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Cancer Care Team Roles

158212659_8Head and neck cancer is likely to be managed by a team of health care professionals. You may see some of these team players only once or for a short duration, whereas others you may see during most of the treatment course. There are some members of the team, such as a pathologist or a head and neck radiologist, that you may never meet at all, but expertise in evaluating your pathologic slides or your imaging studies may be vitally important.

Who should be on this team? Whether or not you have some of these members on your team depends on your individual treatment plan. You may only require surgery and not need radiation, so you may only work with a surgeon and not a radiation oncologist. Your cancer care team may include the following team members:

  • Registered nutritionist: Ideally, a registered dietitian should assess the patient at baseline and periodically throughout his or her disease course. The dietitian will provide strategies to deal with treatment side effects. In addition, the dietitian may need to be consulted if a patient loses a significant amount of his or her ideal body weight.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
  • Speech pathologist: A baseline assessment of swallowing in addition to the ability to speak should be evaluated.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.The speech pathologist will recommend strategies and exercises to be performed during treatment and post-treatment to maintain or improve swallowing and speaking function.2 Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9. Many patients need rehabilitation with a speech pathologist post-treatment. Between 34 to 70 percent of head and neck patients will develop speech impairment during the course of their treatment.3 Chen H-C, Evans KFK, Salgado CJ, Mardini S. Methods of voice reconstruction. Seminars in Plastic Surgery. 2010:227-232.
  • Cytopathologist: A health care professional who uses a microscope to evaluate cells.
  • Pathologist: A health care professional who uses a microscope to evaluate tissue; a pathologist will play a role in diagnosing the disease.4 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.
  • Radiologist: A health care professional who specializes in evaluating images and will evaluate extensiveness of the disease; this health care professional will also play a role in diagnosing the disease.
  • Radiation oncologist: A physician who uses radiation therapy to treat cancer.
  • Surgeon: A physician who will physically cut the tumor out of the patient and/or reconstruct anatomic structures compromised from the removal of the tumor.
  • Prosthodontist/dentist: Radiation can cause cavities, so you may wish to consult a dentist before treatment.1Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.You might need to consult a prosthodontist since teeth, parts of the jaw or other structures such as the nose or the ear may need to be removed to treat the cancer, and a prosthodontist specializes in creating a prosthesis to help you restore functions that may have been affected by your surgery.4 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.
  • Medical oncologist: A physician who specializes in several aspects of cancer care, such as diagnosis and the management of cancer (e.g., chemotherapy).4 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.The medical oncologist is likely to be a specialist who you will interact with at several points during your cancer journey.
  • Social worker: Works with the patient and the patient’s caregivers to address their psychological well being.4 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.

Other health care professionals may work with you and/or the cancer care team, depending on your needs. For example, a psychiatrist may be part of the team. Alternatively, an addiction specialist may be a member of your team.

http://vimeo.com/64108654
These nurses, they do much, much more than provide medical care. They are counselors and friends at the same time. Lynn H. (wife of a tongue cancer survivor)

References

1 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

2 Gaziano JE. Evaluation and management of oropharyngeal Dysphagia in head and neck cancer. Cancer Control. 2002 Sep-Oct;9(5):400-9.

3 Chen H-C, Evans KFK, Salgado CJ, Mardini S. Methods of voice reconstruction. Seminars in Plastic Surgery. 2010:227-232.

4 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.

5 Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.

6 Ko CY, Chang JT, Chaudhry S, Kominski G. Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery. 2002 Aug;132(2):268-73.

7 Karanicolas PJ, Dubois L, Colquhoun PH, Swallow CJ, Walter SD, Guyatt GH. The more the better?: the impact of surgeon and hospital volume on in-hospital mortality following colorectal resection. Ann Surg. 2009 Jun;249(6):954-9.

8 Billingsley KG, Morris AM, Dominitz JA, et al. Surgeon and hospital characteristics as predictors of major adverse outcomes following colon cancer surgery: understanding the volume-outcome relationship. Arch Surg. 2007 Jan;142(1):23-31; discussion 32.

9 Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40.

10 Friese CR, Earle CC, Silber JH, Aiken LH. Hospital characteristics, clinical severity, and outcomes for surgical oncology patients. Surgery. 2010 May;147(5):602-9.

11 National Cancer Institute Website. Accessed at http://www.cancer.gov/dictionary on February 18, 2013.

12 Hoffman B. Cancer survivors at work: a generation of progress. CA Cancer J Clin. 2005 Sep-Oct;55(5):271-80.