

Earlier studies have also shown an advantage of bypass surgery over angioplasty, especially in patients over 65 and in patients suffering from other medical problems, such as diabetes.

If you have coronary artery disease, there are several factors that determine which treatment option is best for you, including:

Severity and extent of your coronary artery diseaseSymptoms, such as chest pain and shortness of breathOverall heart functionOther medical problems, such as diabetes, kidney disease, peripheral artery disease, or a prior stroke or heart attack

For patients with severe narrowing of very small blood vessels, neither coronary bypass surgery nor coronary angioplasty might be the right treatment choice. Instead, medication and lifestyle changes might be the best treatment option. Some lifestyle changes include:

Quitting smokingEating a heart-healthy diet to reduce high blood pressure and high cholesterolIncreasing physical activityLosing weight

If you have coronary artery disease, talk to your doctor about which treatment option is best for you.

Sources:

Science Daily
http://www.sciencedaily.com/releases/2009/03/090319203850.htm

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Hospital surgery puts dozens of patients at risk of CJD

He said: ''In this incident we do not have a single confirmed case of CJD. However, we do have one patient who was at high risk and 38 people at extremely low risk.

''We know all the surgical instruments used on this group of patients were cleaned, disinfected and sterilised normally. However, it is possible that the proteins which cause CJD, known as prions, survived these routine sterilisation procedures so an extremely small risk of transmission remains.''

The original operation involving the ''index case'' occurred in 2007 at one of ABMU's four main hospitals in South Wales - Singleton and Morriston in Swansea, Neath Port Talbot and Princess of Wales Hospital in Bridgend.

Dr Hoffman said at the time of the surgery the index case's high risk of developing CJD was not known by doctors at the hospital or the GP.

Once the high risk of the patient was identified in 2009 - before another operation - PHW contacted the UK CJD incidents panel made up of experts from around the UK.

Health officials then investigated what instruments had been used in the original operation and their subsequent usage.

It was in February this year that the panel said the health board should contact the 38 patients involved.

PHW said it would not provide any further details on the index case, such as what hospital or the age or sex of the person, in case it identified them.

However, in explaining why the number of those who are now at risk was a relatively low number - given the number of operations ABMU had performed in the two-year time period - Dr Hoffman explained it was because the the operations were of a ''specialist'' nature.

Of the 38 people who are at ''low risk'' - 37 were from Mid and West Wales and one was from North Wales.

Dr Hoffman would not be drawn on whether the 38 had donated blood since the operations, but confirmed Public Health Wales had contacted the Welsh Blood Service.

But he stressed the likelihood of someone contracting CJD "from a contact of a contact" was highly unlikely.

"All patients at risk have been contacted and there is no risk to anybody else," said Dr Hoffman. "People who have had any type of surgery in the ABMU area since 2007 but have not been contacted by us have no reason at all to worry."

Dr Hoffman said he personally spoken to two of the patients and they were obviously "worried and upset".

"We do understand that it's very upsetting for the patients to live with this uncertainty for years to come," he added.

"Our advice is they should carry on to live their lives as before."

CJD is a rare disease that affects the structures of the brain and causes incurable neurological symptoms. There is no cure or treatment.

PHW said anyone who is aware they are at increased risk of CJD should not donate blood or organs and should always inform their surgeon or doctor before undergoing "any health procedure".

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