Navigating Cancer Centers

Caribou

Caribou

August 18, 2020

A recent study in the Journal of Thoracic Oncology showed that the choice of a cancer center affected outcomes for people with stage IV lung cancer. This study demonstrates the importance for finding a cancer center with specialists who are familiar with the latest research and updates about your diagnosis. For that reason, picking a cancer center is a very important part of managing your cancer diagnosis. 

Before receiving treatment at a leading cancer center, it’s important to understand who is part of your care team, identify the different types of cancer centers, and know how to become a patient at the cancer center of your choice.

Your Cancer Care Team

Oncologist 

An oncologist is a doctor who specializes in diagnosing and treating cancer. Your oncologist oversees your care from diagnosis throughout the course of the disease. In general, a person with cancer is often treated by a team of oncologists who specialize in different areas of oncology.

An oncologist manages a patient’s care throughout the course of the disease. This starts with the diagnosis. His or her role includes:

  • Explaining the cancer diagnosis and stage

  • Talking about all treatment options and his or her preferred choice

  • Delivering quality and compassionate care

  • Helping a patient manage the symptoms and side effects of cancer and cancer treatment.

Different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. For instance, a patient may need treatment with a combination of surgery, chemotherapy, and radiation therapy. This is called a multidisciplinary team.

There are three major types of oncologists: 

  • A medical oncologist treats cancer using chemotherapy or other medications, such as targeted therapy or immunotherapy.

  • A surgical oncologist removes the tumor and nearby tissue during surgery. He or she also performs certain types of biopsies to help diagnose cancer.

  • A radiation oncologist treats cancer using radiation therapy.

Other types include:

  • A gynecologic oncologist treats gynecologic cancers, such as uterine, ovarian, and cervical cancers.

  • A pediatric oncologist treats cancer in children. Some types of cancer occur most often in children and teenagers. This includes certain brain tumors, leukemia, osteosarcoma, and Ewing’s sarcoma. Types of cancer more common in children sometimes also occur in adults. In these situations, an adult may decide to work with a pediatric oncologist.

  • A hematologist oncologist diagnoses and treats blood cancers, such as leukemia, lymphoma, and myeloma.

Oncology Nurse 

The responsibilities of an oncology nurse may include:

  • Giving a physical examination

  • Giving chemotherapy and other medication

  • Identifying patient needs

  • Coordinating care with the other members of the oncology team

  • Educating and counseling patients and families

  • Performing research as part of a clinical trial

Oncology Nurse Practitioner 

They meet with patients independently while collaborating with the oncology team. They are supervised by an oncologist. The responsibilities of an oncology nurse may include:

  • Giving physical examinations and evaluating a person’s health

  • Diagnosing and treating certain conditions

  • Recommending diagnostic and laboratory tests, and reading the results

  • Prescribing medications and giving chemotherapy

  • Managing cancer and treatment side effects

  • Educating and counseling people about cancer

  • Performing certain procedures

  • Performing research as part of a clinical trial

Patient Navigator 

This individual guides people from diagnosis through survivorship. A patient navigator can help a person find counseling, financial, and other support services. Patient navigators can be nurses, social workers, or volunteers.

Palliative Care Doctors and Nurses 

The palliative care team works closely with other oncology team members to prevent and treat the symptoms and side effects of cancer and its treatment. A palliative care doctor is especially helpful when a person is still experiencing pain and other symptoms despite treatment for these symptoms.

Physicians Assistant

A PA works with a doctor, delivering a broad range of services. The responsibilities of a PA may include:

  • Performing physical examinations

  • Recommending diagnostic and laboratory tests, and reading the results

  • Helping with surgery

  • Managing cancer and treatment side effects

  • Prescribing medications and giving chemotherapy

  • Educating and counseling people about cancer

  • Performing certain procedures

Oncology Social Worker 

An oncology social worker can help people cope with cancer and the challenges the disease brings. This may include leading support groups, providing counseling, or helping people find financial support and other resources.

