Stakeholder’s Perspective: Physician

The article by Dr Hansen provides a great overview of the challenges facing patients from initial diagnosis of cancer through survivorship. Patients typically are diagnosed with cancer suddenly in the midst of living their lives. The various stressors in life that exist prior to diagnosis can be further exacerbated after diagnosis. As oncology providers, in addition to having knowledge of the options to treat a patient’s cancer, we need to make sure we understand the patient as a whole— both the patient and the person.

Even more so than in many other fields in medicine, a team approach in oncology is essential to working with the patient as a person. In my own practice, we have the availability of social workers, case managers, program nurses, infusion nurses, nurse practitioners, nutritionists, psychologists, psychiatrists, financial resource specialists, complementary medicine providers, pain and palliative care specialists, chaplaincy, and a survivorship program. While not every patient will utilize each of these resources, most will routinely work with several of these team members during their cancer journey. Further, in my experience, patients may discuss different stressors or concerns with each of these providers. It is essential for the team to work together and share information with each other to allow each member of a patient’s team to provide the most effective care possible. For example, I am currently caring for a Gulf War veteran with metastatic cholangiocarcinoma. When I first met him, in taking his social history I learned he had worked in a local hospital as an orderly in the operating room but had not been able to work for the past 2 months due to symptoms resulting from his cancer. Then, a few weeks into treatment, I learned from his infusion nurse that he was delinquent in his rent and his landlord was evicting him. She immediately involved a social worker as well as a case manager, and together they worked with the Veterans Administration hospital system to assist in group housing options.

A unique feature of the care of cancer patients is the frequency of contact with many of them. While our initial history of the patient may not comprehensively cover all of the challenges that Dr Hansen discusses, over time it is important to examine each of these areas to determine which supports are needed during a patient’s cancer journey.