Types of Oncologists & the Team Approach

When it comes to cancer treatment, one of the most frequently asked questions is "What kind of Oncologist should I see?"  There are so many kinds of doctors who describe themselves as oncologists: pediatric, medical, radiation, surgical, gynecologic, neuro- &  psycho-... Which types are formally trained to do cancer surgery? drug treatment? radiotherapy?

Are they interchangeable?  In a word, NO!, and this is true on an international scale.  

Hieronymous Bosch  A barber doing Awake Neurosurgery!

Decades ago, before the advent of complex yet significantly better options, cancer was treated by Jacks- & Jills-of-all-trades.  (In fact, centuries ago, barbers did it all.)  These days, however, the management of cancer has become so complex that one can't reasonably expect a single physician to master the intricacies of each pertinent discipline.  It now takes a multi-disciplinary team to optimize treatment planning.  In such a team, each member brings his or her focused expertise to the table, and all considerations of the represented specialties are discussed.  Differences are threshed out to enable a coordinated "best" plan that is specific to each patient.  The beauty of this is that it actually costs a patient much less to consult such an empaneled team than it would to see each specialist separately.  Soon (where not yet applicable), the laws of supply & demand will move institutions to package their teams' services for the consumers' benefit.

Imagine updating oneself in multiple specialties for, say... Breast Cancer:   new surgical techniques with hands-on training, Mammosite brachytherapy and other recent radiation technologies, the 1001 clinical drug trials for invasive and non-invasive breast malignancies, for pre-operative, adjuvant, and metastatic settings.  Then review the status of each modality every 3 months when you haven't even finished going through the standards you'd started out with.  Now do the same for the different soft tissue sarcomas of the breast. Then all the other cancers possible in humans ....Phew! 

For basic information on oncologists, try these links--

1. Define "Oncologist". Check out your doctor's credentials, not a casual description.
2. "Cancer surgeon" on a card does not imply formal subspecialization. General surgeons hereabouts can claim this title without benefit of certification... and in good faith. There is considerable overlap between the jobs of a general "cancer" surgeon and a surgical oncologist, you see, but its the skills learned from experts where they differ. Just what is the advantage of having a formally trained Surgical Oncologist on one's management team? Its important for you to know what this rare bird can offer.
3. What is the extent of a gynecologic oncologist's duties?
4. The tough job of Pediatric Oncologists
5. What is a Medical Oncologist, & what do they do?
6. Radiation Oncologists vs. the UK's Clinical Oncologists
7. Then there are the "Neuro-oncologists", a very confusing term indeed. The surgical neuro-oncologists are neurosurgeons who have had the benefit of regimented clinical training in the surgical management of brain/spine/nerve tumors. Medical neuro-oncologists, on the other hand, may be neurologists or internist-medical oncologists who are proficient in the medical management of such tumors--ie, by treatment with drugs (vs the knife or radiation).

• From the outset, it is certain that the different neuro-oncologists must work as a team, with each member contributing knowledge from his/her area of expertise. But just who best speaks for each specific area? The fact that some  facilties overseas take on both surgeons amd medical people for non-surgical work in clinical (hands-on with patients) or research (hands-off) jobs in their neuro-oncology units contributes significantly to the difficulties in defining the subsequent roles of their products.   For this reason, the practice is not popular at major training centers.  It would take a wise and conscientious hospital credentials committee to define what a program has prepared a doctor for.
   

As for surgeons who administer systemic chemotherapy when a properly trained specialist is easily accessible in the area, let's just say that, outside of gynecologic oncology, I know of no other area where that practice is considered optimal in this, the 21st century.  Even when I was still in training, surgical oncology trainees at chemotherapy units were just "passing through", just as we had to sit through their hair-raising  audit sessions in similar outsiders' roles.  After all, we were already being trained to deal with each other in a proper context even then.