Pathologist 

A pathologist is a medical doctor who specializes in looking at cells, tissues, and organs to diagnose disease. It is most likely that you will never meet your pathologist. But your pathologist plays an important role in determining the type of cancer you have. The responsibilities of a pathologist may include:

  • Determining the results of tests done on tissue samples

  • Providing the final diagnosis of cancer

  • Working directly with the treating doctors

Registered Dietician 

An RD provides education on eating well and provides recommendations to help people with cancer cope with dietary needs. In hospitals and other health care centers, the dietitian provides medical nutrition therapy.

Diagnostic Radiologist 

A radiologist is a medical doctor specialized in using imaging tests to help diagnose disease. The responsibilities of a diagnostic radiologist include reviewing and interpreting the results of imaging tests.

Rehabilitation Therapist 

These professionals help people with cancer return to their highest level of functioning. For example, they can help people with brain tumors regain speech and independence or help people with breast cancer learn exercises to regain strength after a mastectomy.

Religious Support 

A chaplain offers spiritual support and rituals for people with cancer and their families. These professionals may also lead support groups. Most hospitals have clergy on staff that work with people of all faiths. But some people may prefer to work with their own clergy person.

Types of Cancer Centers

NCI Designated 

National Cancer Institute Designated cancer centers: 

  • The NCI Cancer Center program has more than 60 centers and meet specific standards: 

  • NCI also offers the National Clinical Trials Network, once known as cooperative groups. These large networks of researchers, doctors, and other health care professionals do clinical trials across the country.

  • Each year, U.S. News & World Report releases its annual list of the top 50 hospitals in the United States. The publication highlights facilities that specialize in certain medical fields, including oncology. Almost 4,700 U.S. hospitals are considered in the rankings.

  • Of those topping the list of best cancer hospitals, several have met the standard of care required by the National Cancer Institute to receive the official "Comprehensive Cancer Center" designation. Today, there are only 71 hospitals to have received such status.

Cancer Centers vs. Comprehensive Cancer Centers 

The various NCI designated cancer centers are grouped into two types or categories: 

  • Cancer Centers integrate research activities across three major areas: laboratory research, clinical research, and population-based research. Many of these centers also provide care and services for cancer patients.

  • Comprehensive Cancer Centers also have extensive community outreach and education programs, in addition to the same activities conducted by Cancer Centers.

ACS Accredited 

The American College of Surgeons (ACS). Through its Commission on Cancer (CoC), ACS has accredited more than 1,500 cancer programs. CoC treatment centers offer many services, including diagnostics, treatment, rehabilitation, and support services. Learn more about CoC cancer programs.

Achieving accreditation by the CoC ensures your patients receive:

  • Comprehensive, patient-centered care through a multidisciplinary team-approach

  • Access to information on clinical and new treatment options

  • Ongoing monitoring of care and lifelong patient follow-up

  • Psycho-social support and survivorship care

  • Continuous quality improvements in care

Accredited by The Joint Commission

This group evaluates general health care programs. It offers performance reports for thousands of its accredited programs and organizations. You can review the Joint Commission’s performance report for specific treatment centers.

How to Find a Cancer Center 

Step 1: Find your options 

Where to begin: 

  • Ask your current oncologist or primary care physician to recommend doctors in your area or in the area where you are moving.

  • Call your health insurance plan's member services line to ask for a list of oncologists. Or search the insurance plan's website, if available.

  • Call local hospitals, or hospitals in the area of your choice and ask about their physician referral service. 

  • Review the list of NCI Designated cancer centers. You can call them and ask about oncologists that practice there. This list is available at the end of this document. 

  • Ask family, friends, and other support group members for suggestions. 

  • Search online physician directories: The American Society of Clinical Oncology (ASCO) provides a free, searchable database of ASCO member oncologists. Other medical associations, such as the American Medical Association and the American College of Surgeons, have online databases of doctors as well.

Step 2: Narrow your options 

Here are some questions to ask when picking your doctor: 

What are the doctor’s credentials? 

  • Is the doctor board certified? Search for board-certified oncologists with the American Society of Clinical Oncology (ASCO)

  • What is the doctor’s education, training, and years in practice? 

  • Does the doctor have experience with your type of cancer? 

  • How many patients does the doctor see with your type of cancer per year? 

  • Does the doctor participate in your health insurance plan? 

  • Is the doctor accepting new patients? 

  • How convenient are office hours and location? 

  • Does the office have supportive staff? 

