Most people know that cancer is treated by Oncologists — doctors who specialize in the treatment of cancer. What I didn’t know was just how many different professionals would also be involved in my treatment and care. Here’s an overview of some of the professionals who made up my cancer care team:
Radiation Oncologist. This Doctor specializes in treating cancer with radiation. They plan how many treatments, the dosage, and where to focus the radiation based on known, best practices. My Radiation Oncologist was the head of my cancer treatment team: he called all of the shots and all treatments and therapies had to go through him. My Radiation Oncologist specializes in head and neck cancers.
Chemo Oncologist. This Doctor specializes in treating cancer with chemotherapy. Chemo enhances the effects of the radiation, so the chemo treatments are planned based on the radiation therapy. The Chemo Oncologist also monitors blood levels to ensure that the effects of chemo aren’t unduly causing more harm than good, and if the blood work isn’t optimal he will decide whether or not the next chemo session should be carried out or not.
Microsurgeon. Even though my particular tumour was considered inoperable (well, it was actually operable but I would lose my voice box) a Microsurgeon was part of my cancer care team. There was a chance that there would still be a need for surgery once the tumour had shrunk. The Microsurgeon also was responsible for performing the scope procedure at my clinic appointments. He used the scope to look at the actual tumour site down my throat, and further down into the esophagus.
Pre-Planning Team. This team created the custom mask that would be used to snugly clamp me down to the radiation bed in order to confine me during radiation treatments. They then did the initial CT scan that showed the Radiation Oncologist exactly where and how large the tumour was. I was given a very small tattoo (a small dot) on my lower chest so that I could be aligned to precisely the same position during treatment as I was during the pre-planning CT scan.
Radiation Therapists. This group of people operate the sophisticated equipment that provides the radiation therapy in prescribed doses. The therapists position you on the radiation bed, apply the custom mask and clamp it down, then initiate the computer program that is custom tailored to your specific treatment plan. While the computer controls the radiation intensity and focus, the therapists monitor you and the equipment safely away from the radiation in another room. They also provide feedback to the Radiation Oncologist about your sessions such as condition of your skin, requirement for a new mask, etc.
Chemotherapy Nurses. The Chemo nurses that I dealt with were some of the most caring, empathic people I have ever met. It’s their job to administer the chemo drugs and whatever pre- and post-treatment medications are required. They also cleaned my PICC line and drew blood for the lab tests so that I wouldn’t have to line up at the bloodwork lab. They administered the various infusions that I needed and brought me warmed blankets and cold juices. They made sure that everyone in their care was as comfortable as they could be. They carried out their tasks with the utmost concern for the wellbeing of their patients. In fact one nurse changed my assigned bed to an empty one near the window, just so that I could have a nice view of the garden during my 6 – 7 hour chemo treatment. They also made sure that I knew what to do in case of reaction or emergency (such as a fever spike.) Special thanks go out to Sherry and Marcy!
Clinic & Triage Nurses. A triage nurse in the clinic was responsible for meeting with me prior to my appointment with the Oncologist. They recorded my weight and vitals (blood pressure, temperature, etc) and noted any concerns and symptoms that the Oncologist needed to know about before seeing me. The clinic nurse attended my meeting with the Oncologist to take any notes, dispense requisitions or informational leaflets, and take samples for the lab (e.g. when my feeding tube got infected), or administer any on-the-spot medications such as pain relief.
Dietician. Cancer typically causes weight loss and it’s the dietician’s job to ensure that the patient is following an eating regimen that provides enough protein and nutrients to curb that weight loss. In my case, the dietician’s initial role was to assist me with a diet that could easily be swallowed. As my swallowing difficulties worsened, she arranged for the feeding tube that would be the sole source of my food intake and she determined the best feeding supplement for me, as well as how much I should have daily based on my weight and protein requirements. The dietician taught me how to use the tube and was also responsible for the maintenance of it, including the replacement of the stopper tip when it would no longer stay closed on its own. The dietician was present in every clinic appointment with the Radiation Oncologist.
Social Worker & Counsellor. The Social Worker is responsible for assisting you with a wide variety of concerns, such as arranging transportation to your treatments, assisting with financial arrangements, and any other concerns you may have. A counsellor was available to help with any psychological or emotional issues.
