Lung Cancer Healthcare Team

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The Multi-Disciplinary Lung Cancer Team

Lung cancer can cause a great deal of uncertainty, but there is a team of highly trained professionals whose job it is to help the person with cancer through these difficult times. The number of people whom a person with lung cancer will meet and the information that he or she will receive about therapy can be overwhelming and confusing. As a caregiver, you should try to meet as many of the members of the healthcare team as possible so that you can fully support the person with cancer along his or her journey.

The following information provides a brief overview of members of the cancer care team and includes a short list of questions that you and the person with cancer may want to ask about treatment.

Pulmonologist
A pulmonologist, or lung doctor, is a physician who specializes in diseases of the airway and lungs. If the person with cancer is found to have one or more nodules, sometimes referred to as ‘spots’, on his or her lungs based on a chest x-ray or a CT scan, then a pulmonologist may be one of the first physicians the patient will see. A pulmonologist’s focus is to aid in reaching a diagnosis, including helping to determine whether the nodule seems to be lung cancer. The patient’s consultation with a pulmonologist may include various procedures, such as a bronchoscopy and biopsies.

Radiologist
A radiologist is a physician who specializes in reading body imaging including x-rays, computed tomography (CT) scans, and Positron Emission Tomography (PET) scans. Radiologists help diagnose lung cancer and can perform CT-guided biopsies of tumors. A radiologist and a radiation oncologist are different doctors with distinct specialties.

Radiation Oncologist
Radiation oncologists are physicians who specialize in the use of radiation therapy to treat cancer. The focus of radiation oncologists is to help design a treatment plan and direct radiation therapy. Radiation oncologists work closely with an array of other healthcare providers, including radiation oncology nurses, medical physicists, radiation therapists, and dosimetrists. Radiation oncologists will help the person with cancer choose the most effective radiation therapy for his or her specific cancer.

Medical Oncologist
Medical oncologists are physicians who specialize in systemic therapy, including chemotherapy, for the treatment of cancer. The person with cancer may meet a medical oncologist in an outpatient clinic or in the hospital. Medical oncologist will determine if the person with cancer is a candidate for chemotherapy, what type of chemotherapy he or she will receive, and the duration of treatment. Medical oncologists will frequently monitor the condition of the person with cancer while he or she is receiving chemotherapy and will help minimize the side effects of treatment.

Thoracic Surgeon
Thoracic surgeons are physicians who specialize in chest surgery, which includes the chest wall, mediastinum, lungs, esophagus, and diaphragm. Thoracic surgeons perform diagnostic procedures and surgical treatment for patients with lung cancer. During the patient’s evaluation, the surgeons will assess how fit the person with cancer is for surgery. This determination may involve obtaining laboratory tests or specialized studies. Before treatment, thoracic surgeons will discuss the options for surgery and will be the primary physician managing the patient’s care in the hospital after surgery.

Palliative Care Team
Palliative medicine is a relatively new medical specialty that can assist with symptom management, including general pain, nerve pain, shortness of breath, and fatigue. In addition, palliative care physicians can help families and caregivers navigate the complex medical environment. A palliative care physician can be especially helpful by offering valuable assistance with decisions at crucial points in treatment. Palliative care can be provided at any point in the course of the cancer care, including during active treatment.

Physician Assistant or Nurse Practitioner
Physician assistants (PA) and nurse practitioners (NP) are medical professionals who work as part of the care team both in both the outpatient clinic and in the hospital. When the plan is straightforward during treatment, the person with cancer may regularly see a PA or an NP instead of his or her oncologist.

Oncology Nurse
Every oncologist has a specially trained nurse who works with the person with cancer to provide practical coping skills for dealing with the effects of cancer and the treatments. The oncology nurse can be a valuable partner for caregivers.

Social worker
A social worker has training to help patients deal with mental, emotional, and daily living issues.  Social workers take care of the connections with other agencies, including home health providers, infusion companies, oxygen and medical equipment agencies, and hospice providers. Social workers can also help the person with cancer determine whether he or she is eligible for government programs or other aid. In addition, social workers are trained to counsel patients about grief and coping issues. Finally, a social worker can assist you and the person with cancer manage important legal issues, such as developing Durable Power of Attorney and Living Will documents.

Free copies of the Caring Ambassadors Lung Cancer Program’s “Your Treatment Team” Brochure can be ordered from the Caring Ambassadors website.

For a lung cancer patient, putting together his or her healthcare team will involve a lot of difficult choices. As a caregiver, you can help the patient make these decisions in an organized and logical manner. Encourage the person with cancer to include any and all factors directly or indirectly involved in care. For example, the person with cancer might be struggling with a decision to see a highly regarded medical oncologist at a university hospital in the next state or staying with the local, community oncologist.

You can help the person with cancer make this choice by helping him or her construct a simple list of the advantages for each choice, making sure that you include practical issues that will affect daily life:

Should we go to a university oncologist or an oncologist in our community?

Advantages of university oncologist

  • Specializes in a type of cancer
  • Access to clinical trials
  • Access to specialized surgeons, radiation oncologists
  • Recognizes early complications

Advantages of oncologist closer to home

  • Treatments are standardized, so they would be the same
  • Closer communication with your personal physician
  • Less burden on travel (time, costs) for patient and family
Clinical Trials

At their heart, clinical trials are research to benefit future lung cancer patients. The person with cancer may choose to explore clinical trial options as a generous gesture, hoping that he or she can contribute to advancing the science of lung cancer care. Sometimes it is possible that a clinical trial can offer immediate help to patients participating in the trial by offering access to possible new treatments. Clinical trials are usually offered when current therapies are sub-optimal or when no proven therapies are available. If the person with cancer decides to participate in a clinical trial, he or she will, at the very least, be watched closely and receive treatment from clinicians who are dedicated to advancing lung cancer treatments. Even if the health of the person with cancer does not directly improve being in the clinical trial, he or she may find peace of mind and pride knowing that the trial will help develop treatments for future patients.

Clinical trials, including those used to develop cancer treatments, are the final step in a long process to test new drugs or other treatments. Testing of a new cancer drug or treatment is completed in an orderly series of steps called phases. This process allows researchers to obtain reliable information about the drug or treatment in order to protect patients in each part of the study. Understanding the different phases of clinical trials can help you provide sound advice to the person with cancer if he or she is considering joining a study.

  •  Phase 1 trials: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
  • Phase 2 trials: The focus of phase 2 trials is safety. During this phase, researchers determine whether the drug or treatment is effective in people who have a certain disease or condition. For example, participants receiving the new drug or treatment may be compared with similar participants receiving the current standard of care or a different drug or treatment.
  • Phase 3 trials: In a phase 3 clinical trial, the drug or treatment is administered to a large group of people to confirm effectiveness, monitor side effects, compare to commonly used drugs or treatments, and collect information that will allow the drug or treatment to be utilized safely.
  • Phase 4 trials: Phase 4 studies are conducted after a drug or treatment has been approved for use in the general public. Phase 4 trials are conducted to provide more information about side effects, long-term risks and benefits, and effectiveness in the general population.

See: Lung Cancer Choices, Chapter 6: Clinical Trials and Emerging Therapies for Lung Cancer