  • How easy is it to get appointments or to talk to the doctor? 

  • If the doctor is not available, who handles the emergencies? 

  • Ask whether the doctor has access to clinical trials. These are research studies involving people.

Here are some questions to ask when picking your cancer center: 

  • The treatment center staff, including nurses, physician assistants, social workers, and technicians will be a part of your cancer care team. Consider how comfortable they make you feel. 

  • How much experience does the center have treating your type of cancer? 

  • How many patients does the cancer center cater towards? 

    • A cancer center that caters to a larger number of patients may have some advantages. The latest and greatest in technology—such as imaging and radiation therapy resources—come at a price. And a cancer center that treats more patients may be in a better financial position to invest in the newest equipment. There is also a greater likelihood that a high-volume center will have support groups designed specifically for people with a certain type of cancer.

  • How effective has the cancer center been at treating those people? 

  • How close is the center to your home/office? 

  • What support services does the cancer center offer?

  • Will access to social workers, dietitians, etc. be provided? 

  • Does the care center offer a place for you or close ones to stay? 

  • Is the care center near airports, hotels, or restaurants?   

Here are some additional factors to consider: 

  • How comfortable do you feel with the doctor? 

  • Does the doctor encourage questions for better understanding? 

  • Is the doctor’s communication respectful and comfortable? 

To find the answers to these questions, ask the person who referred you, call the doctor’s office directly, or schedule a consultation appointment. Before doing so, check if you will be charged for calls or meetings in person, as they are likely not covered by your health insurance.

Step 3: Provide information 

To begin your journey at the new cancer center with a new doctor, you will need to transfer medical records to the new doctor from your current doctor’s office. Your current doctor’s office will have their own procedure of doing this. Ask them for help. 

It may involve giving the office written permission allowing the office to copy and transfer the records. You can ask for your own copy as well. You might be charged a fee when doing this as the records would be for your personal use.

Get an appointment at a Cancer Center today

Cancer Center vs. a Clinic

If you or a loved one has been diagnosed with cancer, there are many reasons you may want to get care from a comprehensive cancer center rather than a local oncology practice or clinic. It may be that the disease is an uncommon form of cancer, for instance, or one that is resistant to standard therapies. Or, you may simply want a second opinion from someone who is a leader in their field.

Reasons for a new doctor may include: 

  • You are moving to a new location 

  • You are changing health insurance plans 

  • Your doctor is moving 

  • Your doctor is retiring  

Top Cancer Centers 

  1. MD Anderson Cancer Center

  2. Memorial Sloan Kettering Cancer Center

  3. Mayo Clinic

  4. John Hopkins Hospital 

  5. Dana-Farber/Brigham and Women's Cancer Center

  6. Cleveland Clinic 

  7. UPMC Presbyterian Shadyside

  8. H. Lee Moffitt Cancer Center and Research Institute

  9. Massachusetts General Hospital

  10. Northwestern Memorial Hospital

Receiving Care at Cancer Centers 

When to Call the Cancer Center or Doctors 

It is important to ask your health care team which signs and symptoms to expect, and which ones need medical attention right away.

Some serious side effects that need medical attention include:

  • Infection

  • Deep vein thrombosis (DVT), which is a potentially life-threatening blood clot

  • Pulmonary embolism (PE), which is a blood clot in the lung and a medical emergency

  • Tumor lysis syndrome (TLS), which is a life threatening vital organ injury

Inpatient vs Outpatient 

Once you choose a treatment center, it is important to find out if you will receive your medical care in an inpatient or an outpatient setting. For inpatient care, you stay in the hospital and are closely watched during treatment and recovery. Outpatient treatment does not require a hospital stay. It can take place at a hospital building, clinic, or doctor’s office. Talk with your health care team to learn about the types of settings where you may receive treatment.

Planning for Emergencies at Cancer Centers 

Steps to Planning for Emergencies: 

  1. Talk with your health care team about any natural disasters that occur and how at risk you are of facing one 

  2. Plan with family, friends and neighbours about emergency protocols. Consider who will be checking on you, or who will be checking on those you normally check up on. 

  3. Create an emergency kit 

  4. Keep your medical information handy for emergencies

In the case of an emergency, find an emergency cancer center immediately.