It Takes a ‘Huge Clinic Village’ to Create a Dream Cancer Care Team

When a patient initially receives their cancer diagnosis, they may not know what the road ahead is going to look like, and specifically, who is going to lead them down it. At first, one may only consider their oncologist, but the truth is that there are many moving parts to a cancer care team — all of which are essential to providing optimal care.

From nurse coordinators to clinical social workers and more, each team member plays a different role in advocating for the patients’ needs, whether it be their specific treatment needs, side effect management or psychological/psychosocial support.

“After that first initial appointment, there is a … huge clinic village that takes care of the patient from anywhere to the admin assistant of the doctor who will take the calls for the patients or will triage those portal messages,” said Lisa Anderson, a GI cancer nurse navigator at MedStar Georgetown University Hospital in Washington.

A Medical Team Where Every Player Is Crucial

“There’s the clinical nurse coordinator in the clinic who does all the heavy lifting as far as education, managing symptoms, also taking patient calls and whatever else the doctor would like them to do … you have the medical assistants who room the patients, you have the lab techs who draw labs, the fellows, the doctors, the nurse practitioners, the PAs, social work, dietitian, geneticist. It's a huge team just in that group, so behind every patient, there's at least a dozen people taking care of that patient,” Anderson added, during a presentation at the 12th Annual Ruesch Center Symposium.

Depending on the stage of a patient’s cancer, a surgeon might be either the first or last person they see. Often, their surgeon is considering diagnosis, staging and coordination of care — all of which affect the timing of their treatment plans.

This means surgeons will also be in close collaboration with radiologists, oncologists, primary care providers, rheumatologists or nephrologists.

“So I mean, our job in the operating room is coordinating the whole operation and the team, and our job before that I feel like is the same — as we're really trying to coordinate who should be where, when, and how can we help get patients through that,” explained Dr. Emily R. Winslow, regional director of hepatopancreaticobiliary surgery at MedStar Georgetown University Hospital.

Surgeons also play a role in reducing patients’ anxiety about their procedures and explaining what will happen and what the recovery process should look like.

“I don't think we should ever make it seem reasonable to have no fear about an operation — there should be some small amount of concern, of course, but we try to put that in perspective against the concern about the problem that the patient has, and the reason we need to do surgery and what it'll be like to get better,” Winslow said.

Surgeons also often partner up with other types of surgeons who have differing areas of expertise, depending on the patient’s disease.

Smaller Teams in Each Area Representing the Larger Care Team

Another large and crucial part of GI cancer treatment is radiation. About half of patients with cancer receive radiation at some point during their treatment journey, with goals varying between curative to prolonging life or symptom management.

“With our field, another important aspect of what we do is the technology,” said Dr. Keith Unger during an interview with CURE®. “So having cutting-edge technology and cancer treatments available — that can help improve outcomes.”

Unger is the director of the gastrointestinal cancer service and the Department of Radiation Oncology Resident Program director at MedStar Georgetown University Hospital. During his presentation at the symposium, he also explained that radiation includes more than just the radiologist.

“On the technical side — the radiation side — I represent a huge team behind the scenes,” he said. “So we have physicists … there’s also team members who are out in front and actually see you probably more than the physicians. Our radiation therapists will interface with patients on the daily basis and are really a great support for patients through their radiation treatments.”

Navigating the Emotional and Psychosocial Impacts of Cancer

An essential part of the cancer care team also includes someone to help support the psychosocial care of patients and their loved ones.

A clinical social worker may help patients navigate their diagnosis and treatment process, manage caring for their children, help coordinate transportation, understand and address financial or insurance concerns and implications, manage the impact on a patient’s career or work environment and circumnavigate difficult emotions.

“And there are some really fantastic resources that can help you navigate that specific intersection,” said Sara Field, a clinical social worker at the George Washington Cancer Center. “Something else that I tell patients is that it becomes your responsibility as a patient to figure out what's most helpful, what's not, and then to communicate that. And it’s a lot easier said than done when you're also navigating a diagnosis.”

Field added that she often points patients to support groups that can be helpful for working through various issues with others going through a similar experience.

“We do know that a significant number of people are very distressed when they receive a cancer diagnosis, and that makes perfect sense, right? This is probably one of the hardest things that somebody is going to go through in their life,” Field said during an interview with CURE®. “And so I think one of the things is really tapping into what your tools or skills are, or what your coping techniques that have helped you in the past, and really being able to mobilize and use them.”

She also explained that mobilizing an existing support system is very important, because people may want to help you, but need help knowing what it is you need.

Important Tools for Patients

Every cancer care team eventually comes down to the most important member: the patient receiving treatment. And patients should always remember it’s equally important that they advocate for themselves, explained Unger.

“I think it's very key before embarking on treatments or making big decisions that you really build a good relationship with your clinical team and ensure that there's good communication, both ways,” he explained.

It’s never a bad idea to ask questions or seek out a second opinion, either.

“When making really big, important decisions like this, oftentimes, I found it helpful with my patients to have them meet with other patients who've been in similar situations so that they know the questions to ask, so that they can have some better reference,” Unger added.

If they have someone they can depend on to bring to an appointment, patients should make use of this family member or friend to help them advocate for themselves. This could be someone who takes notes during the visit, helps the patient remember questions they might want to ask or simply provides comfort and support.

Additionally, these loved ones who provide support or act as the primary caregiver for a patient should also know that they can seek help for their own emotional or practical needs.

“I always introduce myself as the social worker who provides care to patients and loved ones,” Field said. “… My expertise and passion is really in mental health and emotional support for patients and caregivers. And I think that we can always be doing better in attending to the psychosocial needs of all of our patients.”

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