Assembling Your Breast Cancer Treatment Team
Many women have one primary care physician – an internist, a gynecologist, or a family practitioner – whom they have known for some time. Over the years, many women have also seen a specialist or several specialists, such as an endocrinologist about a thyroid problem, a dermatologist who removed a mole, or an orthopedic surgeon regarding knee pain. In most cases, one physician becomes responsible for treating that specific problem while (ideally) communicating information about the patient and the medical problem to the primary care physician.
The treatment of breast cancer is different, however, because cancer care is almost always a team effort involving and coordinating multiple physicians, including a primary care physician, a gynecologist, a radiologist, a surgeon, a medical oncologist, a radiation oncologist, a plastic surgeon or reconstructive surgeon, and nurses with special training in medical and radiation oncology. The cancer care team also includes your family, friends, neighbors, and possibly clergy, as well as a large support network of knowledgeable nurse clinicians and potentially a psychologist or social worker and a nutritionist.
Cancer care is almost always a team effort involving and coordinating multiple physicians.
Choosing Your Physicians and Your Team A large number of physicians are brilliant and technically excellent, and a large number of physicians are kind, compassionate, supportive, and good listeners. These two skills (technical ability and empathy) often go hand-in-hand.
Ideally, you want physicians who are knowledgeable and compassionate and who will give you the time and attention you need during this process. If you have a primary physician whom you know and trust, you usually can rely on his or her recommendations for a surgeon whom he or she has gotten to know over time. Similarly, if you see a surgeon whom you trust, you usually will find that the surgeon and your primary care physician will direct you to an excellent medical oncologist, radiation oncologist, and reconstructive surgeon.
It is an excellent idea to ask friends, neighbors, and other healthcare professionals for feedback as you assemble your treatment team. Certain criteria are essential. Your physicians should be board certified in their fields, which indicates that they have met certain criteria and passed certain examinations to obtain these credentials. It is okay to ask these physicians how often they treat women who have the specific type of cancer that you have. Also, you can create a list of questions about your specific condition and treatment options, about how often you can expect to see them over time, and about any personal treatment strategies or philosophies that they have concerning treatment.
The doctor-patient relationship is exactly that – a relationship. And it starts with the first meeting. The first meeting is an opportunity to get to know these doctors and also for them to hear from you about your concerns, worries, and expectations.
During the days and weeks after the diagnosis of breast cancer, a woman may meet more new physicians than she has met in her entire life. These specialists can offer their opinions and advice based on a review of the woman’s history, her physical examination, the X-ray findings, and biopsy results, if available. During this time, the woman has the opportunity to decide whether she has confidence in each doctor and is comfortable with him or her.
Other Team Members Much of the day-to-day support for women with breast cancer comes from family, friends, neighbors, the extended community, and clergy. But the role of oncology nurses in the care of women with breast cancer is immense. The nurse often sees a patient more frequently than the physician and often gets to know her better and more personally than the physician does. Women frequently feel more comfortable telling their nurses more details than they tell their doctors about their response to treatment and side effects. Oncology nurses and nurses in the surgeon’s office and radiation centers as well as technologists can become good friends and important allies in the treatment process.
Other team members can also provide invaluable help and support. Some women choose to see a psychologist, social worker, or other counselor during treatment. The support and guidance of these professionals can make a difficult time easier. Some women also benefit from seeing a nutritionist during their treatment, welcoming the chance to grow stronger and feel better through dietary choices.
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Dr. Kenneth Miller, a practicing
medical oncologist, is an assistant
professor of medicine and oncology at
the Yale Cancer Center, Yale School of
Miller, Kenneth D. Choices in Breast Cancer Treatment: Medical Specialists and Cancer Survivors Tell You What You Need to Know. pp. 75-81. © 2008 The Johns Hopkins University Press. Reprinted with permission of The Johns Hopkins University Press.
This article was originally published in Coping® with Cancer magazine, September/October 2008.