Speech & Swallowing Therapist. At my cancer care centre the Speech Therapist was also the Swallowing Therapist since both speech and swallowing involve the same muscles of the throat, tongue, and larynx. Even though my speech wasn’t affected (other than losing my voice), I still saw her because at one point the radiation had affected my swallowing. Liquids were going down my airways instead of down the esophagus. After treatment was completed and I was able to swallow again, she performed a barium X-ray test to see if the muscles involved in swallowing were functioning properly, and she prescribed exercises to strengthen them: stick your tongue almost all the way out, gently clamp down on it with your teeth so that it doesn’t move, smile and then try to swallow. It may take some practice but I assure you it can be done 🙂
Pharmaceutical Team. Before, during, and after treatment I required a large number of prescriptions and over-the-counter drugs. My pharmacy was involved in all phases of my treatments, suggesting OTC remedies, procuring liquid or crushable forms of medications, and delivering the medications to my house. They knew my medication history and my treatments and I relied heavily on them.
Community Health Care. After each chemo session I required daily in-home hydration via IV for several days afterwards. The community health care provider in my home town arranged for nurses to hook me up via my PICC line & unhook me, stock up the necessary medical supplies and plasma solutions at my home, take my blood pressure, and change the dressing on my PICC line weekly. They also arranged for the prescription for the feeding tube liquid meal replacement since I was under home health care.
Dental Specialist. My cancer treatment centre required me to see their own Dentist in order to check the condition of my teeth and jaw prior to treatment. Radiation can affect the jaw bone, and should any major dental work be necessary in the next few years (such as having a tooth pulled) it could cause a lot of issues so any dental work would need to be completed before treatment commenced. She also recommended using a baking soda mouth rinse to avoid a side effect of my chemo which is mouth sores, and she recommended a toothpaste that had quadruple the amount of flouride in it to further protect my teeth. Even though the radiation was not focussed on my jaw, it could have received low dose radiation scatter.
Booking Coordinators. The booking coordinators are responsible for scheduling all of your appointments. There were separate booking coordinators for general check-in at the hospital daily, then separate booking coordinators for the clinic, chemo sessions, radiation sessions, and also for MRI/CT scans. With all of these separate schedules it helped to get organized. The coordinators that I dealt with were aware of our traveling distance and they were more than accommodating in trying to schedule us before or after rush hour.
General Practitioner. My GP was involved throughout my cancer diagnosis, treatment, and follow-ups, and ongoing care. She received a copy of all of the cancer treatment oncology reports so that she was kept completely up to date on my medical wellbeing. She also took care of any side effects such as prescribing antibiotics when the opening in my gut for my feeding tube got infected.
Other specialists or groups you may interact with:
Learning or Educational Centre. Both cancer care centres that were involved in my treatment (see my post on the treatment runaround) had educational and/or reference materials for cancer patients. The first centre offered seminars on chemo and radiation treatments, what to expect, etc. The second centre may have had the same offerings but by the time I was referred to them, I was starting treatment immediately; however, the centre at Sunnybrook has a learning centre where you could get reference materials on a wide variety of cancer-related topics. I highly recommend reading all of the informational materials and attending all seminars relating to your treatment before it starts, and bring a second set of eyes/ears with you.
Geneticist. My case was referred to a Geneticist to see if there were any hereditary factors that contributed to the development of my cancer. Unfortunately the Geneticist I was referred to was based out of Orillia and my treatments were in Toronto, so I was not able to attend any of those appointments.
Volunteers (drivers, hospital volunteers, etc). During the course of my treatment I was helped by many volunteers: they guided me to appointments, pushed me in a wheelchair when I wasn’t able to walk, ushered me into waiting rooms, helped me with my “wellness” questionnaire at every clinic appointment, brought cookies and soups (I couldn’t eat but my husband enjoyed them), made sure that free coffee was always available, offered books & magazines, etc. Every single one of them, from the aged retiree to the high school co-op students were friendly and always willing to help. Bless them!
Cancer Support Groups. There are so many wonderful support groups that you can reach out to, such as Gilda’s house, Canadian Cancer Society, etc. Some offer emotional support, some offer lodgings for out-of-towners, some offer information on where to find additional resources, some offer spiritual support, and the list goes on. Check your own community resources to find out what’s available to you.
Spiritual Leader. For questions of faith, reach out to your spiritual leader. They are more than willing to help guide and comfort you. My next door neighbour, a retired Minister, was very concerned about my spiritual well-being. In fact he lent me his mother’s bible and he blessed me and my house, twice!
Everyone’s cancer care team will be unique according to the specifics of their cancer and their treatment, and may have fewer or additional members of the team as required (e.g. physiotherapists, MRI/CT scans specialists, etc.) The point is that more professionals may be involved in your treatment than you may be aware of. They’re there to help so don’t hesitate to ask questions or raise any concerns with them.
I touched very briefly here on what the team members were responsible for, but in future posts I’ll delve deeper into specifically what my radiation and chemotherapy treatments experiences entailed.
—Sandi
Next time: More organizational help and practical tips.
Image courtesy of AKARAKINGDOMS at FreeDigitalPhotos.net