Overview of the Oncology Health Care Team
Because cancer is a complex and serious illness, medical management must be supplemented by other types of care. A group of professionals, which may include social workers, psychiatrists, nurses, rehabilitation specialists, nutritionists, clergy, and hospice workers, work with the oncologists, other medical providers, and the patient as an oncology health care team.
The make-up of the team depends on the patient's needs; it is not necessary for an oncology team to have a member from each profession. The number and kind of physicians, specialists, and other professionals on a team depends on several factors:
- Availability of specialists
- Extent of the disease at diagnosis
- Geographic location of care facility
- Lead physician's opinion
- Type of treatment chosen
Whatever the composition of the oncology team, members work together to provide the best treatment to help the patient maintain their quality of life, and to support the patient and his or her family through the entire process.
Initially, the primary care physician heads up the team (depending on the type of cancer and the stage of treatment). Leadership may shift among the different specialists involved. For example, the surgeon oversees care until recovery from surgery is complete. For some types of cancer, a specialist serves as team coordinator for the entire treatment (e.g., for cancer of the female reproductive system a gynecologic oncologist coordinates the team).
Oncology Social Workers
Hospitals that treat cancer patients often employ social workers. Social workers help patients navigate not only the psychological difficulties but also the practical ones that arise with cancer. It is a good idea for patients to make an appointment with a social worker as soon as possible after receiving a cancer diagnosis.
If there is no social worker on staff, the hospital can direct the patient to a local agency. Individual physicians and nurses can also provide patients with referrals. Additionally, national organizations and their local affiliates often compile databases of social workers who specialize in chronic illness and/or oncology.
Social workers provide counseling to individuals, families, and groups. They can help their cancer patients and their families cope with the shock of diagnosis, the confusion of making treatment choices, and the physical pain of treatment. They can also help patients communicate with their doctors, make practical decisions about daily life, and manage the considerable stress that accompanies a serious illness.
Social workers can guide patients and their families through bureaucratic systems and can refer them to reputable agencies for many kinds of assistance, including the following:
- Child care
- Financial services
- Food stamps and other state and federal aid programs
- Home care
- Insurance information and claim submission
- Unemployment and Social Security disability benefits
The primary job of a nurse is to implement the medical plan that has been outlined by the physician. Nurses administer medications, assess symptoms, draw blood, monitor vital signs, supervise dressing changes, and monitor intravenous (IV) lines. Nurses also instruct patients about many medical care issues, such as the following:
- Coordination of care
- Dosage, safety, and side effects of medication
- Personal hygiene
- Self-care, including the use of injection devices
Some nurses receive special training in oncological care; most major hospitals employ oncology nurses. However, all nurses can provide care to cancer patients, either on an inpatient or an outpatient basis. Sometimes, nurses care for patients in the patients' homes, performing their duties during brief visits.
Insurance sometimes covers these services, if they are requested by a physician. The patient can also hire a private duty nurse. Private duty nurses attend patients for longer periods of time, but their services are not covered by insurance.
Oncology Home Health Aides
Home health aides visit patients' homes to perform light household chores, such as laundry or cooking. Their services are less expensive than a nurses', but they often are not covered by insurance.
Members of the oncology team are good resources for finding nursing or home health care workers. The National Association for Home Care and Hospice provides advice on choosing home health care workers. When seeking a nurse or home health aide, it is advisable to check credentials, ask about training, and verify that the employee is bonded.
Oncology Rehabilitation Specialists
Rehabilitation specialists help cancer patients recover from the physical changes that accompany their illness, function in everyday activities and reach their goals for physical health, and help patients and their families learn how to adapt daily activities and routines to new needs.
Rehabilitation specialists advise seeking an early referral to prevent disability; at any stage of treatment, they work closely with oncologists to plan and implement rehabilitative care. Specifically, rehabilitation specialists provide expertise in the following areas:
- Bladder and bowel management
- Exercise (for strength, endurance)
- Muscle deconditioning and weakness
- Nutritional problems
- Personal fitness training and instruction
- Problems with swallowing and/or speech function
- Prosthetic fitting for amputees
- Relaxation training (biofeedback)
- Sexual dysfunction
- Spasticity and/or weakness
- Spinal and brain injuries secondary to cancer
Rehabilitation specialists are physiatrists (physicians who specialize in rehabilitation), physical therapists, occupational therapists, and speech therapists. The rehabilitation team might also include vocational rehabilitation specialists who offer job counseling or retraining. Some rehabilitation centers and clinics also include social workers, psychologists, chaplains, and nurses on staff. Rehabilitation specialists offer their services in both inpatient and outpatient settings and in the patients home.
All successful rehabilitation begins with a comprehensive functional assessment. Assessment procedures test the strength, flexibility, mobility, and endurance of the affected body part or function. After assessing the patient's physical abilities, rehabilitation specialists develop and implement exercise routines that focus on strengthening a weak body part or function or on relieving pain. Patients are guided through the correct way to do the exercises and are given an exercise plan.
It is important to ask your primary care physician what services are available to help you make the adjustment to any physical limitations caused by cancer and/or its treatments. Only certain kinds of rehabilitation for cancer are covered by insurance and in those cases, there must be a physician's referral.
Many organizations provide rehabilitation programs, such as the American Cancer Society, the ENCORE program of the YWCA, and the National Coalition for Cancer Survivorship. In addition, some communities have social service organizations that provide free rehabilitation services for uninsured people. A social worker could best direct you in your search.