Medical Oncologists: An essential link on the cancer care team
Unlike some diseases, most forms of cancer require treatment by teams of specialists. Although a cancer patient may meet these specialists in different sequences or at different stages of treatment, the team all works toward the same goal.
At AAMC’s DeCesaris Cancer Institute, the team or “multidisciplinary” approach is a hallmark of cancer care. It is a team in every sense, comprised of medical oncologists, surgeons, radiation oncologists, pathologists, radiologists, physicists, nurses, technicians, and therapists, each with his or her own role integrated among the others.
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Yet the number of specialists involved and an expanding range of treatment options mean that patients need advice and guidance to sort through it all as a treatment program unfolds. Medical oncologists are the physicians who fill this vital role. They counsel cancer patients and become the essential link in explaining care options, offering recommendations and insights, and then implementing and managing the overall direction of care while keeping the family’s primary care physician informed.
Stanley Watkins, Jr.., M.D., a medical oncologist and medical director of AAMC’s Cancer Initiative, says the coordination among cancer specialties at AAMC is essentially seamless. “Patients may come in contact with a medical oncologist at different points along a care spectrum,” he says,“after seeing a surgeon or before. But the strength and benefit of our team approach is that the patient senses that he or she is entering a family of specialists whose training and practice focus exclusively on cancer. Our nurse navigators, as they facilitate the logistics of care, contribute greatly to that sense.”
Training, education, exploration and discovery
A medical oncologist is a physician who specializes in the ongoing study and comprehensive understanding of the biology and science of cancer, and who specializes also in treating the disease using chemotherapy or hormonal and biological therapies.
A physician becomes a medical oncologist after a three-year residency in internal medicine and, following certification, another two to three years in an oncology fellowship. During the fellowship,much of the training involves research, which examines clinical issues surrounding patient care as well as pursuing new developments in a laboratory setting. This focus and emphasis on research carries over from the fellowship into a medical oncologist’s everyday practice.
Thirty or more clinical trials are under way at any given time at the DeCesaris Cancer Institute and at Annapolis Oncology Center. Patients come from around the Mid-Atlantic region and as far away as Europe to avail themselves of treatments that hold the promise of breaking new ground in treating cancer. Dr.Watkins said, “The doctors in our practice average at least ten hours a week of reading to stay current with new developments, which come at a rapid pace.”
Chemotherapy and the science of cancer
Along with their roles in managing a patient’s interface among the elements of treatment, medical oncologists specialize in cancer therapies employing anticancer drugs?chemotherapy?as well as hormones or biological compounds. Anti-cancer drugs used in chemotherapy attack cancer cells and stop them from growing or multiplying. Hormonal and biological therapies target the cancer cell more specifically, exploiting the cell’s own features to stop or slow down growth.
Medical oncologists may prescribe one or more types of these therapies as treatment for cancer. How or whether it is used depends on the type of cancer, its stage (how far it has progressed), and a patient’s overall health. These circumstances also determine whether chemotherapy will be employed to cure the cancer, control it, or relieve symptoms to enhance quality of life.
The consensus among the seven medical oncologists at Annapolis Oncology Center is that as the result of research and clinical trials, the effectiveness of chemotherapy for certain cancers has improved considerably. As a group they underlined the fact that the field is in a constant state of change and that emerging new therapies or enhancements of existing ones offer great promise for some forms of cancer.
The medical oncologist, as part of a multidisciplinary team, assists in scheduling and coordinating the order in which each treatment—surgery, chemotherapy and radiation therapy— takes place. If chemotherapy is involved it can take place at different pointsduring treatment. The medical oncologist also helps patients manage the side effects of treatments as well as the physical symptoms of the cancer itself.
Case conferences bring specialists face to face
Achieving the seamless coordination among cancer specialties cited by Dr. Watkins requires that specialists communicate closely and often. At AAMC’s DeCesaris Cancer Institute, this occurs during weekly case conferences. At case conferences, physicians present individual cases for review by their colleagues from all other specialties— surgeons, radiation oncologists, pathologists, radiologists, and of course, medical oncologists.
Diagnostic images are shown on large screens. A physician presents a verbal summary of important clinical aspects of the case. The specialists share insights and opinions from the perspective of each of their specialties. The result is a multidisciplinary consultation on each case that takes place in person, across a table, every week.
Orchestrating the array of talent and technology available at AAMC’s DeCesaris Cancer Institute presents clear benefits for patients. And when that team shares the common goal of beating cancer, patients are the winners.