Since we have reviewed what to expect when you meet the surgeon, many of you may also be interested in what to expect with a visit to the Oncologist. Not every patient is a surgical candidate, so most cancer patients are diagnosed and followed by an Oncologist. The largest part of my career has been spent working with one Oncologist who specializes in lung cancer and mesothelioma. Depending on where you live, the type of office setting your Oncologist practices within will vary. I work for a hospital and clinic system in which a team of Oncologists practice in a cancer center Monday- Friday. Our team of Oncologists has a schedule in which they alternate between clinic and hospital duties.
Why am I seeing an Oncologist?
I will focus on lung cancer and mesothelioma for a patient who has just been diagnosed. Many patients start out in the primary care physician’s office or pulmonology department when they are diagnosed. The focus today will not be on the diagnosis since this has been covered in my first blog.
What brings a patient to an oncologist is the staging and treatment of the lung cancer. An earlier stage lung cancer (1a or b) may never step foot in an Oncology office. Typically those patients are cared for and followed by the thoracic surgeon.
If your cancer requires the care of an oncologist, he/she will make the stage assessment, follow NCCN guidelines if treatment is recommended, prescribe the chemotherapy regimen, and will also determine if radiation oncology is needed. The oncologist is the main provider who will make a radiation referral. Not every cancer patient requires radiation, so it is determined by the Oncologist and the NCCN guidelines for treatment if radiation is medically necessary. Radiation can be given at the same time as chemotherapy for optimum results.
Surgical candidates will start with the expected number of chemotherapy treatment and then have restaging scans. The oncologist will then decide if the patient is ready for a surgical evaluation. There are cases in which patients will have surgery followed by chemotherapy. This individualized plan is devised between your Oncologist and thoracic surgeon based on the specific location and size of your cancer. This team effort is a multidisciplinary approach involving.
What will my Oncologist order for me?
This is a very general topic as each stage of lung cancer is very different. Some patients require only CT scans; other patients require PET scans or an MRI of the brain. With small cell lung cancer, only CT scans and bone scans along with an MRI of the brain is required.
Mesothelioma is often diagnosed through chest xray, ct scan, and/or a pleural fluid sample. The extent of disease is best measured through a PET scan. Some patients with mesothelioma require a few cycles of chemotherapy, repeat PET scan, then evaluate for surgery. Not every patient with mesothelioma is a surgical candidate, so they will remain in the care of the oncologist. This set of patients may still see a thoracic surgeon if they continue to develop pleural effusions and need a more permanent solution to drain the buildup of fluid. The multidisciplinary approach between the pulmonologist, oncologist, and thoracic surgeon is an ideal practice with mesothelioma.
Life with chemotherapy
One of the biggest fears and concerns of cancer patients is the treatment plan. Your oncologist will be the leader in creating an individual treatment plan for YOU. Which type of chemo, the dose of chemo, the number of cycles or rounds of chemo, the point of restaging scans, and the reassessment after scans is all up to the Oncologist. This is a HUGE task. There are so many chemotherapy agents to treat the same type of cancer; it can be very overwhelming to understand why a particular chemotherapy regimen has been chosen for you. You may hear your oncologist use the words “first line” or “second line”. This is simply referring to the “first choice” in treating your stage and type of lung cancer. These guidelines are from the NCCN (National Comprehensive Cancer Network), so your oncologist cannot “make up” or self-create a regimen. All of the science and research has created this foundation of guidelines and proven therapies. These guidelines do change; however, this is part of the challenge and ongoing education of your Oncologist.
When your oncologist tells you what type of chemotherapy you will receive, he/she will review the side effects of each drug, time duration expected to receive each drug, and they will also provide you with medications to counteract nausea/vomiting. The temporary use of steroids is also used before and after certain chemotherapy agents to decrease side effects. Not every patient will be prescribed steroids – this is simply based on the type of regimen chosen for you.
Questions to ask your Oncologist
- “Is my cancer treatable or curable?”
- “When do I need to call your office?”
- “What exactly is a fever and why may I have fever?”
- “When should I start taking my nausea medication?”
- “Can you write down when I need to start and stop my steroid medication?”
- “After how many cycles of chemotherapy are you going to re-scan to see if this chemo is working?”
- “What about pain? Am I going to have pain, if so, what do I take?”
- “Am I going to lose my hair? May I have a prescription for a wig?”
Finding the right Oncologist
After reviewing how essential an Oncologist is in your care, it is very important to find the right Oncologist for you. Going online and researching which Oncology team has lung cancer and mesothelioma specialists is a very good way to start. Most large practices with an Oncology group have some Oncologists who take a special interest in lung cancer. In a smaller city with fewer options, a general Oncologist treats more of a broad spectrum of cancer patients. Asking your current physicians for an opinion or recommendation may also help in making a decision. Today, many patients are guided to the appropriate Oncologist via nurse navigator who is familiar with the various specialties of each Oncologist. It is important for you to feel comfortable with your choice and have the ability to ask questions
By: Alaina Mokhtarnejad – Thoracic Oncology Nurse Navigator at Ochsner Medical Center in New Orleans, LA