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Ovarian Cancer: Build a Winning Treatment Team

By Steven Vasiley, MD

 

 

If there is a diagnosis or strong suspicion of ovarian cancer, immediately go find a board certified gynecologic oncologist. This is a gynecologist who has undergone years of extra training and examinations to become board certified in the care of women with gynecologic cancers. This includes performing surgery, giving chemotherapy and recommending whether or not radiation is required. Note that radiation is rarely used in ovarian cancer treatment.

A board eligible oncologist who has completed fellowship training is an option as well. This means they have completed training, but are required to practice a few years before being allowed to take the final board certification exam. These energetic, recently trained oncologists are usually in practice with more senior physicians so you will often receive team based care in such private or University practices.

If you are under the care of a gynecologic oncologist who does not inspire confidence or does not present some kind of positive outlook, go find another one. This is not to say that they should be painting a rose garden picture. However, it is reasonable to expect your main physician to be objective but encouraging if at all possible. The treatment is hard and the outcome may not always be the best, but you do have a fighting chance and you should feel that your gynecologic oncologist is in your corner, providing personal attention and state-of-the-art information throughout.

Do not let anyone, including friends, family physicians, general gynecologists, surgical oncologists, medical oncologists, or any other doctor convince you that their team is just as good in the absence of a gynecologic oncologist. You absolutely, positively need a gynecologic oncologist as part of your team!! Again, do not let anyone convince you otherwise.

You can find help and a list of gynecologic oncologists in your area at www.sgo.org (Society of Gynecologic Oncologists) or www.wcn.org (Womens Cancer Network). To my knowledge there is no comprehensive and accurate international directory. However, you might try contacting the International Gynecologic Cancer Society at www.igcs.org, who may be able to help you find a gynecologic oncologist in your country.

Your gynecologic oncologist may or may not work closely with a medical oncologist instead of administering chemotherapy his/her-self. A medical oncologist is a doctor who specializes in giving chemotherapy to patients with all different types of cancer, gynecologic or not. Most do not see as many patients with ovarian cancer as a gynecologic oncologist, but can be very important members of a team approach in treating your cancer. In centers or medical groups where treatment is regularly delivered by a multi-disciplinary team, medical oncologists play a critical role in administering the chemotherapy, working in conjunction with a gynecologic oncologist.

Who else do you need? First of all, don't forget that YOU are a team member! The doctors you work with will give you options, opinion, information, treat you etc., but you must be an active decision-maker because we are talking about YOUR body here. You also have to be aware of what to look for in how your body responds, so that you can relay that information to your doctor(s). They cannot guess what might be going on with you. Make sure that you feel comfortable with your doctors. You should be able to ask questions, and relay fears and concerns.

When you visit your doctor(s), make sure you have all your questions lined up and write them down if you need to in order to stay organized. Some doctors will let you record your visits, others will prefer that you don't. An alternative is to bring a family member or friend to help you hear everything.

Other members of the team might include:

Primary Care Doctor - Your Primary Care Doctor is hopefully the one you already know and trust for your basic medical care. Usually, this doctor is a Family Practitioner by training, but may be an Internal Medicine doctor or a Gynecologist. They will often stay involved to take care of your health beyond that of cancer care and help in situations where medical management is required around the time of surgery.

Surgical Oncologist - Surgical oncologists are surgeons who spend extra years training to surgically take care of cancer patients. They are not a substitute for a gynecologic oncologist, but may be very helpful when your surgical needs go beyond that of a gynecologic oncologist. For example, while gynecologic oncologists are trained to perform surgery in many areas of the body, a surgical oncologist may be involved when a large part of the liver needs to be removed or chest surgery needs to be done.

Nurse Practitioner - Nurse-practitioners are nurses who have gone beyond the basic RN degree and received extra training in healthcare. They may assist your doctors by performing examinations on you and may or may not be authorized to write prescriptions for medications you need. This depends upon the State you live in.

Oncology Nurse - Oncology nurses are RNs who have specialized, and are often specifically certified in, cancer care. Most often you may have oncology nurses helping administer chemotherapy to you; something that they are specially certified to do.

Social Worker - Licensed social workers are your connection to broad range of support networks in your medical facility and surrounding community. Social workers may intervene by providing individual, couple, or family counseling, offering group education or support, and by working with community groups in the development of resources to assist patients in meeting their own needs.

A psychosocial assessment provides the basis for the social worker intervention. This assessment includes evaluation of patient resources, strengths, and support systems, such as:

 

  • past coping behaviors
  • family support
  • living arrangements
  • education level
  • employment
  • leisure interests
  • financial situation
The social worker also addresses the patient's emotional response and reaction to the illness, the impact of the disease upon the family, the effect on the patient's relationships and roles, and other personal or social problems. Alternative or Complementary Practitioners - Many centers have integrative medicine programs, or have at least some practitioners who represent alternative and complementary approaches to cancer care. The most proven options are those which help control your symptoms, help support your strength and possibly your immune system. These practitioners may have various degrees including PhD, naturopathy(ND), chiropractic (DC), or may have no degrees but with extensive experience in massage therapy, music therapy or accupuncture/accupressure. Rather than shopping for unknown practitioners with uncertain skills, the best strategy is to ask for a referral from an enlightened mainstream medicine practitioner. There is a lot of misinformation and misguided people out there, whose advice can harm you and cause you to lose your best chance of a cure.

 

Finally, the following are some general questions you might want to consider in setting up your team and selecting your main physicians.

  • Are you fellowship trained and board certified or board eligible?
  • Who will be my main doctor in coordinating treatment?
  • Do you believe in discussing options with me, including possible research alternatives?
  • If I have problems during treatment who do I call and how do I reach them? Is this the same on weekends?
  • What costs are covered by my insurance and who do I talk with about this?
  • What kind of support services are available to me and where do I find them?
  • If you are interested in complementary and natural aids, you may want to ask if your doctor would be willing to consider or discuss complementary and alternative options, or refer to a colleague who can.
To your victory!!

Steven A. Vasilev MD,MBA,FACOG,FACS is a fellowship trained and board certified gynecologic oncologist, which means he is specially trained and certified to take care of women with gynecologic cancers using a broad spectrum of skills. He has practiced at academic as well as private centers, has been on the faculty of three universities and continues to be involved in research and education. You can visit http://www.gyncancerdoctor.com to learn more about screening, prevention and treatment of gynecologic cancers.

 

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